December 30, 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 Internet ready to listeners. Welcome
to the edition of the Doctor Lavine Medical Hour. Phone
lines are open. It's a wonderful Saturday morning. Christmas is
around the corner. I hope everyone is ready to go.
Still a few days left of the shopping for Christmas.
(00:22):
Remember that's not what it's all about, right, It's all
about just having a good time and spending time with
family and just trying to be positive, you know, turn
that situations into better situations, and not all about just
the gift givings. So be careful out there. It can
(00:44):
be so stressful talking with my patients, but it's always
a holiday season, infestive time, and everyone loves his time,
so I have fun. But yes, sits around the corner.
And yeah, we have some good weather this morning. It's
cool but sunny, but crisp, clean, clear, so it's great
(01:05):
weather outside and hopefully you're having a wonderful Saturday morning.
So far I am, and we want to thank you
for joining us for another edition of this show. Remember
we're here live every Saturday between eight and nine sort
of answering questions about health care and medicine as you
all know, just like everything else. It can be complicated
(01:27):
and confusing a lot of times with our healthcare, we
what's good, what's bad? What should I do? Things sort
of contradict themselves. When you hear things, you have physical complaints,
you want them better? How do you fix it? So
that's the genesis of the show. And we hear for
you a nine to klv i eight hundred three three
(01:52):
zero kovi. And as you know, this is normally vaccine time,
and we still are pushing vaccines if you haven't gotten yours.
We talked about maybe having a pill form of a vaccine.
That would be awesome if it came in a tablet
(02:13):
or a capsule, so super convenient, that would be just amazing.
I'm sure they've tried to do that, but just technology
maybe in the future had been able to accomplish that,
but that would be a cool idea and making it
just more and more super convenient to everybody. But hopefully
(02:34):
you've been having a good time this December. We're looking
forward to the new year. Got another week or so
of this year, so we always sort of recap the
year and see if what we're looking forward to to
the new year and kind of go back and look
and see if there's anything we need to talk about,
(02:54):
sort of clean up and finish up the year, and
might do that next week, but phone lines are open
eight nine to six, kov I give us a call.
One thing that we talk about all the time in
my position as a primary care physician, or one common
(03:17):
complaint that we see all the time, is what we
call a dema are swelling when those feet, are those ankles,
or those legs get swollen. You can sort of see
it in the mirror. Sometimes you can feel it in
your ankles are your feet, And I thought I would
spend some time today talking about that while we wait
(03:41):
on phone callers, because it's a very common complaint and
there's several different common reasons for that when we see that,
but that's what a doctor sort of calls it. When
your ankles are puffy, are there swelling. Sometimes it's one ankle,
sometimes it's two ankles. Sometimes it's the top of your foot,
(04:04):
Sometimes it's the leg, you know, in terms of wood side,
Sometimes it's both. And that's sort of what the doctor
does all day is to try and figure out why
that's happening. But it's very very common, and I thought
I would just sort of hit some high points and
(04:26):
why that's so common in my experience, when someone gets
that swelling again, we call that edema. More specifically, we
call that peripheral edema because it is sort of and
the periphery sort of like your hand is away from
(04:46):
the central part of your body. We call that proximal
and the hand is what we will call distal from
the central part of the body. So a lot of
times when you get ankle and foot dima and leg edema,
we call that peripheral, meaning it's sort of away from
the central part of your body. And like I said, again,
(05:10):
sometimes you just wake up and you see it there.
Sometimes you can feel it that your foot is larger
than the other one. Maybe you can't put that shoe
on that you love, You can't fit inside that shoe
that you used to wear all the time, And that's
sort of how you'd notice it. But some common causes
(05:32):
of that. Number one is a condition we call DVT
our deep vein thrombosis, super super common in our country
and for a lot of reasons. Why that is the
main reason is because we've gotten better at treating our
(05:56):
cancers and our cardiovascar disease. We are getting and unfortunately,
as we get older, some of us has become a
bit more sedentary. Michael from Pasadena, How can we help you?
Speaker 2 (06:09):
Oh, good mornings. Doctor. I wanted to let you know.
First of all, this year has been a very busy
year for me medically, and uh, I've talked to you
quite a bit, and I want to thank you for that.
I did get my hu implannable loop recorder put in
(06:30):
and I'm doing fine. And my question today is my
final project is my back. I've talked to you about
it before. Uh, I'm stooped over quite a bit.
Speaker 1 (06:48):
Hello, Michael, we'll have Michael. Hey, Michael, give us a
call back so we can finish that question. You're talking
about your back and you're being stooped over, and you
know we were talking about perphiladema very briefly, certainly back
(07:08):
issues a lord lumbar spine. Hey Mike, what's up?
Speaker 2 (07:12):
Oh? Okay, did you hear anything I said?
Speaker 1 (07:15):
You said that you were stooped over in your back.
We heard that and then you fell off.
Speaker 2 (07:22):
Okay, what happened with my back is that I I'm
not in Uh, I'm not in any real pain. I
can straighten my back. Out, say, at the gym, I
can hang from a from a ride and straighten out,
but as soon as I get off of that from
(07:46):
stretching out, the most comfortable position is stooped over a
little bit. And I can lay from out in the
bed for a while, and but when I get up up, Uh,
I ended up going back to that stooped over position.
The center of my back is kind of the backbone
(08:07):
is kind of poosed out. And I I did call
a doctor about this, and someone said I should go
to a surgeon and they recommend a back brace.
Speaker 3 (08:20):
Or but.
Speaker 2 (08:24):
Uh, you have I talked to you about it before
and you mentioned doing something else when I don't remember
what it was. But uh, I don't know. My mom
had problems with her back, and I'm I'm a she
had back surgery and she was never right after that
back surgery. Uh. That was years ago, though, and so
(08:45):
maybe things have changed. I don't know. The back surgery
is the best thing, but I don't know what to do.
What what what I've been told is I have degenerative
back disease or disc disease and lower back the vertebrate
(09:06):
are real close together. I was six one and three
quarters on five ten and a half. Now it's when
I'm straightened out. It's because of the collapsing of those
of the discs between the vertebrate.
Speaker 1 (09:26):
Yeah, Michael, I would say that in my experience in
when I have conversations with my patients about this particular problem. Certainly,
I think even most surgeons back surgeons, which are normally neurosurgeons,
but there are some orthopedic surgeons that operate on the back.
(09:50):
Is Yeah, you sort of wait as long as you
can with these back surgeries because I think a lot
of people don't give the back it's due credit in
terms of it being a complex structure. We all know
about the brain and the heart, but we think of
the back sort of as this simple sort of anatomical location.
(10:13):
It's just a back. It's just bones and muscle and
tendons and connective tissue, and that it's not as a
complicated surgery or a complicated situation as maybe brain surgery
or open heart surgery or cancer surgery. We just I
don't think we give it its respect that it deserves.
(10:33):
And I'm here to tell you that the back is
a very complicated anatomical site, and the surgeons have come
a very long way in terms of improving the outcomes
as it pertains to back surgery, because in my experience,
(10:54):
anytime you start cutting into the back, it can certainly
generate some long term issues after the surgery. Even though
the surgery was deemed successful and the surgeon did a
great job, sometimes you can still be left with pain
and discomfort and limited mobility when you start cutting on
(11:18):
the back. It's one of those anatomical sites that just
doesn't want to be messed with, and when you mess
with it, you better be sure you're doing as little
as possible to not irritate it or make it angry,
otherwise it can sort of lock up on you and
really sidle on you because you know your back is hurting.
(11:38):
Just like you said, you can't hardly walk straight, and
it's sort of at the central part of your core core.
And so yeah, we normally don't want to go in
if we don't have to. So you wait, wait, wait,
until it just gets so bad that a surgery is
really necessary and will be very helpful. There are some
(12:01):
clinical indications for emergency back surgery, and most of the
time that involves severe neurological deficits or dysfunction, meaning maybe
you can't feel your legs, maybe you can't walk, You
have sort of lost the control of your bowels and
your bladder, you know, And that's sudden and onset or
(12:24):
even if it gradually happens. That's always a fear with
back problems, which again our collar Michael, are you still there?
Speaker 2 (12:33):
Yeah, I'm here.
Speaker 1 (12:34):
Okay. You have this degenitive joint disease which causes what
we call spinal stenosis. It starts to pinch the nerves
and when the nerves get pinched, they get injured, and
sometimes that injury can cause permanent damage. So again paralysis,
chronic pain, things of that nature. So yeah, my suggestion
(12:58):
to you is your weight long as possible, and continue
to work with your back doctor and utilize other modalities
for your back, such as physical therapy. Are these injections,
the back races are fine? I think they got They
were popular for a couple of years and they sort
(13:18):
of fill out of favor. Various different medications to help
you deal with the discomfort, and yeah, continue to try
and work through these symptoms and worst case scenario, yes
you have to go in and get cut on as
they say, to help with the symptoms. So, but I
think most surgeons and most patients you have to kind
(13:42):
of wait until they really have to go in. So
that would be my recommendation.
Speaker 2 (13:46):
Buddy, I'm not Lenny. Real pain. I walk two or
three quarter miles and I work out the gym for
a couple hours and a real pain. It's just yesterday
someone came up to me. All even they have to say.
Speaker 3 (14:06):
What's wrong?
Speaker 2 (14:07):
You're back? You know? What can I say? I just
it's hurtful and I want to I just would like
to walk straight again, you know, straight up and down.
Speaker 1 (14:18):
Well, I think yeah, I think that that's a question.
You would have to ask the surgeon or the doctor
performing the procedure, what is the expected outcome of the procedure,
such as, if we do this, what am I to
expect long term? Am I'm going to be able to
walk straight again? Am I going to have any pain?
(14:41):
Et cetera, et cetera. Try to get an understanding of
what the expectation is if you do perform a procedure.
Sometimes the doctor can perform the procedure and the outcome
is not what you would like, and they can't really
guarantee anything. So sometimes again and it's better not to
go in there. I know that again, when you do
(15:06):
go into the back and start putting in screws and
plates and you start cutting in there, just man, it
can open up a Pandora's box of problems that you
can never get rid of, which is why most people,
most surgeons recommend waiting or not even doing the surgery.
I know the local surgeons are very conservative about doing operations,
(15:28):
and as you get up in age, they tend to
shy away from doing any sort of back surgery. And
it has a lot to do with just a post
operative course that in their experience, aging or an older
age person just doesn't do as well after surgery as
someone who's younger, so they tend to be more conservative
(15:50):
with an older person. There's things like osteoporosis and other
medical issues that might impact wound healing. Maybe you have diabetes,
maybe you have heart problems. Whatever the case may be,
things have to be really in your favor before surgeons
feel real comfortable going into surgeon operating. They want to
(16:11):
make sure the outcome is what you would expect, just
because a lot of times, you know, if they start
doing this, then you're kind of stuck with it, and
there just needs to be a great understanding between the
doctor and the patient about the expectations. So I know
you would like to walk straight, and yeah, you might
have to go to a few different doctors to get
(16:32):
a few different opinions. Which is the best thing if
you have time, is to go talk to a couple
of different practitioners surgeons and see what, if anything, they
can do for you. So any other questions.
Speaker 2 (16:47):
Michael, oh no, I just I do want to thank
you for all your help this year. I feel like
you're my doctor and you're you're you're the best. All
right with America.
Speaker 1 (17:00):
Christmas to you as well, Michael, and I hope you
have a wonderful, happy and say holiday. All right, buddy,
Well appreciate that. Phone lines are open eight nine six
kalv I win one hundred three three zero klv. I'll
be back in two minutes. All right, welcome back to
(17:29):
the doc, Lulene Mock. Our phone lines are open eight
nine to six kV I win one hundred three three
zero kov I. Speaking of common complaints, back pain, that
is a very very common complaint. I was talking about
peripheral edema. Are those fat ankles that you might get
(17:50):
and the fat feet that you might get as you
get older, and the common cause of that. But back pain,
that's a very common complaint as well, and we see
a lot more of that in the winter months. We
see a lot of muscular sclet complaints in the winter months,
and certainly has to do with the cold temperature out there,
(18:13):
and those joints start getting a little tight and a
little achy and painful when it gets cold outside. And
back painess is very very common, super duper common, and
a lot of times again, it just has to do
with that what we call degenerative joint disease process, sort
(18:34):
of the aging process of the muscular scale system, the joints,
the joint system. We don't think of the joint system
as a system like the cardiovascular system, right or the
immune system. We're familiar with that, but the joint system,
it's alive and well, you know, we think of our
(18:55):
bones it's just sort of these very hard structures and
just sitting there, but they are alive as well. They
interact with the human body and everything is sort of
interacting with each other, and unfortunately, as we get older,
you get a lot of those anatomical shifts in the
anatomy of the lower back, the spine, the disks, the
(19:19):
spacing between all these pain sensitive structures. It's really tight
in the backside, kind of like a finger. If you
saw the cross section of a finger, you know there's
a lot of different structures in just the digit, the
finger itself. If you have a cross sections, you know,
muscle and bone and nerves and blood vessels and tendons
(19:44):
just in this one little, very compact structure. And you
get that same sort of compact anatomical orientation there in
the lower back again, which is why when you start
going in there with scalpels and the instruments that they
used to get into the back, you're sort of injuring
in a controlled fashion all of those pain sensitive structures,
(20:07):
which is why sometimes after surgery it can be a
little rough and the outcome is not what you want
it to be, just like with anything I think we
talked about before, informed consent meaning you've had a conversation
with the practitioner that performed their procedure and there's an
(20:28):
understanding of the expected outcome of the procedure, and as
a part of that, the expected outcome the understanding is
that it may not happen that way. That's the understanding
when you sign your name on the dotted line, that
you've had this conversation with this doctor, you talked about it,
(20:51):
you had time to answer, get your questions answered. Which
is why, especially for surgical procedures, even for medical decision making,
whenever you take the prescription, you know me, I basically
write prescriptions all day or send eat scripts all day.
(21:12):
That's sort of how I work. I'm not a surgeon.
I'm not cutting and stitching and removing things mechanically or surgically.
And there seems to be more of a time out period,
if you will, when a procedure is performed. When something's
being removed or cut, or you're being investigated physically with
(21:33):
some sort of procedure or surgery, there seems to be
more time with the as a pause and let's make
sure we understand what we're doing, and you're going to
sort of sign off by signing this piece of paper
that you completely understand why you're doing it, what the
expected outcome is, and the potential for adverse reaction. We
(21:55):
don't do it so much with medications. We sort of
go into our doctor's office, or we go to the
minorcare the er, we get a prescription, and I think
we more freely are easily take that tablet or that
capsule or that liquid, We drink it without much pause.
(22:17):
Having said that, compared to when I first became a physician,
to now, there is certainly more information that patients are
getting to inform them of the potential adverse reaction and
potential interaction with different medications. And yes, some patients, even
(22:40):
though they go through that, go through the trouble of
going somewhere to get evaluated, waiting for the whole evaluation
take place, which if you've been to the er of minorcares,
you know that that whole process can take five hours,
six hours, a whole day of going in, getting testing,
(23:01):
multiple testing, and then finally being given an answer whether
or it's right or wrong, or accurate or inaccurate. But
you're given a diagnosis, you get your prescription. I do
find more patients that are saying, you know what, I
don't really want to take this medica. I want to
talk to my primary care physician first, and I'm going
to take everything to them and we're going to look
(23:24):
over and talk about it. I'm a little bit skeptical
about these medications that have been given to me. So
I do see a bigger increase in that sort of
situation where maybe they feel like they don't know the
healthcare professionals as well, they don't have this relationship that
(23:46):
has been going on for a long time, which is
why most people have a primary care physician, to have
that one healthcare professional that knows them better everything that's
been going on with them in the past year or
two or ten years and just sort of has that
comfort about answering some difficult questions that can come up
(24:06):
throughout the year. Where again, these medicines can cause harm
when we take them, we have to be careful about
that at that time. So again, the back is very complicated,
and we would encourage you to maybe get a second opinion,
third opinion when it comes to an operation on that back.
(24:29):
But that spinal stenosis degenitive joint disease super duper common,
and I think the idea that I like to endorse
is that for most people they will never have surgery.
And I know it hurts in the back and maybe
have that sensation of things traveling down your leg to
(24:50):
your foot, those are the symptoms of spinal synosis. A
lot of time when the nerve is being irritated, you
just want to quote cut it out or cut into
to it and just fix it. That's what a lot
of people will say is I don't want to put
a band date on it. I want to actually go
in there and fix it. And that's the issue. Just
(25:12):
back surgery is complicated sometimes and just a back does
not want to be bothered with. And yes, when you
have sponsorinosis and nerves being pinched, the ideas to go
in there mechanically fix it and it's you fix it
and it goes wey. You don't take any medicines, all
these things almost like you have a tumor, cut it out,
(25:33):
just get rid of it. It's just that back surgery
is just not a simple straightforward thing. So that's a
lot of times not going to be an option up
front and it's going to be managed without surgery. And
that's when sort of you go through all these different practitioners,
you know, pain management, maybe physical therapy, chiropractor, neurologist, and
(25:58):
we have all these different groups of medicines that we'd
like to use when its pertains to the back, antime flammatories,
must relaxers, medicines that we use for nerve pain, steroids,
antime flammatories, just all these different modalities of treatments for
the back. Just because of the issues that I mentioned
(26:21):
to you, you know, not to forget about. Like I said,
physical therapy, which again is a great modality to help
with controlling the back pain. And the other thing about
back pain is that in my experience, the more unhealthy
you are, you tend to have more back pain issues,
(26:43):
meaning if you're overweight, if you smoke, smoking is big.
It's what I've seen in general is that smokers didn't
have hard to control back pain, meaning that if they
develop back pain for the reason the smoking almost sort
of interferes with our ability to manage the pain with
(27:07):
simple STRAIGHTFORW medications, they normally need more medications. They normally
the smoking perpetuates the pain, meaning it lasts longer, it
generates more disability. That's just what I've seen over the
years when I deal it to smoker versus a non
smoke or smoker, as it pertains to low back pain
(27:31):
or chronic low back pain. So if you're overweight, you're smoking,
you're inactive you know your diet is not what it
needs to be. I've seen that with my own eyes.
Just the differences with patients who are successful managing their
back pain in those who are not. Is you kind
(27:51):
of have to be healthy. I mean, you really have
to focus on what you're eating and drinking and certainly
keeping that weight down. I've said this a number of times.
We're heading into the new year, we're always prioritizing our
weight and we want to get it down. Low back
pain we also call that door salgia or lumbar ridiculopity.
(28:16):
These are some terms we start throwing around when as
it pertains to the lower back when you're heavy. You know,
in that body mass index at ratio between your weight
and your heights, when that body mass index is thirty
or above, you tend to have more issues with your
back because again you're carrying more weight. And when you're
(28:38):
heavy and you're carrying more weight, that's a whole different
metabolic presence in your body, and it will start to
cause some degenitive changes of the muscular skeletal system, whether
it be your neck, are your knees, or your feet.
It's a real thing. Audrey from Viider can we you.
Speaker 3 (29:01):
Yes. I had surgery about a few weeks ago, and
during recovery I had a problem. So I called the
surgeon's office and I thought maybe I could speak to
the nurse, and instead she referred me to my primary physician.
(29:25):
I thought, well, that's odd because my primary physician didn't
do the surgery, So what is that something that they.
Speaker 1 (29:36):
Do now, Audrey, Not really, I mean I have I
have heard that before. Really, yes, ma'am, even with my
own patience. And that's why you need to sort of
take a pause before you have any elective procedure. We
(29:58):
have to think about what's going to come after their procedure,
because a lot of times that's that's the issue. It's
not actually the surgeon itself, but it's afterwards, what are
my expectations and yeah, are you going to help me
or or is you're going to let my primary care
physician manage this particular problem. And I do see that
(30:19):
with some surgeons that after a certain period of time,
and I would probably say after a month or so,
if you're still having issues, yes, the surgeons a lot
of times will sort of get you back to your
primary to help manage the particular physical complaints that you're having.
(30:40):
You know, because surgeons operate and that's really where they
spend a lot of their time. They're they're operators, they're
they're performing procedures, and that's where they like to spend
their time. And yeah, I think professionally, there's there's a
period of time after their procedure where yes, they do
feel responsible for you, and they will they will do
(31:02):
their best to help you take care of the particular situation.
Speaker 2 (31:06):
That you have.
Speaker 1 (31:08):
But then beyond that point, and every surgeon is different
in terms of their time period that they're going to
help this particular patient. And so that's something you can
talk about prior to performing their procedure, is what what
about after the procedure? Are you going to help me?
(31:29):
I mean, how long are you going to help me
try and get through problems that may come up? I
mean those are good questions to ask prior to the surgery.
Speaker 3 (31:37):
Yeah, but they's something you don't think about, you know, have.
Speaker 1 (31:41):
A time correct, I agree, And so again, normally about
a month or two, this is my experience working with surgeons.
About a month or two after that, if you're still
kind of having issues, yes, they will try and get
you to different practitioners, and I think I think, for one,
(32:03):
it's not something that they do all day. They're not
an expert a lot of times with these chronic issues,
and they would like to get you to other practitioners
or doctors that are more skilled at helping you manage
maybe pain or discomfort or whatever you're going through. I
do see that. I think it's a lot of it
(32:25):
has to do with the fact that, hey, I'm not that
experience with this. I'd like to get you to a
different practitioner to help us out, maybe get a fresh approach.
Maybe I don't have quite the time that it's going
to take to manage this, and I want you to
get to a different doctor that does this all day,
that focuses on pain and how to deal with it.
(32:48):
So a lot of times just I will see that
the surgeon who performed the operation will send you to
a pain management doctor.
Speaker 2 (32:56):
Yeah.
Speaker 3 (32:57):
Well it wasn't anything curious or anything, but it was
just something that I was concerned about.
Speaker 1 (33:03):
Yeah, oh absolutely. And you know the primary care doctor,
which is what I am, the healthcare professional, kind of
like your central medical hub if you will. Yes, we're
there sort of as a last resort. If something's not
working out, you can always get back to your primary
and your hub to see what's the next step in
(33:25):
trying to resolve this problem of this issue. And again,
every surgeon's different, every situation is different. But I've heard
that from surgeons before, and I don't think it's necessarily
a bad thing. It just depends on the situation. Sometimes
your primary care physician can reach out to the surgeon
(33:46):
and have a more professional conversation about what's happening with you,
and talking between the doctors a lot of times get
a better idea of how to manage. So it's not
unusual for that to happen when you call the surgeon
and say, hey, get back with your primary. I hear
(34:07):
that all the time. My patient's still me all the time,
and I'm fine with it, to be honest with you,
because that's my part in this whole system, is to
be there to sort of clean up things that maybe
didn't go well. And that's just sort of my position,
and I understand that, and I'm fine with it, and
I'll do what I can to help you. Again, sometimes
(34:29):
I call the surgeon and get just sort of a
better story about what happened and what's going on. So yeah,
we're there to help you. So that's that's not unusual,
be honest with you.
Speaker 3 (34:39):
Oh okay, well I was just I was just curious about,
you know, this procedure. So thank you doctor.
Speaker 1 (34:47):
All Right, Audrey, you have a happy holiday and America Christmas.
All right. Phone lines open eight nine to six kov
I one one hundred and three to three zero Okyova.
I'll be back in two minutes. All right, welcome back
(35:17):
to Docta ME Medical. Our phone lines are open A
nine to six kvy I one hundred and three three
zero kiov I informed. Yes, because once you do that operation,
or like I said, even when you take that medication,
we're just can't guarantee the outcome or what's going to happen.
We just can't dry it up like that all the time.
(35:37):
For the for the most part, yeah, everything works out
the way it's opposed to. And that's why a lot
of times, especially with operations and procedures, sometimes the doctor
doing it says, no, you're not a candidate. We can't
do it. We cannot perform this procedure because I cannot
guarantee the outcome. I'm afraid that if we do this,
(35:58):
things are not going to work. Got same thing with medications.
We have this conversation a lot with patients doctor, do
you think this is a good medication? Should I take
this medication? And we say no because we don't want
to test the waters. We don't want to start the
pot as it pertains to what might happen and could
be injurious to you and something that you might have
(36:22):
to go through that may change your life forever. Even
again a simple piece of paper and a prescription. Just
like a procedure, things don't go as planned. It could
you know, change the trajectory of things that you're going through.
So yeah, always take a pause and try to have
that conversation and answer or ask those questions. It can
(36:44):
be complicated, and I'm sure you can go to some
website and it sort of tells you what is some
questions some general questions to ask if you're having a procedure,
you know, you know, top five questions that you want
to answer it before you go through procedure. And I
know a lot of times sometimes the procedure procedure needs
to happen urgently and maybe in pain or you're suffering
(37:07):
just want it out, and you trust that doctor. That
doctor is going to perform the procedure. And again we're
trained to perform things and recommend things that are going
to help. But again, at the end of the day,
no physician or healthcare professional can guarantee what's going to happen.
(37:27):
Can't do that, and I know it can be super
frustrating when things cannot be predicted, but unfortunately that is
the way that is. And surgeons, doctors, healthcare professionals, we
deal with that every day, trying to again guarantee outcomes.
(37:49):
I work a lot in the hospital at Baptist every
day and I see some of you there in the hospital,
and we talk about the radio program of the common
refrains that I hear all the time as a doctor
in the hospital when patients are going home is I
don't want to have to come back, you know, if
you discharge me, I don't want to have to come back.
(38:11):
I don't I want to stay at home. And I
chuckle at that, because again there's this perception that you know,
we can sort of dial this thing up exactly and
we can predict what's going to happen, almost like a weatherman.
We have this radar, and we can kind of see
based on their formulas and the patterns that this is
(38:34):
what's going to happen. And again, for the most part,
most of the time that it does work out that way.
We might have some idea, but certainly things happen that
are unexpected and unpredicted in the hospital all the time.
I'm always amazed working in the hospital and working with
patients and families where you start out one day with
(38:57):
this and then tomorrow it's a different day and something
different is happening, and that's unfortunately the way it is.
Just can't draw that up, especially in medicine, the way
we wanted to. We do our best as a surgeon
and as a healthcare professional to make sure that if
we do discharge, if we do have a surgery, they
(39:19):
would recommend that it's in our opinion, the risk is
very low and the benefit is very high. Sort of
that risk benefit ratio that we talk about all the time,
and that's really at the center of just about every
decision a doctor and a healthcare professional makes, whether like
I said, it's a simple antibiotic, or if it's even
(39:41):
a bypass surgery, open heart surgery, or even a back surgery,
there has to been understanding that, again, the outcome cannot
be sort of dialed up as we would like to,
and you have to assume that sometimes it doesn't go
as planned and you have to be ready for that
planned for it. And that's something you can talk about
(40:03):
with your healthcare professional before you sort of consent to
this procedure or this medication, even though, like I said,
it's an antibiotic or it's a blood pressure medication. A
lot of patients are admitted to the hospital for just
adverse reaction to meds. You know, they're on several meds.
(40:25):
Maybe they went to their health care provider three days ago,
they started taking this medicine and then all of a sudden, booms,
something happens and the pharmaceutic, the pharmacist not farm. Yeah,
the pharmacists have gotten better at the time of handing
out their prescription, sort of helping us go over these
(40:47):
meds and the potential for adverse reaction. You sometimes have
a face to face conversation with the pharmacists. Sometimes you
just sort of get this slew of paperwork with all
the potential outcomes in and my experience, most patients find
this to be overwhelming. It's a lot of fine small print.
They're not really going to go over all these side
(41:10):
effect issues. They went to the healthcare professionals supposed to
know what happens and all the outcomes and sort of
be informed about that as a prescription is being handed,
so that they have a general orientation about what could happen.
But again, these different practitioners involved with getting you your
(41:32):
medication have gotten more involved. And it's for a good
reason again to make sure that you understand what's going
on before you commit to taking this medication, because again,
it might bump you a little bit, might cause a
little hiccup in your day, or your week or your
month when you're just taking this medication. And as we
(41:54):
get older, yeah, more people are taking more medications to
help them feel better, help them feel natural, help them
feel right. And we, as a medical doctor again I'm
not a surgeon, we spend a lot of time with that,
just managing adverse reaction with medications when things don't work
out the way they're supposed to be. And yeah, I
(42:16):
would have to say, over the years, I tried to
prescribe the least amount of medications possible because I have
that general understanding that as I start stacking those meds
on top of each other, that adverse things might start happening.
And I again, even when I have a new patient
or someone comes in multiple complaints, a lot of times
(42:37):
I will tell them let's just start with his first
and we'll come back and answer or get to these
other problems, because again, we don't want to overwhelm your
system with all these new prescription chemicals. If you will,
because we want to stay oriented, we want you to
feel neutral, and we're just trying to help with all
(42:59):
those things. So we're coming to the end of the show.
I want to wish everyone marry Merry Christmas, and hopefully
you have a happy and safe holiday. Remember it's just
all good. We don't want any bad outcomes, so don't
drink and drive and just have a good time and
(43:20):
no problems. And I hope you have a good holiday weekend.
Thank you for joining me. We'll see you next week.
All right, South East Texas Internet ready to listeners. Welcome
to the edition of the Doctor Lavine Medical Hour. Phone
lines are open. It's a wonderful Saturday morning. Christmas is
around the corner. I hope everyone is ready to go.
Still a few days left of the shopping for Christmas.
(00:22):
Remember that's not what it's all about, right, It's all
about just having a good time and spending time with
family and just trying to be positive, you know, turn
that situations into better situations, and not all about just
the gift givings. So be careful out there. It can
(00:44):
be so stressful talking with my patients, but it's always
a holiday season, infestive time, and everyone loves his time,
so I have fun. But yes, sits around the corner.
And yeah, we have some good weather this morning. It's
cool but sunny, but crisp, clean, clear, so it's great
(01:05):
weather outside and hopefully you're having a wonderful Saturday morning.
So far I am, and we want to thank you
for joining us for another edition of this show. Remember
we're here live every Saturday between eight and nine sort
of answering questions about health care and medicine as you
all know, just like everything else. It can be complicated
(01:27):
and confusing a lot of times with our healthcare, we
what's good, what's bad? What should I do? Things sort
of contradict themselves. When you hear things, you have physical complaints,
you want them better? How do you fix it? So
that's the genesis of the show. And we hear for
you a nine to klv i eight hundred three three
(01:52):
zero kovi. And as you know, this is normally vaccine time,
and we still are pushing vaccines if you haven't gotten yours.
We talked about maybe having a pill form of a vaccine.
That would be awesome if it came in a tablet
(02:13):
or a capsule, so super convenient, that would be just amazing.
I'm sure they've tried to do that, but just technology
maybe in the future had been able to accomplish that,
but that would be a cool idea and making it
just more and more super convenient to everybody. But hopefully
(02:34):
you've been having a good time this December. We're looking
forward to the new year. Got another week or so
of this year, so we always sort of recap the
year and see if what we're looking forward to to
the new year and kind of go back and look
and see if there's anything we need to talk about,
(02:54):
sort of clean up and finish up the year, and
might do that next week, but phone lines are open
eight nine to six, kov I give us a call.
One thing that we talk about all the time in
my position as a primary care physician, or one common
(03:17):
complaint that we see all the time, is what we
call a dema are swelling when those feet, are those ankles,
or those legs get swollen. You can sort of see
it in the mirror. Sometimes you can feel it in
your ankles are your feet, And I thought I would
spend some time today talking about that while we wait
(03:41):
on phone callers, because it's a very common complaint and
there's several different common reasons for that when we see that,
but that's what a doctor sort of calls it. When
your ankles are puffy, are there swelling. Sometimes it's one ankle,
sometimes it's two ankles. Sometimes it's the top of your foot,
(04:04):
Sometimes it's the leg, you know, in terms of wood side,
Sometimes it's both. And that's sort of what the doctor
does all day is to try and figure out why
that's happening. But it's very very common, and I thought
I would just sort of hit some high points and
(04:26):
why that's so common in my experience, when someone gets
that swelling again, we call that edema. More specifically, we
call that peripheral edema because it is sort of and
the periphery sort of like your hand is away from
(04:46):
the central part of your body. We call that proximal
and the hand is what we will call distal from
the central part of the body. So a lot of
times when you get ankle and foot dima and leg edema,
we call that peripheral, meaning it's sort of away from
the central part of your body. And like I said, again,
(05:10):
sometimes you just wake up and you see it there.
Sometimes you can feel it that your foot is larger
than the other one. Maybe you can't put that shoe
on that you love, You can't fit inside that shoe
that you used to wear all the time, And that's
sort of how you'd notice it. But some common causes
(05:32):
of that. Number one is a condition we call DVT
our deep vein thrombosis, super super common in our country
and for a lot of reasons. Why that is the
main reason is because we've gotten better at treating our
(05:56):
cancers and our cardiovascar disease. We are getting and unfortunately,
as we get older, some of us has become a
bit more sedentary. Michael from Pasadena, How can we help you?
Speaker 2 (06:09):
Oh, good mornings. Doctor. I wanted to let you know.
First of all, this year has been a very busy
year for me medically, and uh, I've talked to you
quite a bit, and I want to thank you for that.
I did get my hu implannable loop recorder put in
(06:30):
and I'm doing fine. And my question today is my
final project is my back. I've talked to you about
it before. Uh, I'm stooped over quite a bit.
Speaker 1 (06:48):
Hello, Michael, we'll have Michael. Hey, Michael, give us a
call back so we can finish that question. You're talking
about your back and you're being stooped over, and you
know we were talking about perphiladema very briefly, certainly back
(07:08):
issues a lord lumbar spine. Hey Mike, what's up?
Speaker 2 (07:12):
Oh? Okay, did you hear anything I said?
Speaker 1 (07:15):
You said that you were stooped over in your back.
We heard that and then you fell off.
Speaker 2 (07:22):
Okay, what happened with my back is that I I'm
not in Uh, I'm not in any real pain. I
can straighten my back. Out, say, at the gym, I
can hang from a from a ride and straighten out,
but as soon as I get off of that from
(07:46):
stretching out, the most comfortable position is stooped over a
little bit. And I can lay from out in the
bed for a while, and but when I get up up, Uh,
I ended up going back to that stooped over position.
The center of my back is kind of the backbone
(08:07):
is kind of poosed out. And I I did call
a doctor about this, and someone said I should go
to a surgeon and they recommend a back brace.
Speaker 3 (08:20):
Or but.
Speaker 2 (08:24):
Uh, you have I talked to you about it before
and you mentioned doing something else when I don't remember
what it was. But uh, I don't know. My mom
had problems with her back, and I'm I'm a she
had back surgery and she was never right after that
back surgery. Uh. That was years ago, though, and so
(08:45):
maybe things have changed. I don't know. The back surgery
is the best thing, but I don't know what to do.
What what what I've been told is I have degenerative
back disease or disc disease and lower back the vertebrate
(09:06):
are real close together. I was six one and three
quarters on five ten and a half. Now it's when
I'm straightened out. It's because of the collapsing of those
of the discs between the vertebrate.
Speaker 1 (09:26):
Yeah, Michael, I would say that in my experience in
when I have conversations with my patients about this particular problem. Certainly,
I think even most surgeons back surgeons, which are normally neurosurgeons,
but there are some orthopedic surgeons that operate on the back.
(09:50):
Is Yeah, you sort of wait as long as you
can with these back surgeries because I think a lot
of people don't give the back it's due credit in
terms of it being a complex structure. We all know
about the brain and the heart, but we think of
the back sort of as this simple sort of anatomical location.
(10:13):
It's just a back. It's just bones and muscle and
tendons and connective tissue, and that it's not as a
complicated surgery or a complicated situation as maybe brain surgery
or open heart surgery or cancer surgery. We just I
don't think we give it its respect that it deserves.
(10:33):
And I'm here to tell you that the back is
a very complicated anatomical site, and the surgeons have come
a very long way in terms of improving the outcomes
as it pertains to back surgery, because in my experience,
(10:54):
anytime you start cutting into the back, it can certainly
generate some long term issues after the surgery. Even though
the surgery was deemed successful and the surgeon did a
great job, sometimes you can still be left with pain
and discomfort and limited mobility when you start cutting on
(11:18):
the back. It's one of those anatomical sites that just
doesn't want to be messed with, and when you mess
with it, you better be sure you're doing as little
as possible to not irritate it or make it angry,
otherwise it can sort of lock up on you and
really sidle on you because you know your back is hurting.
(11:38):
Just like you said, you can't hardly walk straight, and
it's sort of at the central part of your core core.
And so yeah, we normally don't want to go in
if we don't have to. So you wait, wait, wait,
until it just gets so bad that a surgery is
really necessary and will be very helpful. There are some
(12:01):
clinical indications for emergency back surgery, and most of the
time that involves severe neurological deficits or dysfunction, meaning maybe
you can't feel your legs, maybe you can't walk, You
have sort of lost the control of your bowels and
your bladder, you know, And that's sudden and onset or
(12:24):
even if it gradually happens. That's always a fear with
back problems, which again our collar Michael, are you still there?
Speaker 2 (12:33):
Yeah, I'm here.
Speaker 1 (12:34):
Okay. You have this degenitive joint disease which causes what
we call spinal stenosis. It starts to pinch the nerves
and when the nerves get pinched, they get injured, and
sometimes that injury can cause permanent damage. So again paralysis,
chronic pain, things of that nature. So yeah, my suggestion
(12:58):
to you is your weight long as possible, and continue
to work with your back doctor and utilize other modalities
for your back, such as physical therapy. Are these injections,
the back races are fine? I think they got They
were popular for a couple of years and they sort
(13:18):
of fill out of favor. Various different medications to help
you deal with the discomfort, and yeah, continue to try
and work through these symptoms and worst case scenario, yes
you have to go in and get cut on as
they say, to help with the symptoms. So, but I
think most surgeons and most patients you have to kind
(13:42):
of wait until they really have to go in. So
that would be my recommendation.
Speaker 2 (13:46):
Buddy, I'm not Lenny. Real pain. I walk two or
three quarter miles and I work out the gym for
a couple hours and a real pain. It's just yesterday
someone came up to me. All even they have to say.
Speaker 3 (14:06):
What's wrong?
Speaker 2 (14:07):
You're back? You know? What can I say? I just
it's hurtful and I want to I just would like
to walk straight again, you know, straight up and down.
Speaker 1 (14:18):
Well, I think yeah, I think that that's a question.
You would have to ask the surgeon or the doctor
performing the procedure, what is the expected outcome of the procedure,
such as, if we do this, what am I to
expect long term? Am I'm going to be able to
walk straight again? Am I going to have any pain?
(14:41):
Et cetera, et cetera. Try to get an understanding of
what the expectation is if you do perform a procedure.
Sometimes the doctor can perform the procedure and the outcome
is not what you would like, and they can't really
guarantee anything. So sometimes again and it's better not to
go in there. I know that again, when you do
(15:06):
go into the back and start putting in screws and
plates and you start cutting in there, just man, it
can open up a Pandora's box of problems that you
can never get rid of, which is why most people,
most surgeons recommend waiting or not even doing the surgery.
I know the local surgeons are very conservative about doing operations,
(15:28):
and as you get up in age, they tend to
shy away from doing any sort of back surgery. And
it has a lot to do with just a post
operative course that in their experience, aging or an older
age person just doesn't do as well after surgery as
someone who's younger, so they tend to be more conservative
(15:50):
with an older person. There's things like osteoporosis and other
medical issues that might impact wound healing. Maybe you have diabetes,
maybe you have heart problems. Whatever the case may be,
things have to be really in your favor before surgeons
feel real comfortable going into surgeon operating. They want to
(16:11):
make sure the outcome is what you would expect, just
because a lot of times, you know, if they start
doing this, then you're kind of stuck with it, and
there just needs to be a great understanding between the
doctor and the patient about the expectations. So I know
you would like to walk straight, and yeah, you might
have to go to a few different doctors to get
(16:32):
a few different opinions. Which is the best thing if
you have time, is to go talk to a couple
of different practitioners surgeons and see what, if anything, they
can do for you. So any other questions.
Speaker 2 (16:47):
Michael, oh no, I just I do want to thank
you for all your help this year. I feel like
you're my doctor and you're you're you're the best. All
right with America.
Speaker 1 (17:00):
Christmas to you as well, Michael, and I hope you
have a wonderful, happy and say holiday. All right, buddy,
Well appreciate that. Phone lines are open eight nine six
kalv I win one hundred three three zero klv. I'll
be back in two minutes. All right, welcome back to
(17:29):
the doc, Lulene Mock. Our phone lines are open eight
nine to six kV I win one hundred three three
zero kov I. Speaking of common complaints, back pain, that
is a very very common complaint. I was talking about
peripheral edema. Are those fat ankles that you might get
(17:50):
and the fat feet that you might get as you
get older, and the common cause of that. But back pain,
that's a very common complaint as well, and we see
a lot more of that in the winter months. We
see a lot of muscular sclet complaints in the winter months,
and certainly has to do with the cold temperature out there,
(18:13):
and those joints start getting a little tight and a
little achy and painful when it gets cold outside. And
back painess is very very common, super duper common, and
a lot of times again, it just has to do
with that what we call degenerative joint disease process, sort
(18:34):
of the aging process of the muscular scale system, the joints,
the joint system. We don't think of the joint system
as a system like the cardiovascular system, right or the
immune system. We're familiar with that, but the joint system,
it's alive and well, you know, we think of our
(18:55):
bones it's just sort of these very hard structures and
just sitting there, but they are alive as well. They
interact with the human body and everything is sort of
interacting with each other, and unfortunately, as we get older,
you get a lot of those anatomical shifts in the
anatomy of the lower back, the spine, the disks, the
(19:19):
spacing between all these pain sensitive structures. It's really tight
in the backside, kind of like a finger. If you
saw the cross section of a finger, you know there's
a lot of different structures in just the digit, the
finger itself. If you have a cross sections, you know,
muscle and bone and nerves and blood vessels and tendons
(19:44):
just in this one little, very compact structure. And you
get that same sort of compact anatomical orientation there in
the lower back again, which is why when you start
going in there with scalpels and the instruments that they
used to get into the back, you're sort of injuring
in a controlled fashion all of those pain sensitive structures,
(20:07):
which is why sometimes after surgery it can be a
little rough and the outcome is not what you want
it to be, just like with anything I think we
talked about before, informed consent meaning you've had a conversation
with the practitioner that performed their procedure and there's an
(20:28):
understanding of the expected outcome of the procedure, and as
a part of that, the expected outcome the understanding is
that it may not happen that way. That's the understanding
when you sign your name on the dotted line, that
you've had this conversation with this doctor, you talked about it,
(20:51):
you had time to answer, get your questions answered. Which
is why, especially for surgical procedures, even for medical decision making,
whenever you take the prescription, you know me, I basically
write prescriptions all day or send eat scripts all day.
(21:12):
That's sort of how I work. I'm not a surgeon.
I'm not cutting and stitching and removing things mechanically or surgically.
And there seems to be more of a time out period,
if you will, when a procedure is performed. When something's
being removed or cut, or you're being investigated physically with
(21:33):
some sort of procedure or surgery, there seems to be
more time with the as a pause and let's make
sure we understand what we're doing, and you're going to
sort of sign off by signing this piece of paper
that you completely understand why you're doing it, what the
expected outcome is, and the potential for adverse reaction. We
(21:55):
don't do it so much with medications. We sort of
go into our doctor's office, or we go to the
minorcare the er, we get a prescription, and I think
we more freely are easily take that tablet or that
capsule or that liquid, We drink it without much pause.
(22:17):
Having said that, compared to when I first became a physician,
to now, there is certainly more information that patients are
getting to inform them of the potential adverse reaction and
potential interaction with different medications. And yes, some patients, even
(22:40):
though they go through that, go through the trouble of
going somewhere to get evaluated, waiting for the whole evaluation
take place, which if you've been to the er of minorcares,
you know that that whole process can take five hours,
six hours, a whole day of going in, getting testing,
(23:01):
multiple testing, and then finally being given an answer whether
or it's right or wrong, or accurate or inaccurate. But
you're given a diagnosis, you get your prescription. I do
find more patients that are saying, you know what, I
don't really want to take this medica. I want to
talk to my primary care physician first, and I'm going
to take everything to them and we're going to look
(23:24):
over and talk about it. I'm a little bit skeptical
about these medications that have been given to me. So
I do see a bigger increase in that sort of
situation where maybe they feel like they don't know the
healthcare professionals as well, they don't have this relationship that
(23:46):
has been going on for a long time, which is
why most people have a primary care physician, to have
that one healthcare professional that knows them better everything that's
been going on with them in the past year or
two or ten years and just sort of has that
comfort about answering some difficult questions that can come up
(24:06):
throughout the year. Where again, these medicines can cause harm
when we take them, we have to be careful about
that at that time. So again, the back is very complicated,
and we would encourage you to maybe get a second opinion,
third opinion when it comes to an operation on that back.
(24:29):
But that spinal stenosis degenitive joint disease super duper common,
and I think the idea that I like to endorse
is that for most people they will never have surgery.
And I know it hurts in the back and maybe
have that sensation of things traveling down your leg to
(24:50):
your foot, those are the symptoms of spinal synosis. A
lot of time when the nerve is being irritated, you
just want to quote cut it out or cut into
to it and just fix it. That's what a lot
of people will say is I don't want to put
a band date on it. I want to actually go
in there and fix it. And that's the issue. Just
(25:12):
back surgery is complicated sometimes and just a back does
not want to be bothered with. And yes, when you
have sponsorinosis and nerves being pinched, the ideas to go
in there mechanically fix it and it's you fix it
and it goes wey. You don't take any medicines, all
these things almost like you have a tumor, cut it out,
(25:33):
just get rid of it. It's just that back surgery
is just not a simple straightforward thing. So that's a
lot of times not going to be an option up
front and it's going to be managed without surgery. And
that's when sort of you go through all these different practitioners,
you know, pain management, maybe physical therapy, chiropractor, neurologist, and
(25:58):
we have all these different groups of medicines that we'd
like to use when its pertains to the back, antime flammatories,
must relaxers, medicines that we use for nerve pain, steroids,
antime flammatories, just all these different modalities of treatments for
the back. Just because of the issues that I mentioned
(26:21):
to you, you know, not to forget about. Like I said,
physical therapy, which again is a great modality to help
with controlling the back pain. And the other thing about
back pain is that in my experience, the more unhealthy
you are, you tend to have more back pain issues,
(26:43):
meaning if you're overweight, if you smoke, smoking is big.
It's what I've seen in general is that smokers didn't
have hard to control back pain, meaning that if they
develop back pain for the reason the smoking almost sort
of interferes with our ability to manage the pain with
(27:07):
simple STRAIGHTFORW medications, they normally need more medications. They normally
the smoking perpetuates the pain, meaning it lasts longer, it
generates more disability. That's just what I've seen over the
years when I deal it to smoker versus a non
smoke or smoker, as it pertains to low back pain
(27:31):
or chronic low back pain. So if you're overweight, you're smoking,
you're inactive you know your diet is not what it
needs to be. I've seen that with my own eyes.
Just the differences with patients who are successful managing their
back pain in those who are not. Is you kind
(27:51):
of have to be healthy. I mean, you really have
to focus on what you're eating and drinking and certainly
keeping that weight down. I've said this a number of times.
We're heading into the new year, we're always prioritizing our
weight and we want to get it down. Low back
pain we also call that door salgia or lumbar ridiculopity.
(28:16):
These are some terms we start throwing around when as
it pertains to the lower back when you're heavy. You know,
in that body mass index at ratio between your weight
and your heights, when that body mass index is thirty
or above, you tend to have more issues with your
back because again you're carrying more weight. And when you're
(28:38):
heavy and you're carrying more weight, that's a whole different
metabolic presence in your body, and it will start to
cause some degenitive changes of the muscular skeletal system, whether
it be your neck, are your knees, or your feet.
It's a real thing. Audrey from Viider can we you.
Speaker 3 (29:01):
Yes. I had surgery about a few weeks ago, and
during recovery I had a problem. So I called the
surgeon's office and I thought maybe I could speak to
the nurse, and instead she referred me to my primary physician.
(29:25):
I thought, well, that's odd because my primary physician didn't
do the surgery, So what is that something that they.
Speaker 1 (29:36):
Do now, Audrey, Not really, I mean I have I
have heard that before. Really, yes, ma'am, even with my
own patience. And that's why you need to sort of
take a pause before you have any elective procedure. We
(29:58):
have to think about what's going to come after their procedure,
because a lot of times that's that's the issue. It's
not actually the surgeon itself, but it's afterwards, what are
my expectations and yeah, are you going to help me
or or is you're going to let my primary care
physician manage this particular problem. And I do see that
(30:19):
with some surgeons that after a certain period of time,
and I would probably say after a month or so,
if you're still having issues, yes, the surgeons a lot
of times will sort of get you back to your
primary to help manage the particular physical complaints that you're having.
(30:40):
You know, because surgeons operate and that's really where they
spend a lot of their time. They're they're operators, they're
they're performing procedures, and that's where they like to spend
their time. And yeah, I think professionally, there's there's a
period of time after their procedure where yes, they do
feel responsible for you, and they will they will do
(31:02):
their best to help you take care of the particular situation.
Speaker 2 (31:06):
That you have.
Speaker 1 (31:08):
But then beyond that point, and every surgeon is different
in terms of their time period that they're going to
help this particular patient. And so that's something you can
talk about prior to performing their procedure, is what what
about after the procedure? Are you going to help me?
(31:29):
I mean, how long are you going to help me
try and get through problems that may come up? I
mean those are good questions to ask prior to the surgery.
Speaker 3 (31:37):
Yeah, but they's something you don't think about, you know, have.
Speaker 1 (31:41):
A time correct, I agree, And so again, normally about
a month or two, this is my experience working with surgeons.
About a month or two after that, if you're still
kind of having issues, yes, they will try and get
you to different practitioners, and I think I think, for one,
(32:03):
it's not something that they do all day. They're not
an expert a lot of times with these chronic issues,
and they would like to get you to other practitioners
or doctors that are more skilled at helping you manage
maybe pain or discomfort or whatever you're going through. I
do see that. I think it's a lot of it
(32:25):
has to do with the fact that, hey, I'm not that
experience with this. I'd like to get you to a
different practitioner to help us out, maybe get a fresh approach.
Maybe I don't have quite the time that it's going
to take to manage this, and I want you to
get to a different doctor that does this all day,
that focuses on pain and how to deal with it.
(32:48):
So a lot of times just I will see that
the surgeon who performed the operation will send you to
a pain management doctor.
Speaker 2 (32:56):
Yeah.
Speaker 3 (32:57):
Well it wasn't anything curious or anything, but it was
just something that I was concerned about.
Speaker 1 (33:03):
Yeah, oh absolutely. And you know the primary care doctor,
which is what I am, the healthcare professional, kind of
like your central medical hub if you will. Yes, we're
there sort of as a last resort. If something's not
working out, you can always get back to your primary
and your hub to see what's the next step in
(33:25):
trying to resolve this problem of this issue. And again,
every surgeon's different, every situation is different. But I've heard
that from surgeons before, and I don't think it's necessarily
a bad thing. It just depends on the situation. Sometimes
your primary care physician can reach out to the surgeon
(33:46):
and have a more professional conversation about what's happening with you,
and talking between the doctors a lot of times get
a better idea of how to manage. So it's not
unusual for that to happen when you call the surgeon
and say, hey, get back with your primary. I hear
(34:07):
that all the time. My patient's still me all the time,
and I'm fine with it, to be honest with you,
because that's my part in this whole system, is to
be there to sort of clean up things that maybe
didn't go well. And that's just sort of my position,
and I understand that, and I'm fine with it, and
I'll do what I can to help you. Again, sometimes
(34:29):
I call the surgeon and get just sort of a
better story about what happened and what's going on. So yeah,
we're there to help you. So that's that's not unusual,
be honest with you.
Speaker 3 (34:39):
Oh okay, well I was just I was just curious about,
you know, this procedure. So thank you doctor.
Speaker 1 (34:47):
All Right, Audrey, you have a happy holiday and America Christmas.
All right. Phone lines open eight nine to six kov
I one one hundred and three to three zero Okyova.
I'll be back in two minutes. All right, welcome back
(35:17):
to Docta ME Medical. Our phone lines are open A
nine to six kvy I one hundred and three three
zero kiov I informed. Yes, because once you do that operation,
or like I said, even when you take that medication,
we're just can't guarantee the outcome or what's going to happen.
We just can't dry it up like that all the time.
(35:37):
For the for the most part, yeah, everything works out
the way it's opposed to. And that's why a lot
of times, especially with operations and procedures, sometimes the doctor
doing it says, no, you're not a candidate. We can't
do it. We cannot perform this procedure because I cannot
guarantee the outcome. I'm afraid that if we do this,
(35:58):
things are not going to work. Got same thing with medications.
We have this conversation a lot with patients doctor, do
you think this is a good medication? Should I take
this medication? And we say no because we don't want
to test the waters. We don't want to start the
pot as it pertains to what might happen and could
be injurious to you and something that you might have
(36:22):
to go through that may change your life forever. Even
again a simple piece of paper and a prescription. Just
like a procedure, things don't go as planned. It could
you know, change the trajectory of things that you're going through.
So yeah, always take a pause and try to have
that conversation and answer or ask those questions. It can
(36:44):
be complicated, and I'm sure you can go to some
website and it sort of tells you what is some
questions some general questions to ask if you're having a procedure,
you know, you know, top five questions that you want
to answer it before you go through procedure. And I
know a lot of times sometimes the procedure procedure needs
to happen urgently and maybe in pain or you're suffering
(37:07):
just want it out, and you trust that doctor. That
doctor is going to perform the procedure. And again we're
trained to perform things and recommend things that are going
to help. But again, at the end of the day,
no physician or healthcare professional can guarantee what's going to happen.
(37:27):
Can't do that, and I know it can be super
frustrating when things cannot be predicted, but unfortunately that is
the way that is. And surgeons, doctors, healthcare professionals, we
deal with that every day, trying to again guarantee outcomes.
(37:49):
I work a lot in the hospital at Baptist every
day and I see some of you there in the hospital,
and we talk about the radio program of the common
refrains that I hear all the time as a doctor
in the hospital when patients are going home is I
don't want to have to come back, you know, if
you discharge me, I don't want to have to come back.
(38:11):
I don't I want to stay at home. And I
chuckle at that, because again there's this perception that you know,
we can sort of dial this thing up exactly and
we can predict what's going to happen, almost like a weatherman.
We have this radar, and we can kind of see
based on their formulas and the patterns that this is
(38:34):
what's going to happen. And again, for the most part,
most of the time that it does work out that way.
We might have some idea, but certainly things happen that
are unexpected and unpredicted in the hospital all the time.
I'm always amazed working in the hospital and working with
patients and families where you start out one day with
(38:57):
this and then tomorrow it's a different day and something
different is happening, and that's unfortunately the way it is.
Just can't draw that up, especially in medicine, the way
we wanted to. We do our best as a surgeon
and as a healthcare professional to make sure that if
we do discharge, if we do have a surgery, they
(39:19):
would recommend that it's in our opinion, the risk is
very low and the benefit is very high. Sort of
that risk benefit ratio that we talk about all the time,
and that's really at the center of just about every
decision a doctor and a healthcare professional makes, whether like
I said, it's a simple antibiotic, or if it's even
(39:41):
a bypass surgery, open heart surgery, or even a back surgery,
there has to been understanding that, again, the outcome cannot
be sort of dialed up as we would like to,
and you have to assume that sometimes it doesn't go
as planned and you have to be ready for that
planned for it. And that's something you can talk about
(40:03):
with your healthcare professional before you sort of consent to
this procedure or this medication, even though, like I said,
it's an antibiotic or it's a blood pressure medication. A
lot of patients are admitted to the hospital for just
adverse reaction to meds. You know, they're on several meds.
(40:25):
Maybe they went to their health care provider three days ago,
they started taking this medicine and then all of a sudden, booms,
something happens and the pharmaceutic, the pharmacist not farm. Yeah,
the pharmacists have gotten better at the time of handing
out their prescription, sort of helping us go over these
(40:47):
meds and the potential for adverse reaction. You sometimes have
a face to face conversation with the pharmacists. Sometimes you
just sort of get this slew of paperwork with all
the potential outcomes in and my experience, most patients find
this to be overwhelming. It's a lot of fine small print.
They're not really going to go over all these side
(41:10):
effect issues. They went to the healthcare professionals supposed to
know what happens and all the outcomes and sort of
be informed about that as a prescription is being handed,
so that they have a general orientation about what could happen.
But again, these different practitioners involved with getting you your
(41:32):
medication have gotten more involved. And it's for a good
reason again to make sure that you understand what's going
on before you commit to taking this medication, because again,
it might bump you a little bit, might cause a
little hiccup in your day, or your week or your
month when you're just taking this medication. And as we
(41:54):
get older, yeah, more people are taking more medications to
help them feel better, help them feel natural, help them
feel right. And we, as a medical doctor again I'm
not a surgeon, we spend a lot of time with that,
just managing adverse reaction with medications when things don't work
out the way they're supposed to be. And yeah, I
(42:16):
would have to say, over the years, I tried to
prescribe the least amount of medications possible because I have
that general understanding that as I start stacking those meds
on top of each other, that adverse things might start happening.
And I again, even when I have a new patient
or someone comes in multiple complaints, a lot of times
(42:37):
I will tell them let's just start with his first
and we'll come back and answer or get to these
other problems, because again, we don't want to overwhelm your
system with all these new prescription chemicals. If you will,
because we want to stay oriented, we want you to
feel neutral, and we're just trying to help with all
(42:59):
those things. So we're coming to the end of the show.
I want to wish everyone marry Merry Christmas, and hopefully
you have a happy and safe holiday. Remember it's just
all good. We don't want any bad outcomes, so don't
drink and drive and just have a good time and
(43:20):
no problems. And I hope you have a good holiday weekend.
Thank you for joining me. We'll see you next week.
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