December 14, 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 Southeast Texas internet radio listeners. Good morning,
it's dark Levigne on the Dark Lavine Medical Hour, taking
your phone calls answering health care related questions live in
the series of klv I in Beaumont, Texas, across the
street from Parkdale Mall, trying to help you out during
(00:21):
this holiday season, toward the end of the year. Things
are coming to an end this year twenty five, looking
far for the year twenty six, how can we make
things better? How can we right the wrongs? So give
us a call. More than happy to try and help
(00:42):
you out. Eight nine to six lv I win in
one hundred three three zero klv I. I'm just wishing
for some colder weather, right. It's kind of muggy, foggy
this morning, not very cold, kind of warm, actually not
too bad.
Speaker 2 (01:00):
As you know. I like more of the winter weather.
Speaker 1 (01:03):
This is the holiday season, so we'd like to get
more of that cold, windy weather, right. Not snow snow,
it's just too much to deal with, but just some
coldness out there. That's one thing that I remember doing
this recent Thanksgiving Day is the weather was perfect. It
(01:23):
was just a great beautiful day. And today it seems
kind of overcast at least so far. But anyway, thank
you for joining for the edition of this show. We're
here every Saturday trying to help you, trying to help
you answer some questions about your health so you can
stay alive, live longer.
Speaker 2 (01:42):
Be healthier. What does that look like? What does that mean?
Speaker 1 (01:47):
So we'll appreciate your phone calls, gifts called two way radio.
We'd love to hear from you. In the meantime, I
normally will chat about whatever is rolling through my head
as I appear, as I think about, or maybe some
things that happened this past week that are of interest.
And one thing that came to mind is just sort
(02:10):
of the cost of medications in this country. We don't
talk about it a whole lot, and every now and
then it comes up, and certainly it comes up, I
guess on an individual level when you have to get
new prescriptions, I would assume that anytime the doctor or
the healthcare professional says again to write for prescription, I'm
(02:32):
sure the first thing that comes to most patients' minds
is how much is this going to cost?
Speaker 2 (02:39):
Right?
Speaker 1 (02:39):
I mean, I think most people understand meds. Medications, man,
they cost money, big money, especially the good stuff, right,
they cost a lot of money. And the one thing
that I was I remember that I said, hey, you
know what I'm going to talk about at this Saturday,
(03:02):
is that most of the time helps don't really know
when they write the prescription, are e prescribed the prescription
ultimately how much it's going to cost you. We don't
really have that system in place to easily find out
how much a medication is going to ultimately cost you
(03:26):
when you get.
Speaker 2 (03:27):
To the pharmacist.
Speaker 1 (03:29):
We are certainly taught to learn the diseases and the
medical research and the guidelines sort of tell us about
which medicines are the ones preferred or recommended by the
experts for particular disease. We have all these guidelines as
(03:50):
it pertains to most diseases, at least the common stuff,
all the blood pressure, cholesterol, diabetes stuff out there. This
guide lines that every healthcare professional can go to if
they're unclear or they're fuzzy about it, and it's updated periodically,
maybe every couple of years or so. The experts kind
(04:14):
of convene and they look at the latest data, latest research,
the latest expert thoughts on how to best manage these diseases.
They call this gold directed therapy GDT. Is how we
talk about that our lingo when we're talking to each other,
(04:35):
Goal directed therapy. So all of these decisions in terms
of which medications to prescribe to you is supported by
the experts who research these diseases at the big medical
institutions here in this country. They sort of tell practitioners
like me who are sort of in the community, on
(04:56):
the ground, sort of in the middle, love it the soldiers,
if you will, what is the best thing to do
for your patient. They don't really introduce cost though there's
no cost about it. Right, this medicine, the research supports
(05:17):
this medication, not this one. And if you want to
be a good doctor, if you want to be considered
a good doctor and do the best for your patient,
then this is the medication that we recommend for you.
So what do you recommend or how do you do that?
And it has nothing to do with cost at all,
(05:40):
And it's a disconnect, right, We're more concerned about, Hey,
this medication works good for you, and we're not really
thinking about the cost. But we need to, right, because
sometimes that can influence which medicine we do prescribe.
Speaker 2 (05:56):
If we know it's going to cost you arm in the.
Speaker 1 (05:58):
Leg, and maybe you're not in the best financial position,
you know, why would we prescribe that knowing you can't
afford it, that sort of thing. So that's a huge
disconnect in the medical world. Currently, we don't you know,
we have all these electronic devices that do all this
thinking for us, that make we're supposed to make prescribing
(06:21):
easier and faster. But if you've ever tried to get
a prescription from any doctor's office, you know that it
can sometimes our healthcare professional's office, sometimes it can be
difficult to get the prescription to you just because of
all these obstacles, whether it be at the pharmacy or
(06:42):
whether it be the insurance company, or whether the healthcare
professional of the doctor's office didn't do this so I
had to do that right, And it just sort of stalls,
and a week goes by and you still don't have
your medication, and you're busy, and you call the doctor's office,
you call the pharmacists, and just all these obstacles just
(07:02):
to get one medication refill. Just imagine if you had
several medicines that you had to feel that that might
be a major issue.
Speaker 2 (07:12):
As it pertains to that.
Speaker 1 (07:14):
So I just didn't know if you guys knew that
most healthcare professionals do not really know at the end
of the day, how much it's going to cost you,
and we don't have a system in place we being
the prescribers that can very easily allow us to figure
that out, maybe going to some website or if it
(07:35):
was sort of built into our electronic medical records so
that we would prescribed it, it calculated very easily how
much it's going to cost you at the pharmacist, and
that would be neat right, And maybe in the future
we'll have that capability. But I guess as the as
(07:55):
the medical doctors, the medical representative, we're just trying to
get you the best medicine that medical research says you
should get and not necessarily completely ignore the cost. But
certainly it's not a priority. It's more about what's the
best medicine, And so a lot of times we'll get
(08:16):
we prescribe it, they take it to the pharmacy. My god,
it's five hundred dollars to six hundred dollars. Then we
get the callback saying, well it's too expensive, give me
a different one, and I think that that sounds reasonable, right.
The doctor should know all this stuff. He's prescribing it
or she's prescribing it. They should know all this stuff.
But I guess that's my point. What I'm trying to
(08:40):
share with you today is that most of us do
not know how much it's going to cost you at
the time you pick it up at the pharmacy, and
we don't sort of have this list of other medicines
that should cost you less depending on your insurance and
what's going to happen at the pharmacy, because again, there's
(09:02):
sort of a disconnect. We sort of know ballpark area
that it's you know, if it's generics, certainly generics tend
to be less expensive and name brand brand new tend to.
Speaker 2 (09:13):
Be more expensive.
Speaker 1 (09:14):
We kind of get that part of it, but we
don't ultimately know which medicine how much it's going to cost.
And it's a part of the prescribing system that needs
to be worked on, right, so we can kind of
clarify better how much it's going to cost the patient
(09:35):
at the end of the day, But that system is
not developed yet, and a lot of times, just because
that's a time consuming process to figure out, well, okay,
that one is too expensive.
Speaker 2 (09:46):
What else can we give them?
Speaker 1 (09:50):
From my standpoint, I don't want to sort of keep
going in circles, right. We need to get you a
medication that works for you. I can pick another medicine,
and I'm talking about myself. I don't know what other
practitioners do. I can pick another medicine, but do I
know how much that's going to cost you?
Speaker 2 (10:07):
I don't.
Speaker 1 (10:08):
I'm just going off the latest research and the latest data,
and I throw another medicine out there, and you have
to go through the same process. Well, let me get
to the pharmacy and sandwich costs? Oh again, too expensive?
Do you got another one? And instead of sort of
doing that a lot of times, I ask my patients
to take a minute and reach out to the insurance company,
(10:34):
because most insurance companies have a formulary that has all
of the medications on it and would just how much
pretty much it's going to cost. They call it a
tier system, typically a tier one, two, three fours. Traditionally
how they've done it, And if my memory serves me correct,
a Tier one is more expensive and a Tier force
(10:57):
less expensive.
Speaker 2 (10:58):
It could be the opposite way.
Speaker 1 (10:59):
I can't remember, but basically some sort of tear system
to let you know this one's expensive, this one's the
least expensive. But every insurance company is different, right, Medicare
is different from United Health, different from Humanity, different from
all the others, Blue Cross, Blue Shield. And then you
might have this special personalized plan that even though it's
(11:21):
Blue Cross, Blue Shield, it's a different one. And on
this one, the drug plan is different from the other one.
And can you just imagine, I mean, it's probably over
fifty plans out there, and it's difficult for doctor's office
to know all of the particular parts of these plans
(11:41):
and exactly which drug is going to cost you which amount,
and it's sort of a frustrating deal for everyone involved.
The patient to prescribe and then the pharmacist. Again, no
system in place yet so that it makes it a
smooth transaction, and it can be a very cumbersome transaction
(12:06):
unfortunately in that situation. But if you have more questions
about that, give us called eight nine six kV. I
want one hundred three three zero KALV. I'll be back
in two minutes. All right, Welcome back to Doctri Medical
(12:27):
Our phone lines that opened eight nine six KALV I
want one hundred three three zero kofa chatting about the
expense of medications. And as a prescriber, yes, I wish
that was a better system in place to help us
figure out exactly what the cost of the medication is
(12:48):
going to be when we prescribe it. Unfortunately, we don't
really have that information available when we prescribe the medication,
and so there's this sort of disconnect with that issue.
We just want you to get the best medication possible,
and even when you call your prescriber back, well I
need a different one, we're sort of still at the
(13:09):
same position where we don't really know how much it's
going to cost you when you give it to the pharmacist.
We don't have a system in place now. Just to
cut down on time, and because this is happening frequently
throughout the day at most healthcare professional's office, we will
ask the patients to reach out to their insurance company
(13:32):
and try and help us figure out which medicines are available,
which ones they do pay for, and which one is
going to be the least expensive. Just because it requires
a lot of talking back and forth, just not enough
time in the day for most healthcare providers' offices.
Speaker 2 (13:48):
To do that.
Speaker 1 (13:49):
You can just imagine that we're prescribing medications all day long,
every single day, and the amount of time necessary to
find those things out is monumental, almost overwhelming. It's difficult.
So as far as I know, most insurance companies sort
of have a one eight hundred number and a representative
and you can call them and say, hey, this is
(14:10):
my medicine is with my doctor's trying to give me.
I need a budget friendly alternative. You know, what's the
company paying for? What is the list of alternatives that
should be more affordable for this particular problem. And a
lot of times it doesn't make sense to me because
(14:30):
it could be a patient who has diabetes, like these
injectables that work very well for weight loss, like ozimpic
and Moujarro, the golp one category, which is very popular,
very hot right now, just because it normally will help
a patient lose weight and not eat all day, which
(14:50):
is the issue. Right We have all this food available
to us, and it's hard to sit at home or
sit at work and not entertain the idea of eating
all of that stuff, especially during the holidays when eating
is sort of part of the experience of the holidays.
We want to have a good time and spend some
(15:12):
time with our co workers and family, and just eating
the sort of sugary sweet foods is part of it, right,
It's just laying around. How can you say no to
that stuff? And just all of the gathering and the
celebrating eating and drinking is part of that. And I'm
not really talking about the holidays. I mean, you know,
(15:34):
and I tell people that all the time, a couple
of days of bad eating is not a big deal.
It's just the rest of the time that you have
these issues. When that happens, that's the time when you
need to be really diligent about what you eat and
what you drink, not just a couple of days of
(15:56):
Thanksgiving or a couple of days of Christmas or New
Year's that's not going to a tremendous amount of weight gain.
But these GLP one agonists been out for several years,
very effective, low risk medications you have diabetes. But I
still come across patients who have insurance they have diabetes.
(16:17):
We try to write for GLP one insurance won't pay
for it. Too expensive and that's the part that I
don't quite get. Are they they won't pay for this,
they won't pay for that, And I don't know why.
Most healthcare professionals don't know why they won't pay for things.
You have to call the representatives figured that out and
see which one they do pay for again, because we
(16:39):
don't have a hot list that's updated.
Speaker 2 (16:43):
Every month, every week that.
Speaker 1 (16:45):
Says, Okay, this particular insurance company with this plan, this
is the medicines that they're now paying for it. I mean,
it'll be great if we had a website that we
could all go to, that all the insurance companies bought
into a that doctors, healthcare professionals could go to, sort
of like we have now with narcotics. As you know,
(17:09):
the whole narcotic abuse misuse concern issue out there, we've
worked hard to kind of get that down and we have.
And before this website came into play, most patients who
were struggling with pain and god a little desperate would
(17:31):
just sort of go from practitioner to practitioner to practitioner.
Ers with pain, legitimate pain, legitimate complaints needing prescriptions for
pain medication. Again, there was a time where most healthcare professionals.
Their answer, their resolution to the pain was a narcotic truck.
(17:56):
That was just the way we managed chronic pain, cute
pain here in this country is the use of narcotics.
Everybody was on board, everybody agreed to it, and so
that's what we did, right, and we did that for
many years, and we unfortunately are unfortunately figured out that
that was the wrong thing to do. Narcotics long term
(18:19):
just generate a whole lot of problems for the patient.
It's not the best drug to manage chronic pain. So
we had to get away from that model, and we
certainly had to control the flow of narcotics as it
pertains to prescribe them because it was a free flowing
(18:42):
prescribing sort of time. We were just writing them. Everybody
was happy for a moment and then things start crashing.
So we've sort of had to lock that up.
Speaker 2 (18:53):
And the way we did that.
Speaker 1 (18:54):
Was a website is not available for all healthcare providers
to go to to see if a narcotic has been
prescribed to a particular patient. So we have one in Texas.
So we just have a little password, we get into
that website and we can see if a person has
(19:15):
filled or has been prescribed one to the pharmacy.
Speaker 2 (19:18):
They filled it.
Speaker 1 (19:19):
We can see anywhere in Texas wherever they got it filled.
We can see that on the website because it goes
to this website and we can just line it up. Yes,
you got to hear, you got to hear, you got
to hear. It'd be cool if we had a website
like that for the cost or expense of medications. That
would be cool to go to, so that if we
(19:43):
prescribed to medicine or let's say it came back from
the forums too expensive, we can go to this website
very quickly, look at the list and boom, pick that
medication which should be inexpensive for the patient. But we
don't have that available at up to this point. Hopefully
it will be provided to us at some point. But
(20:05):
a lot of times it's frustrating for the patient the
call the doctor's office, Hey, I need a different drug.
This is too expensive.
Speaker 2 (20:11):
What you got?
Speaker 1 (20:12):
Well, a lot of times I don't know because I
just don't know how much it's going to cost you.
I mean, I know which one I would like you
to be on based on my experience or what the
guidelines are telling me. But there's no consideration of cost
with any of those recommendations. Typically now, things like hypertension, diabetes, cholesterol,
(20:34):
like these routine diseases that we see, we're prescribing the
medicines all the time. Just over time you kind of
figure out which ones are going to be least expensive,
more expensive, and you sort of try and pick it
from that list just your own experience. And a lot
of these drugs are generic, like the cholesterol meds, blood pressure,
(20:58):
heart failure meds, they're kind of all generic, and most
people can't afford those. Just sometimes you get in some
diseases with a lot of these medications are name brand.
Heart failure is one of them. One particular medication that
we like to use is a name brand. It's not
been genericed and it's a good drug and it's recommended.
Speaker 2 (21:20):
Top of the list is if you have heart failure.
Speaker 1 (21:24):
Patients have to be on this medication, only this one,
and it's good and it keeps them out of the
hospital when it improves them and all this sort of thing,
and you write it and then they go to the front, Oh,
it's five hundred dollars, you know, based on this insurance.
What else you got you know, just stuff like that,
and to prescribe as it doesn't make sense because, you know,
why would you not allow your patients to get this
(21:47):
drug because it's proven, the guidelines recommended. It just seems
like you should open the door to get that drug.
Same thing with the gop one category. This stuff gets
patients weight down. When you lose weight, your blood pains.
She gets better, cholesterrug gets better, you feel better, you
go to the doctor less. You know, why not make
this drug just as easy as pie to get that?
(22:08):
You know, that's the part of healthcare that's still a
little confusing to me as a prescriber. Anyway, phone lines
are opened eight nine six kalvye one hundred three three
zero k yeah, I be back in two minutes.
Speaker 2 (22:27):
All right, welcome back to doctor Lena Medical.
Speaker 1 (22:29):
Our phone lines to open eight nine to six kalvy
I won one hundred three three zero Kfjall we have
Richard from Liberty.
Speaker 2 (22:35):
How can we help you?
Speaker 3 (22:37):
Well, I got a little problem. I was in the
hospital for about seven weeks. Last night papul and they
sent me home about the fifteenth of May. Were they
feeding tube because I was unconscious in their comma and
they sent me home with a feeding tube that needed
(22:58):
a special tool to open it, and my wife couldn't
feed me because they said that it take about a
week to get that tool to me, and I was home,
so I thought, well, we'll just go ahead and get
some insurer, get some insta. I go on with the
dog since I wasn't supposed to be able to eat
(23:18):
or drink, and I've got to why I could eat
and drink without a problem at all, and now here
it is deal what's feeding too? When I've called the
doctor at the hospital to try to get it out easily,
he has a recording. He won't call me back. The
people at the hospital won't help me. I've caught my
insurance company. They won't help me. I had some in
(23:40):
home help for my therapy and if they were ready.
The nurse coming in was he removed him before, but
they wouldn't let him remove it. So while I go
about getting this thing out of my stomach and it's
starting to irritate the inside of my stomach now and
who put it in? The doctor Kingwood Hospital, I don't
(24:05):
know his name.
Speaker 1 (24:07):
Okay, And your primary care physician is associated with Kingwood
or not?
Speaker 3 (24:15):
Yeah, she must be. I haven't been able to get
over her because I can't walk and I can't use
a wheelchair. I gives a kid in the walk and
use a wheelchair to where I can get stand up
to get in it. Then it's taken all this time
to get my legs back because I was in a
coma for so long I couldn't you know, I lost
my all my muscles and yeah, coordination. So it's just
(24:38):
getting to work and get up and tolerant and sit
in a wheelchair. But I hadn't tried to get to
my primary care position yet.
Speaker 2 (24:47):
Keys over their dating, Okay, got it?
Speaker 1 (24:51):
Yeah, you know, Richard, most of the time, those feeding
tubes can stand for a long time. Unless you're having
some severe infection, it's normally going to be an outpatient
procedure to remove the tube. I understand it's irritating to you,
but normally, let's say you present to some sort of er.
(25:13):
Let's say you go back to Kingwood and say hey,
I want this tube out. Unless it's an urgent crisis,
they're probably going to say, well, you need to follo
up outpatient, and you need to do this, you need
to do that. And I know that the system can
be very hard to navigate, especially when you're sick and
your care was at a hospital one hundred miles away
(25:36):
and you don't quite know the doctors, and your primary
care doctor that know the doctors, and you just sort
of in this no man's land where everything's disconnected. Like say,
you're sick and you don't really have the ability the
stamina to make all these phone calls and coordinate everything.
Speaker 2 (25:55):
I get that.
Speaker 1 (25:56):
It happens every single day and there's.
Speaker 3 (25:59):
No easy by midnight when actually this is it, let's go.
You ought to be a better way.
Speaker 1 (26:07):
Yeah, yeah, absolutely, we need to keep working on that.
Speaker 3 (26:12):
People. You know I'm a ridiculous.
Speaker 2 (26:15):
Student, correct, So yeah, yeah.
Speaker 1 (26:19):
Normally in this situation, you start with your primary care doctor,
right and get with them and see what they can
do for you in terms of getting the tube out.
But under normal circumstances, whoever put it in is who
takes it out. But again, you were at a hospital
somewhere else, but your home is one hundred miles away
(26:41):
your primary care doctor, which is sort of what we
do every day, is to try and help you get
to another practition that doesn't mind taking it out, even
though they didn't put it in, because the procedure to
put these tubes in this pretty standard, so the doctors
who put them in they know how to take it out.
Even though they didn't put it in, they can always.
Speaker 2 (27:03):
Take it out.
Speaker 1 (27:03):
Especially a gasho trologist, they do most of these tubes,
so probably that's.
Speaker 2 (27:09):
Who put it in.
Speaker 1 (27:09):
Wherever you got it put in, they know how to
remove them and it's not a.
Speaker 2 (27:14):
Very difficult procedure.
Speaker 1 (27:15):
So probably start with your primary and ask what they
can do for you. You can certainly always get back to
the liberty I'm sorry the hospital that you had all
this happened to you, and get the information from the
doctor that put it in the contact their office and
try to get a file perportment there. Again, it's a
(27:37):
lot of work, but that's what you're going to have
to do if you want to get that out. But
normally they're not just going to put you in the hospital.
If everything is fine, you just want it out, They're
not just going to put you in the hospital for that.
They're going to probably discharge you and have you follow
up as an outpatient because it's typically an outpatient procedure,
(27:57):
so very frustrating absolutely, Richard, you're still there.
Speaker 3 (28:03):
Yeah, I'm here.
Speaker 2 (28:05):
Yeah, I can hear you.
Speaker 3 (28:07):
Okay, yeah, I'm uh. He won't return my phone calls,
and the people in the administrative office I'm talking to me.
Speaker 1 (28:17):
Yeah, that's the doctor who put it in. Yeah, okay, yeah,
so yeah, so yeah, probably would have to get with
your primary and let them know, Hey, I'm having problems
with the doctor put it in. Do you have anyone
else that can help me out to take this tube
(28:40):
out and work with your primary to try and resolve
that situation.
Speaker 3 (28:45):
Absolutely, I just haden able to get over there without
lyding the ambulance because I have been able to.
Speaker 1 (28:54):
Yeah, and that's tough, Richard, just because most primaries, you know,
they have to see you. They have to see you somehow,
a lot of doctor's offices are going to these virtual
visits now where if you have a phone, you have
a computer, they can interact with you through the computer.
And that's acceptable and they can take care of you.
But unfortunately, especially if you just got at the hospital
(29:17):
and you want things to happen, you haven't seen them
in several months. I mean, you have to go in
so that they can establish that relationship and get all
your information and see what's going on. Unfortunately, can't do
doctoring over the phone. A lot of times you have
to have a face to face with the practitioner that's
helping you out. So again, I know you're having some
transportation issues, but that has to happen a lot of
(29:42):
times in the situations where you've got to see that
practitioner if you.
Speaker 2 (29:46):
Want to get help from them.
Speaker 1 (29:47):
If they have not seen in a long time, they
don't know what's going on, they don't have your information,
it's hard for them to help you. Okay, Richard, all right, Well,
appreciate Richard's phone call. And that's that's a good question.
You sort of got sick and you went to a big,
(30:09):
major hospital.
Speaker 2 (30:10):
It's outside of your.
Speaker 1 (30:12):
Normal zone of healthcare delivery, and then things start happening.
Speaker 2 (30:17):
What do you do that?
Speaker 1 (30:18):
That's a good that's a good one and sometimes a
very complicated one.
Speaker 2 (30:22):
Bill from Beaumot, how can we help you?
Speaker 4 (30:24):
Uh, Doca. I just want to know what the long
term effects of taking gama penon are and taking it
for neuropathy, and I understand that if that if you
take it a long time, it can be detrimental to
(30:45):
some of the organs. And that's the two questions I
have for you.
Speaker 1 (30:51):
Gaba Penson. Actually, I like Gaba Penson. I've been prescribing
that medication for many years, and a lot of other
practitioners prescribe gabapentin for all sorts of off label usages.
It's also called neurontin, and it's a very popular drug
because a lot of patients are suffering all sorts of
(31:13):
different pain issues out there, whether it be a headache
or back pain or leg pain. We use that medicine
a lot. In my experience, I have not seen any
issues with using gabapent in long term. I mean almost zero.
Sometimes patients can get some swelling in their extremities or
(31:36):
some weight gain, especially at the higher dosages like eight
hundred milligrams three times a day. That's sort of a
high dose for gabapentin. In my experience, most patients are
in lower dosages like three hundred milligrams twice a day.
That's a low dose for gabapentin. So at that dose
it's normally very well tolerated to be used long long
(32:00):
term without any issues with liver or kidney adverse reactions.
I haven't seen them as a prescriber, and I'm in
the hospital every day, I'm in my office every day.
I just don't see it happening. And a lot of
people take this medication every day, and I would just assume,
(32:20):
because of all the surveillance that they have with medications
out there, that if there was something detrimental that was
happening to patients, we would be seeing it. There's no
question it would be reported. And I'm just not seeing it.
I don't ever hear conversations about it and every now
and then, but not at the level.
Speaker 2 (32:40):
It should be.
Speaker 1 (32:41):
Because the percentage of patients taking gabat penton every day
is high. It's very high, primarily because of diabetes, right
It's a big issue in our country, and most diabetic patients,
if the diabetes is not controlled, get a neuropathy. It's painful,
it's uncomfortable, and gabapentin is the most commonly prescribed medicine
(33:01):
for that disease process.
Speaker 2 (33:03):
So a lot of people.
Speaker 1 (33:05):
Take it, and I'm just not hearing a lot of
noise as it pertains to the impact negative impact of
gaba pentton typically a positive drug, so it's a safe
medicine in my opinion, all right, Bill, Did you get that.
Speaker 2 (33:22):
All right? Yeah?
Speaker 1 (33:22):
Gaba Penson. Man, that's that's my buddy. That's my buddy.
That it saves me all day long. Right, when patients
come in hurting, don't feel well, this is nacking them,
whether it be back pain or headache or finger pain
(33:46):
or whatever. Gaba Penton is my buddy, that's my friend.
I use that one a lot, Gaba Penton. Neuronton actually
came out as a seizure medicine, but for whatever reason,
from day one, my experience with gabat pentin or newontin
is that we use it for pain, headaches, migrain headaches.
(34:11):
You get a shingle's reaction on your face or your back,
or you're legging it hurts. Gabapentin. You have numbness and
tingling in your hand, are your your legs? Gaba Pensing headaches, Gabatpenson.
I mean it is prescribed massively by most healthcare providers,
(34:36):
and it's prescribed for a couple of reasons. One it works, right,
it works. I mean most healthcare professions. I've told you
this before. How do we figure out which drug we're
gonna use?
Speaker 2 (34:48):
Now?
Speaker 1 (34:48):
I spend some time talking about guidelines before, and I
was sort of talking about stuff like blood pressure, diabetes,
high CLESSEDO in terms of chronic pain, that we do
have guidelines out there, not as good as our diabetes
hypertension guidelines are getting better just because the treatment of
(35:08):
crimeing pain is an ongoing sort of process in terms
of how we approach it, the research, the data, we're
getting better. But gaba pinson works number one. Number two,
it's proven to be a relatively safe drug, especially.
Speaker 2 (35:26):
Taking it long term.
Speaker 1 (35:29):
That that's what it's proven to be, that sort of drug,
which is why a ton of people are taking it.
And again because of all the attention on drugs and
the adverse reaction and the outcomes with most drugs, especially
drugs that are being prescribed all the time. If something
was really causing some detriment, if something was really happening, man,
(35:53):
we should be seeing it, no question. Just because most
a lot of people take this drug now, it doesn't
mean that you won't maybe have some swelling, like I mentioned,
some swelling some way gain. I've seen that gabapinsing can
make you kind of sleepy, maybe some dizziness, uh, maybe
(36:13):
some mental fogginess, you know. I see those issues. But
it's completely reversible, meaning you get off the drug, the
symptoms go away. It's not sort of a permanent injury
to your body.
Speaker 2 (36:27):
Right.
Speaker 1 (36:29):
And it's prescription. A lot of people feel like, well,
if it's over the counter, it can't harm me. Right,
that's a misconception. That is a huge misconception. Right, it's prescription.
The doctor, healthy professional prescribe it to me, so it's
strong it can hurt me, right, And that's sort of
(36:49):
the odd thing about this whole thing is you get
the prescription drug, you get a booklet of side effects,
right Do you read them? Sometimes you do, sometimes don't.
But a prescription is not written. You go into your
pharmacy of choice, you get a drug over the counter,
let's say a motren or advil. You start taking it.
(37:13):
No booklet of instructions, no warnings, no booklet of warnings.
Speaker 2 (37:18):
I mean, there's no.
Speaker 1 (37:21):
Conversation with a medical professional about the adverse reaction, zero nothing.
You just go pick it up at your own risk. Right,
But those drugs can harm. Remember a lot of the
over the counter drugs used to be prescription. Now they're
over the counter, and all of that attention to the
(37:43):
side effects goes away. Now you're on your own getting
this drug that still can cause harm. These anti inflammatories
Motra and advil leave.
Speaker 2 (37:54):
I'll be profen.
Speaker 1 (37:54):
I use them every day, right in terms of prescribing,
they can cause harm. They do a lot every day.
Kidney failure, ulcers in the stomach, hypertension, swelling in the legs.
I mean, these drugs do that, but they're still popular.
It's like my old buddy Gaba Penton. Phone lines are
(38:17):
open eight nine six Kalvy. I won one hundred three
to three zero kalo Via. I'll be back in two minutes.
All right, welcome back to doctor Memtic. Our phone lines
are open. Eight nine six kalv I won one hundred
three three zero kov I. Man, when you're having fun,
the time goes by so fast. Right, Well, I'm at
the end of the show, my god. Anyway, if you
(38:41):
want to have it, I'm going to talk about something
in particular. There's a topic I'm not covering. You want
to chat about it, remember, you can call the radio station,
you can call my office. Leave that message and we
can chat about it and talk about it. I spent
some time talking about the cost of medications. That's the
big elephant in the room of healthcare.
Speaker 2 (39:02):
Right. We don't talk about it enough.
Speaker 3 (39:03):
Man.
Speaker 1 (39:04):
It's just these good, good medications that are available to
patients that work very well, very clean. It's just so expensive.
I mean, sticker shock bigtime. Five hundred dollars, six hundred
dollars a month. Who's got that a month? No, And
there's no connection between the doctor the prescriber in terms
(39:27):
of the expense. We're just following guidelines, right, But there's
no sort of financial link to that. And I guess
that's hard to do because it depends on your plan
and insurance and all that you're deductible at WISH.
Speaker 2 (39:39):
My wife is here.
Speaker 1 (39:42):
You know, that system is not set up for prescribers
to know how much it's going to cost. You go
to a minor care for an ache and pain, they're
going to prescribe some medication to you. Now, most of
those acute pain medicines are inexpensive. You know, must relaxers
and how inflammatories, pain medicines. That's not the sticker shock.
It's a treatment for asthma, the treatment for your heart
(40:04):
failure and your diabetes, and the cholesterol and the loopus
and the rum charge ritis and cancer. I mean, those
drugs are ha but most doctors just again are not
connected with the expense for your particular plan, so most
of them are not going to know what else you got.
(40:25):
Would give me the second choice, the third choice, the
four show. Yeah, I have other medicines, but I don't
know how much it's going to cost you. You're going
to have to help us out with that. Sometimes the
pharmacists can help you out. A lot of times you
have to make that phone call yourself and help us
help you figure that out. Just its most healthcare providers
off of staff does not have the time to do
(40:48):
that on every single patient. So a lot of times
we kick that back to the patient to help us
out and figure that cost issue out with that particular medication.
Speaker 2 (40:59):
Yes, and again, Gaba Penson, very very good man.
Speaker 1 (41:03):
I'm glad that patient call because we prescribe that medicine
a lot and a lot of people aren't it ironin,
Gaba Penson. It's a safe drug in my opinion, But
don't let it fool you because of medicine is not
over the it's not prescribed and it's over the counter.
Don't let that fool you. It can still harm you.
I mean, these medicines can do harm all. I see
(41:23):
it every day. Just let's just take motrin for instance.
I mean, people get aches and pains, they have headaches,
back pain, stomach pain, and they start taking that medication
and they're taking it every day. And I know in
the package a lot of times it says, hey, if
your pain persists, go see your doctor, because yeah, they
(41:44):
want you to get checked out, like what's causing the pain.
A lot of times it can be something truly serious
and impactful to your life. When you start getting this
pain and you start taking motrin and that's okay work,
I mean, just push through it. Before you know it,
a couple of months goes by, you still have the pain,
(42:05):
you still taking the motrin, and then your legs starts swelling,
your blood pressure goes up, you get shorter breath, and
then you get some lab you got you got kidney failure.
Just like that, it's over the counter. I take it.
I have pain, you got kidney failure. And then oh,
by the way, yeah they found something else too that's
actually causing the pain. So yeah, go get checked out.
(42:27):
If you're having some new pain, you don't know what
it is. It doesn't go away. I get it. It's
cumbersome to go find a doctor. You gotta get numbers
and take off from work and sit for three four hours.
But yeah, if the pain does not subside, or you
have some new physical symptom and that's not getting better, yeah,
go get some lab, get some some X rays. Let
(42:49):
a healthcare provider take a look at you see if
we can kind of figure out what it is, so
you can get on the right medicines.
Speaker 2 (42:55):
Maybe get to the right.
Speaker 1 (42:56):
Doctor and get your diagnosis and get better rather than
letting it just get worse and worse and worse.
Speaker 2 (43:05):
Yeah.
Speaker 1 (43:06):
Anyway, phone lines are closing, y'all have a good week.
We're gonna be off next week and then I'll be
back the following week.
Speaker 2 (43:15):
Take care, don't drink and drive. God bless you.
All right, welcome Southeast Texas internet radio listeners. Good morning,
it's dark Levigne on the Dark Lavine Medical Hour, taking
your phone calls answering health care related questions live in
the series of klv I in Beaumont, Texas, across the
street from Parkdale Mall, trying to help you out during
(00:21):
this holiday season, toward the end of the year. Things
are coming to an end this year twenty five, looking
far for the year twenty six, how can we make
things better? How can we right the wrongs? So give
us a call. More than happy to try and help
(00:42):
you out. Eight nine to six lv I win in
one hundred three three zero klv I. I'm just wishing
for some colder weather, right. It's kind of muggy, foggy
this morning, not very cold, kind of warm, actually not
too bad.
Speaker 2 (01:00):
As you know. I like more of the winter weather.
Speaker 1 (01:03):
This is the holiday season, so we'd like to get
more of that cold, windy weather, right. Not snow snow,
it's just too much to deal with, but just some
coldness out there. That's one thing that I remember doing
this recent Thanksgiving Day is the weather was perfect. It
(01:23):
was just a great beautiful day. And today it seems
kind of overcast at least so far. But anyway, thank
you for joining for the edition of this show. We're
here every Saturday trying to help you, trying to help
you answer some questions about your health so you can
stay alive, live longer.
Speaker 2 (01:42):
Be healthier. What does that look like? What does that mean?
Speaker 1 (01:47):
So we'll appreciate your phone calls, gifts called two way radio.
We'd love to hear from you. In the meantime, I
normally will chat about whatever is rolling through my head
as I appear, as I think about, or maybe some
things that happened this past week that are of interest.
And one thing that came to mind is just sort
(02:10):
of the cost of medications in this country. We don't
talk about it a whole lot, and every now and
then it comes up, and certainly it comes up, I
guess on an individual level when you have to get
new prescriptions, I would assume that anytime the doctor or
the healthcare professional says again to write for prescription, I'm
(02:32):
sure the first thing that comes to most patients' minds
is how much is this going to cost?
Speaker 2 (02:39):
Right?
Speaker 1 (02:39):
I mean, I think most people understand meds. Medications, man,
they cost money, big money, especially the good stuff, right,
they cost a lot of money. And the one thing
that I was I remember that I said, hey, you
know what I'm going to talk about at this Saturday,
(03:02):
is that most of the time helps don't really know
when they write the prescription, are e prescribed the prescription
ultimately how much it's going to cost you. We don't
really have that system in place to easily find out
how much a medication is going to ultimately cost you
(03:26):
when you get.
Speaker 2 (03:27):
To the pharmacist.
Speaker 1 (03:29):
We are certainly taught to learn the diseases and the
medical research and the guidelines sort of tell us about
which medicines are the ones preferred or recommended by the
experts for particular disease. We have all these guidelines as
(03:50):
it pertains to most diseases, at least the common stuff,
all the blood pressure, cholesterol, diabetes stuff out there. This
guide lines that every healthcare professional can go to if
they're unclear or they're fuzzy about it, and it's updated periodically,
maybe every couple of years or so. The experts kind
(04:14):
of convene and they look at the latest data, latest research,
the latest expert thoughts on how to best manage these diseases.
They call this gold directed therapy GDT. Is how we
talk about that our lingo when we're talking to each other,
(04:35):
Goal directed therapy. So all of these decisions in terms
of which medications to prescribe to you is supported by
the experts who research these diseases at the big medical
institutions here in this country. They sort of tell practitioners
like me who are sort of in the community, on
(04:56):
the ground, sort of in the middle, love it the soldiers,
if you will, what is the best thing to do
for your patient. They don't really introduce cost though there's
no cost about it. Right, this medicine, the research supports
(05:17):
this medication, not this one. And if you want to
be a good doctor, if you want to be considered
a good doctor and do the best for your patient,
then this is the medication that we recommend for you.
So what do you recommend or how do you do that?
And it has nothing to do with cost at all,
(05:40):
And it's a disconnect, right, We're more concerned about, Hey,
this medication works good for you, and we're not really
thinking about the cost. But we need to, right, because
sometimes that can influence which medicine we do prescribe.
Speaker 2 (05:56):
If we know it's going to cost you arm in the.
Speaker 1 (05:58):
Leg, and maybe you're not in the best financial position,
you know, why would we prescribe that knowing you can't
afford it, that sort of thing. So that's a huge
disconnect in the medical world. Currently, we don't you know,
we have all these electronic devices that do all this
thinking for us, that make we're supposed to make prescribing
(06:21):
easier and faster. But if you've ever tried to get
a prescription from any doctor's office, you know that it
can sometimes our healthcare professional's office, sometimes it can be
difficult to get the prescription to you just because of
all these obstacles, whether it be at the pharmacy or
(06:42):
whether it be the insurance company, or whether the healthcare
professional of the doctor's office didn't do this so I
had to do that right, And it just sort of stalls,
and a week goes by and you still don't have
your medication, and you're busy, and you call the doctor's office,
you call the pharmacists, and just all these obstacles just
(07:02):
to get one medication refill. Just imagine if you had
several medicines that you had to feel that that might
be a major issue.
Speaker 2 (07:12):
As it pertains to that.
Speaker 1 (07:14):
So I just didn't know if you guys knew that
most healthcare professionals do not really know at the end
of the day, how much it's going to cost you,
and we don't have a system in place we being
the prescribers that can very easily allow us to figure
that out, maybe going to some website or if it
(07:35):
was sort of built into our electronic medical records so
that we would prescribed it, it calculated very easily how
much it's going to cost you at the pharmacist, and
that would be neat right, And maybe in the future
we'll have that capability. But I guess as the as
(07:55):
the medical doctors, the medical representative, we're just trying to
get you the best medicine that medical research says you
should get and not necessarily completely ignore the cost. But
certainly it's not a priority. It's more about what's the
best medicine, And so a lot of times we'll get
(08:16):
we prescribe it, they take it to the pharmacy. My god,
it's five hundred dollars to six hundred dollars. Then we
get the callback saying, well it's too expensive, give me
a different one, and I think that that sounds reasonable, right.
The doctor should know all this stuff. He's prescribing it
or she's prescribing it. They should know all this stuff.
But I guess that's my point. What I'm trying to
(08:40):
share with you today is that most of us do
not know how much it's going to cost you at
the time you pick it up at the pharmacy, and
we don't sort of have this list of other medicines
that should cost you less depending on your insurance and
what's going to happen at the pharmacy, because again, there's
(09:02):
sort of a disconnect. We sort of know ballpark area
that it's you know, if it's generics, certainly generics tend
to be less expensive and name brand brand new tend to.
Speaker 2 (09:13):
Be more expensive.
Speaker 1 (09:14):
We kind of get that part of it, but we
don't ultimately know which medicine how much it's going to cost.
And it's a part of the prescribing system that needs
to be worked on, right, so we can kind of
clarify better how much it's going to cost the patient
(09:35):
at the end of the day, But that system is
not developed yet, and a lot of times, just because
that's a time consuming process to figure out, well, okay,
that one is too expensive.
Speaker 2 (09:46):
What else can we give them?
Speaker 1 (09:50):
From my standpoint, I don't want to sort of keep
going in circles, right. We need to get you a
medication that works for you. I can pick another medicine,
and I'm talking about myself. I don't know what other
practitioners do. I can pick another medicine, but do I
know how much that's going to cost you?
Speaker 2 (10:07):
I don't.
Speaker 1 (10:08):
I'm just going off the latest research and the latest data,
and I throw another medicine out there, and you have
to go through the same process. Well, let me get
to the pharmacy and sandwich costs? Oh again, too expensive?
Do you got another one? And instead of sort of
doing that a lot of times, I ask my patients
to take a minute and reach out to the insurance company,
(10:34):
because most insurance companies have a formulary that has all
of the medications on it and would just how much
pretty much it's going to cost. They call it a
tier system, typically a tier one, two, three fours. Traditionally
how they've done it, And if my memory serves me correct,
a Tier one is more expensive and a Tier force
(10:57):
less expensive.
Speaker 2 (10:58):
It could be the opposite way.
Speaker 1 (10:59):
I can't remember, but basically some sort of tear system
to let you know this one's expensive, this one's the
least expensive. But every insurance company is different, right, Medicare
is different from United Health, different from Humanity, different from
all the others, Blue Cross, Blue Shield. And then you
might have this special personalized plan that even though it's
(11:21):
Blue Cross, Blue Shield, it's a different one. And on
this one, the drug plan is different from the other one.
And can you just imagine, I mean, it's probably over
fifty plans out there, and it's difficult for doctor's office
to know all of the particular parts of these plans
(11:41):
and exactly which drug is going to cost you which amount,
and it's sort of a frustrating deal for everyone involved.
The patient to prescribe and then the pharmacist. Again, no
system in place yet so that it makes it a
smooth transaction, and it can be a very cumbersome transaction
(12:06):
unfortunately in that situation. But if you have more questions
about that, give us called eight nine six kV. I
want one hundred three three zero KALV. I'll be back
in two minutes. All right, Welcome back to Doctri Medical
(12:27):
Our phone lines that opened eight nine six KALV I
want one hundred three three zero kofa chatting about the
expense of medications. And as a prescriber, yes, I wish
that was a better system in place to help us
figure out exactly what the cost of the medication is
(12:48):
going to be when we prescribe it. Unfortunately, we don't
really have that information available when we prescribe the medication,
and so there's this sort of disconnect with that issue.
We just want you to get the best medication possible,
and even when you call your prescriber back, well I
need a different one, we're sort of still at the
(13:09):
same position where we don't really know how much it's
going to cost you when you give it to the pharmacist.
We don't have a system in place now. Just to
cut down on time, and because this is happening frequently
throughout the day at most healthcare professional's office, we will
ask the patients to reach out to their insurance company
(13:32):
and try and help us figure out which medicines are available,
which ones they do pay for, and which one is
going to be the least expensive. Just because it requires
a lot of talking back and forth, just not enough
time in the day for most healthcare providers' offices.
Speaker 2 (13:48):
To do that.
Speaker 1 (13:49):
You can just imagine that we're prescribing medications all day long,
every single day, and the amount of time necessary to
find those things out is monumental, almost overwhelming. It's difficult.
So as far as I know, most insurance companies sort
of have a one eight hundred number and a representative
and you can call them and say, hey, this is
(14:10):
my medicine is with my doctor's trying to give me.
I need a budget friendly alternative. You know, what's the
company paying for? What is the list of alternatives that
should be more affordable for this particular problem. And a
lot of times it doesn't make sense to me because
(14:30):
it could be a patient who has diabetes, like these
injectables that work very well for weight loss, like ozimpic
and Moujarro, the golp one category, which is very popular,
very hot right now, just because it normally will help
a patient lose weight and not eat all day, which
(14:50):
is the issue. Right We have all this food available
to us, and it's hard to sit at home or
sit at work and not entertain the idea of eating
all of that stuff, especially during the holidays when eating
is sort of part of the experience of the holidays.
We want to have a good time and spend some
(15:12):
time with our co workers and family, and just eating
the sort of sugary sweet foods is part of it, right,
It's just laying around. How can you say no to
that stuff? And just all of the gathering and the
celebrating eating and drinking is part of that. And I'm
not really talking about the holidays. I mean, you know,
(15:34):
and I tell people that all the time, a couple
of days of bad eating is not a big deal.
It's just the rest of the time that you have
these issues. When that happens, that's the time when you
need to be really diligent about what you eat and
what you drink, not just a couple of days of
(15:56):
Thanksgiving or a couple of days of Christmas or New
Year's that's not going to a tremendous amount of weight gain.
But these GLP one agonists been out for several years,
very effective, low risk medications you have diabetes. But I
still come across patients who have insurance they have diabetes.
(16:17):
We try to write for GLP one insurance won't pay
for it. Too expensive and that's the part that I
don't quite get. Are they they won't pay for this,
they won't pay for that, And I don't know why.
Most healthcare professionals don't know why they won't pay for things.
You have to call the representatives figured that out and
see which one they do pay for again, because we
(16:39):
don't have a hot list that's updated.
Speaker 2 (16:43):
Every month, every week that.
Speaker 1 (16:45):
Says, Okay, this particular insurance company with this plan, this
is the medicines that they're now paying for it. I mean,
it'll be great if we had a website that we
could all go to, that all the insurance companies bought
into a that doctors, healthcare professionals could go to, sort
of like we have now with narcotics. As you know,
(17:09):
the whole narcotic abuse misuse concern issue out there, we've
worked hard to kind of get that down and we have.
And before this website came into play, most patients who
were struggling with pain and god a little desperate would
(17:31):
just sort of go from practitioner to practitioner to practitioner.
Ers with pain, legitimate pain, legitimate complaints needing prescriptions for
pain medication. Again, there was a time where most healthcare professionals.
Their answer, their resolution to the pain was a narcotic truck.
(17:56):
That was just the way we managed chronic pain, cute
pain here in this country is the use of narcotics.
Everybody was on board, everybody agreed to it, and so
that's what we did, right, and we did that for
many years, and we unfortunately are unfortunately figured out that
that was the wrong thing to do. Narcotics long term
(18:19):
just generate a whole lot of problems for the patient.
It's not the best drug to manage chronic pain. So
we had to get away from that model, and we
certainly had to control the flow of narcotics as it
pertains to prescribe them because it was a free flowing
(18:42):
prescribing sort of time. We were just writing them. Everybody
was happy for a moment and then things start crashing.
So we've sort of had to lock that up.
Speaker 2 (18:53):
And the way we did that.
Speaker 1 (18:54):
Was a website is not available for all healthcare providers
to go to to see if a narcotic has been
prescribed to a particular patient. So we have one in Texas.
So we just have a little password, we get into
that website and we can see if a person has
(19:15):
filled or has been prescribed one to the pharmacy.
Speaker 2 (19:18):
They filled it.
Speaker 1 (19:19):
We can see anywhere in Texas wherever they got it filled.
We can see that on the website because it goes
to this website and we can just line it up. Yes,
you got to hear, you got to hear, you got
to hear. It'd be cool if we had a website
like that for the cost or expense of medications. That
would be cool to go to, so that if we
(19:43):
prescribed to medicine or let's say it came back from
the forums too expensive, we can go to this website
very quickly, look at the list and boom, pick that
medication which should be inexpensive for the patient. But we
don't have that available at up to this point. Hopefully
it will be provided to us at some point. But
(20:05):
a lot of times it's frustrating for the patient the
call the doctor's office, Hey, I need a different drug.
This is too expensive.
Speaker 2 (20:11):
What you got?
Speaker 1 (20:12):
Well, a lot of times I don't know because I
just don't know how much it's going to cost you.
I mean, I know which one I would like you
to be on based on my experience or what the
guidelines are telling me. But there's no consideration of cost
with any of those recommendations. Typically now, things like hypertension, diabetes, cholesterol,
(20:34):
like these routine diseases that we see, we're prescribing the
medicines all the time. Just over time you kind of
figure out which ones are going to be least expensive,
more expensive, and you sort of try and pick it
from that list just your own experience. And a lot
of these drugs are generic, like the cholesterol meds, blood pressure,
(20:58):
heart failure meds, they're kind of all generic, and most
people can't afford those. Just sometimes you get in some
diseases with a lot of these medications are name brand.
Heart failure is one of them. One particular medication that
we like to use is a name brand. It's not
been genericed and it's a good drug and it's recommended.
Speaker 2 (21:20):
Top of the list is if you have heart failure.
Speaker 1 (21:24):
Patients have to be on this medication, only this one,
and it's good and it keeps them out of the
hospital when it improves them and all this sort of thing,
and you write it and then they go to the front, Oh,
it's five hundred dollars, you know, based on this insurance.
What else you got you know, just stuff like that,
and to prescribe as it doesn't make sense because, you know,
why would you not allow your patients to get this
(21:47):
drug because it's proven, the guidelines recommended. It just seems
like you should open the door to get that drug.
Same thing with the gop one category. This stuff gets
patients weight down. When you lose weight, your blood pains.
She gets better, cholesterrug gets better, you feel better, you
go to the doctor less. You know, why not make
this drug just as easy as pie to get that?
(22:08):
You know, that's the part of healthcare that's still a
little confusing to me as a prescriber. Anyway, phone lines
are opened eight nine six kalvye one hundred three three
zero k yeah, I be back in two minutes.
Speaker 2 (22:27):
All right, welcome back to doctor Lena Medical.
Speaker 1 (22:29):
Our phone lines to open eight nine to six kalvy
I won one hundred three three zero Kfjall we have
Richard from Liberty.
Speaker 2 (22:35):
How can we help you?
Speaker 3 (22:37):
Well, I got a little problem. I was in the
hospital for about seven weeks. Last night papul and they
sent me home about the fifteenth of May. Were they
feeding tube because I was unconscious in their comma and
they sent me home with a feeding tube that needed
(22:58):
a special tool to open it, and my wife couldn't
feed me because they said that it take about a
week to get that tool to me, and I was home,
so I thought, well, we'll just go ahead and get
some insurer, get some insta. I go on with the
dog since I wasn't supposed to be able to eat
(23:18):
or drink, and I've got to why I could eat
and drink without a problem at all, and now here
it is deal what's feeding too? When I've called the
doctor at the hospital to try to get it out easily,
he has a recording. He won't call me back. The
people at the hospital won't help me. I've caught my
insurance company. They won't help me. I had some in
(23:40):
home help for my therapy and if they were ready.
The nurse coming in was he removed him before, but
they wouldn't let him remove it. So while I go
about getting this thing out of my stomach and it's
starting to irritate the inside of my stomach now and
who put it in? The doctor Kingwood Hospital, I don't
(24:05):
know his name.
Speaker 1 (24:07):
Okay, And your primary care physician is associated with Kingwood
or not?
Speaker 3 (24:15):
Yeah, she must be. I haven't been able to get
over her because I can't walk and I can't use
a wheelchair. I gives a kid in the walk and
use a wheelchair to where I can get stand up
to get in it. Then it's taken all this time
to get my legs back because I was in a
coma for so long I couldn't you know, I lost
my all my muscles and yeah, coordination. So it's just
(24:38):
getting to work and get up and tolerant and sit
in a wheelchair. But I hadn't tried to get to
my primary care position yet.
Speaker 2 (24:47):
Keys over their dating, Okay, got it?
Speaker 1 (24:51):
Yeah, you know, Richard, most of the time, those feeding
tubes can stand for a long time. Unless you're having
some severe infection, it's normally going to be an outpatient
procedure to remove the tube. I understand it's irritating to you,
but normally, let's say you present to some sort of er.
(25:13):
Let's say you go back to Kingwood and say hey,
I want this tube out. Unless it's an urgent crisis,
they're probably going to say, well, you need to follo
up outpatient, and you need to do this, you need
to do that. And I know that the system can
be very hard to navigate, especially when you're sick and
your care was at a hospital one hundred miles away
(25:36):
and you don't quite know the doctors, and your primary
care doctor that know the doctors, and you just sort
of in this no man's land where everything's disconnected. Like say,
you're sick and you don't really have the ability the
stamina to make all these phone calls and coordinate everything.
Speaker 2 (25:55):
I get that.
Speaker 1 (25:56):
It happens every single day and there's.
Speaker 3 (25:59):
No easy by midnight when actually this is it, let's go.
You ought to be a better way.
Speaker 1 (26:07):
Yeah, yeah, absolutely, we need to keep working on that.
Speaker 3 (26:12):
People. You know I'm a ridiculous.
Speaker 2 (26:15):
Student, correct, So yeah, yeah.
Speaker 1 (26:19):
Normally in this situation, you start with your primary care doctor,
right and get with them and see what they can
do for you in terms of getting the tube out.
But under normal circumstances, whoever put it in is who
takes it out. But again, you were at a hospital
somewhere else, but your home is one hundred miles away
(26:41):
your primary care doctor, which is sort of what we
do every day, is to try and help you get
to another practition that doesn't mind taking it out, even
though they didn't put it in, because the procedure to
put these tubes in this pretty standard, so the doctors
who put them in they know how to take it out.
Even though they didn't put it in, they can always.
Speaker 2 (27:03):
Take it out.
Speaker 1 (27:03):
Especially a gasho trologist, they do most of these tubes,
so probably that's.
Speaker 2 (27:09):
Who put it in.
Speaker 1 (27:09):
Wherever you got it put in, they know how to
remove them and it's not a.
Speaker 2 (27:14):
Very difficult procedure.
Speaker 1 (27:15):
So probably start with your primary and ask what they
can do for you. You can certainly always get back to
the liberty I'm sorry the hospital that you had all
this happened to you, and get the information from the
doctor that put it in the contact their office and
try to get a file perportment there. Again, it's a
(27:37):
lot of work, but that's what you're going to have
to do if you want to get that out. But
normally they're not just going to put you in the hospital.
If everything is fine, you just want it out, They're
not just going to put you in the hospital for that.
They're going to probably discharge you and have you follow
up as an outpatient because it's typically an outpatient procedure,
(27:57):
so very frustrating absolutely, Richard, you're still there.
Speaker 3 (28:03):
Yeah, I'm here.
Speaker 2 (28:05):
Yeah, I can hear you.
Speaker 3 (28:07):
Okay, yeah, I'm uh. He won't return my phone calls,
and the people in the administrative office I'm talking to me.
Speaker 1 (28:17):
Yeah, that's the doctor who put it in. Yeah, okay, yeah,
so yeah, so yeah, probably would have to get with
your primary and let them know, Hey, I'm having problems
with the doctor put it in. Do you have anyone
else that can help me out to take this tube
(28:40):
out and work with your primary to try and resolve
that situation.
Speaker 3 (28:45):
Absolutely, I just haden able to get over there without
lyding the ambulance because I have been able to.
Speaker 1 (28:54):
Yeah, and that's tough, Richard, just because most primaries, you know,
they have to see you. They have to see you somehow,
a lot of doctor's offices are going to these virtual
visits now where if you have a phone, you have
a computer, they can interact with you through the computer.
And that's acceptable and they can take care of you.
But unfortunately, especially if you just got at the hospital
(29:17):
and you want things to happen, you haven't seen them
in several months. I mean, you have to go in
so that they can establish that relationship and get all
your information and see what's going on. Unfortunately, can't do
doctoring over the phone. A lot of times you have
to have a face to face with the practitioner that's
helping you out. So again, I know you're having some
transportation issues, but that has to happen a lot of
(29:42):
times in the situations where you've got to see that
practitioner if you.
Speaker 2 (29:46):
Want to get help from them.
Speaker 1 (29:47):
If they have not seen in a long time, they
don't know what's going on, they don't have your information,
it's hard for them to help you. Okay, Richard, all right, Well,
appreciate Richard's phone call. And that's that's a good question.
You sort of got sick and you went to a big,
(30:09):
major hospital.
Speaker 2 (30:10):
It's outside of your.
Speaker 1 (30:12):
Normal zone of healthcare delivery, and then things start happening.
Speaker 2 (30:17):
What do you do that?
Speaker 1 (30:18):
That's a good that's a good one and sometimes a
very complicated one.
Speaker 2 (30:22):
Bill from Beaumot, how can we help you?
Speaker 4 (30:24):
Uh, Doca. I just want to know what the long
term effects of taking gama penon are and taking it
for neuropathy, and I understand that if that if you
take it a long time, it can be detrimental to
(30:45):
some of the organs. And that's the two questions I
have for you.
Speaker 1 (30:51):
Gaba Penson. Actually, I like Gaba Penson. I've been prescribing
that medication for many years, and a lot of other
practitioners prescribe gabapentin for all sorts of off label usages.
It's also called neurontin, and it's a very popular drug
because a lot of patients are suffering all sorts of
(31:13):
different pain issues out there, whether it be a headache
or back pain or leg pain. We use that medicine
a lot. In my experience, I have not seen any
issues with using gabapent in long term. I mean almost zero.
Sometimes patients can get some swelling in their extremities or
(31:36):
some weight gain, especially at the higher dosages like eight
hundred milligrams three times a day. That's sort of a
high dose for gabapentin. In my experience, most patients are
in lower dosages like three hundred milligrams twice a day.
That's a low dose for gabapentin. So at that dose
it's normally very well tolerated to be used long long
(32:00):
term without any issues with liver or kidney adverse reactions.
I haven't seen them as a prescriber, and I'm in
the hospital every day, I'm in my office every day.
I just don't see it happening. And a lot of
people take this medication every day, and I would just assume,
(32:20):
because of all the surveillance that they have with medications
out there, that if there was something detrimental that was
happening to patients, we would be seeing it. There's no
question it would be reported. And I'm just not seeing it.
I don't ever hear conversations about it and every now
and then, but not at the level.
Speaker 2 (32:40):
It should be.
Speaker 1 (32:41):
Because the percentage of patients taking gabat penton every day
is high. It's very high, primarily because of diabetes, right
It's a big issue in our country, and most diabetic patients,
if the diabetes is not controlled, get a neuropathy. It's painful,
it's uncomfortable, and gabapentin is the most commonly prescribed medicine
(33:01):
for that disease process.
Speaker 2 (33:03):
So a lot of people.
Speaker 1 (33:05):
Take it, and I'm just not hearing a lot of
noise as it pertains to the impact negative impact of
gaba pentton typically a positive drug, so it's a safe
medicine in my opinion, all right, Bill, Did you get that.
Speaker 2 (33:22):
All right? Yeah?
Speaker 1 (33:22):
Gaba Penson. Man, that's that's my buddy. That's my buddy.
That it saves me all day long. Right, when patients
come in hurting, don't feel well, this is nacking them,
whether it be back pain or headache or finger pain
(33:46):
or whatever. Gaba Penton is my buddy, that's my friend.
I use that one a lot, Gaba Penton. Neuronton actually
came out as a seizure medicine, but for whatever reason,
from day one, my experience with gabat pentin or newontin
is that we use it for pain, headaches, migrain headaches.
(34:11):
You get a shingle's reaction on your face or your back,
or you're legging it hurts. Gabapentin. You have numbness and
tingling in your hand, are your your legs? Gaba Pensing headaches, Gabatpenson.
I mean it is prescribed massively by most healthcare providers,
(34:36):
and it's prescribed for a couple of reasons. One it works, right,
it works. I mean most healthcare professions. I've told you
this before. How do we figure out which drug we're
gonna use?
Speaker 2 (34:48):
Now?
Speaker 1 (34:48):
I spend some time talking about guidelines before, and I
was sort of talking about stuff like blood pressure, diabetes,
high CLESSEDO in terms of chronic pain, that we do
have guidelines out there, not as good as our diabetes
hypertension guidelines are getting better just because the treatment of
(35:08):
crimeing pain is an ongoing sort of process in terms
of how we approach it, the research, the data, we're
getting better. But gaba pinson works number one. Number two,
it's proven to be a relatively safe drug, especially.
Speaker 2 (35:26):
Taking it long term.
Speaker 1 (35:29):
That that's what it's proven to be, that sort of drug,
which is why a ton of people are taking it.
And again because of all the attention on drugs and
the adverse reaction and the outcomes with most drugs, especially
drugs that are being prescribed all the time. If something
was really causing some detriment, if something was really happening, man,
(35:53):
we should be seeing it, no question. Just because most
a lot of people take this drug now, it doesn't
mean that you won't maybe have some swelling, like I mentioned,
some swelling some way gain. I've seen that gabapinsing can
make you kind of sleepy, maybe some dizziness, uh, maybe
(36:13):
some mental fogginess, you know. I see those issues. But
it's completely reversible, meaning you get off the drug, the
symptoms go away. It's not sort of a permanent injury
to your body.
Speaker 2 (36:27):
Right.
Speaker 1 (36:29):
And it's prescription. A lot of people feel like, well,
if it's over the counter, it can't harm me. Right,
that's a misconception. That is a huge misconception. Right, it's prescription.
The doctor, healthy professional prescribe it to me, so it's
strong it can hurt me, right, And that's sort of
(36:49):
the odd thing about this whole thing is you get
the prescription drug, you get a booklet of side effects,
right Do you read them? Sometimes you do, sometimes don't.
But a prescription is not written. You go into your
pharmacy of choice, you get a drug over the counter,
let's say a motren or advil. You start taking it.
(37:13):
No booklet of instructions, no warnings, no booklet of warnings.
Speaker 2 (37:18):
I mean, there's no.
Speaker 1 (37:21):
Conversation with a medical professional about the adverse reaction, zero nothing.
You just go pick it up at your own risk. Right,
But those drugs can harm. Remember a lot of the
over the counter drugs used to be prescription. Now they're
over the counter, and all of that attention to the
(37:43):
side effects goes away. Now you're on your own getting
this drug that still can cause harm. These anti inflammatories
Motra and advil leave.
Speaker 2 (37:54):
I'll be profen.
Speaker 1 (37:54):
I use them every day, right in terms of prescribing,
they can cause harm. They do a lot every day.
Kidney failure, ulcers in the stomach, hypertension, swelling in the legs.
I mean, these drugs do that, but they're still popular.
It's like my old buddy Gaba Penton. Phone lines are
(38:17):
open eight nine six Kalvy. I won one hundred three
to three zero kalo Via. I'll be back in two minutes.
All right, welcome back to doctor Memtic. Our phone lines
are open. Eight nine six kalv I won one hundred
three three zero kov I. Man, when you're having fun,
the time goes by so fast. Right, Well, I'm at
the end of the show, my god. Anyway, if you
(38:41):
want to have it, I'm going to talk about something
in particular. There's a topic I'm not covering. You want
to chat about it, remember, you can call the radio station,
you can call my office. Leave that message and we
can chat about it and talk about it. I spent
some time talking about the cost of medications. That's the
big elephant in the room of healthcare.
Speaker 2 (39:02):
Right. We don't talk about it enough.
Speaker 3 (39:03):
Man.
Speaker 1 (39:04):
It's just these good, good medications that are available to
patients that work very well, very clean. It's just so expensive.
I mean, sticker shock bigtime. Five hundred dollars, six hundred
dollars a month. Who's got that a month? No, And
there's no connection between the doctor the prescriber in terms
(39:27):
of the expense. We're just following guidelines, right, But there's
no sort of financial link to that. And I guess
that's hard to do because it depends on your plan
and insurance and all that you're deductible at WISH.
Speaker 2 (39:39):
My wife is here.
Speaker 1 (39:42):
You know, that system is not set up for prescribers
to know how much it's going to cost. You go
to a minor care for an ache and pain, they're
going to prescribe some medication to you. Now, most of
those acute pain medicines are inexpensive. You know, must relaxers
and how inflammatories, pain medicines. That's not the sticker shock.
It's a treatment for asthma, the treatment for your heart
(40:04):
failure and your diabetes, and the cholesterol and the loopus
and the rum charge ritis and cancer. I mean, those
drugs are ha but most doctors just again are not
connected with the expense for your particular plan, so most
of them are not going to know what else you got.
(40:25):
Would give me the second choice, the third choice, the
four show. Yeah, I have other medicines, but I don't
know how much it's going to cost you. You're going
to have to help us out with that. Sometimes the
pharmacists can help you out. A lot of times you
have to make that phone call yourself and help us
help you figure that out. Just its most healthcare providers
off of staff does not have the time to do
(40:48):
that on every single patient. So a lot of times
we kick that back to the patient to help us
out and figure that cost issue out with that particular medication.
Speaker 2 (40:59):
Yes, and again, Gaba Penson, very very good man.
Speaker 1 (41:03):
I'm glad that patient call because we prescribe that medicine
a lot and a lot of people aren't it ironin,
Gaba Penson. It's a safe drug in my opinion, But
don't let it fool you because of medicine is not
over the it's not prescribed and it's over the counter.
Don't let that fool you. It can still harm you.
I mean, these medicines can do harm all. I see
(41:23):
it every day. Just let's just take motrin for instance.
I mean, people get aches and pains, they have headaches,
back pain, stomach pain, and they start taking that medication
and they're taking it every day. And I know in
the package a lot of times it says, hey, if
your pain persists, go see your doctor, because yeah, they
(41:44):
want you to get checked out, like what's causing the pain.
A lot of times it can be something truly serious
and impactful to your life. When you start getting this
pain and you start taking motrin and that's okay work,
I mean, just push through it. Before you know it,
a couple of months goes by, you still have the pain,
(42:05):
you still taking the motrin, and then your legs starts swelling,
your blood pressure goes up, you get shorter breath, and
then you get some lab you got you got kidney failure.
Just like that, it's over the counter. I take it.
I have pain, you got kidney failure. And then oh,
by the way, yeah they found something else too that's
actually causing the pain. So yeah, go get checked out.
(42:27):
If you're having some new pain, you don't know what
it is. It doesn't go away. I get it. It's
cumbersome to go find a doctor. You gotta get numbers
and take off from work and sit for three four hours.
But yeah, if the pain does not subside, or you
have some new physical symptom and that's not getting better, yeah,
go get some lab, get some some X rays. Let
(42:49):
a healthcare provider take a look at you see if
we can kind of figure out what it is, so
you can get on the right medicines.
Speaker 2 (42:55):
Maybe get to the right.
Speaker 1 (42:56):
Doctor and get your diagnosis and get better rather than
letting it just get worse and worse and worse.
Speaker 2 (43:05):
Yeah.
Speaker 1 (43:06):
Anyway, phone lines are closing, y'all have a good week.
We're gonna be off next week and then I'll be
back the following week.
Speaker 2 (43:15):
Take care, don't drink and drive. God bless you.
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