September 14, 2025 • 29 mins
Dr. Sandeep Rao brings the borderland the latest information in healthcare, medicine and technology. He considers himself a hacker in the positive sense, using his intimate knowledge of the medical system to break down some of the barriers to accessing new medical technologies and information.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Good afternoon. It's another weekend here in the heart of
the dusty hue and desert in West Texas. You're listening
to the Medical Hackers. However, you may be tuned in
this week and I'm your host, Doctor Sandy Brow. I'm
here to bring the border Land the latest information in healthcare, medicine,
and technology on the show. I consider myself a hacker,
A hacker in the positive. It's a hacker using my
intimate knowledge of the medical system to breaking down so
(00:27):
the bears, to accessing new medical technologies and current healthcare information.
So I got Juni here in the studio with me.
Speaker 2 (00:35):
Hey, Doc, it's always good to be here with you.
Speaker 1 (00:37):
Brother, it's good to have you. I also have Amber,
and the reason I want to bring both of you
into this is I want to start this thing off
by asking you, guys, since you are on the air,
do you ever feel nervous? Do you ever feel nervous?
I know, Amber, you're on on the country music side,
you're a DJ when you're not doing producing for us.
(00:58):
Do you ever feel nervous when you're on the air
all the time, all the time? Okay, how about Junie,
do you feel nervous?
Speaker 2 (01:04):
Only when I talk to CEOs.
Speaker 1 (01:07):
Not when you're not when you're on with us.
Speaker 2 (01:10):
No, No, I'm good.
Speaker 1 (01:11):
We're just the little folks here.
Speaker 3 (01:14):
Now.
Speaker 1 (01:14):
The reason I want to bring that up is so
this is kind of making the rounds and I saw
this in the news recently, So there are a lot
of influencers who are bringing this more into the spotlight.
They're using their tiktoks, their instagrams to highlight the potential
use of a medication to calm your nerves. I'm sure
(01:35):
have you Are you familiar with beta blockers? Have you
heard of beta blocks? I've heard the term, yes, yes,
So beta blockers are a category of drug that in general,
I'll get into a little bit of it, but it
basically it's called beta blockers because there are these beta
receptors on your heart in elsewhere for your body, including
(01:57):
your brain, and what they do is they block this drug.
The most common one is pro panelol. That's a very
commonly prescribed drug. What it does it blocks those beta receptors,
and what it does is it helps in general. The
overall goal is if it's on your heart, it's designed
to decrease your blood pressure. So this is a common
(02:19):
drug we give for patients you just have high blood
pressure and when the effect on the brain is that
it decreases your anxiety. Okay, Now, the reason I bring
this up is there's a lot of it's getting a
little bit more attention. This is a very old drug though.
This drug's been out since nineteen sixty seven. Okay, he's
been out for a very very long time, over almost
fifty years now, and it's really you know, it's classically
(02:44):
prescribed for high blood pressure, yes.
Speaker 2 (02:48):
Doctor Row. Is it still prescribed a lot because I
remember data blockers being not heavy in the eighties.
Speaker 1 (02:54):
Yeah, So I tend to use and prescribe beta blockers.
Actually I don't use it myself, but I prescribe it
for patients who have elevated blood pressure in a very
what we call in an emergent type of setting. Sometimes
I'll have a patient who comes in, maybe they didn't
take their home medications, and all of a sudden, we
(03:15):
find that they have blood pressures like one eight. And ideally,
when I'm starting a procedure, I don't want their blood
pressure to be sky high, so I give them I
hit them with some medications. Beta blockers are among them.
Sometimes you can give them that drug. I also have
them to take their own home medication. So it's a
very commonly used medication still to this day. It's now
(03:38):
it's a generic drug. It's inexpensive, so it's actually it's
a it's been out there for a long time. It's
been generic for a very long time. But if you
look at it, prescriptions for beta blockers are on the rise,
and it's up almost thirty percent just in the last
five years. And I think it's because of a couple things.
(03:59):
When is your a lot more attention to it from
a lot of these influencers. Some people there are actors
who talk about the fact that they took a beta blocker,
maybe when they're giving a speech for winning an oscar.
I know Robert Downey Junior, he mentioned that he had
just taken a beta blocker when he won a Golden Globe,
and so he said, you know, I'm very calm now
(04:20):
because I popped a beta blocker.
Speaker 2 (04:22):
I think iron Man takes a little more than just
a beta blocker.
Speaker 1 (04:26):
That's true. Sure, that's true. There's there's a lot of
different drugs and a lot of a lot of them,
are you know, as I said, a lot of people
are using them for different indications. And what's now happening
is with the rise of telemedicine, you don't necessarily have
to go see a doc. So if you there are
companies out there that if you had this concern you
wanted to get worked out for this, you could just
(04:47):
get a doc on the phone and they can, you know,
just tell them, you know, you feel a little anxious,
maybe maybe you have high blood pressure. They will prescribe
you this medication. And some people say it might be
being over used.
Speaker 4 (05:01):
Now, someone very close to me was just prescribed it
like a couple of years ago. I think I might
still have some left over. Is that how that works?
Speaker 2 (05:08):
Is that one?
Speaker 1 (05:08):
Right?
Speaker 2 (05:09):
So you think people are using it for anxiety?
Speaker 1 (05:12):
So exactly So where I saw this was there were
a couple of TikTok brides who are talking about for
their big day. They were very anxious, nervous, and they
were advocating, you know what, why don't you pop in
a beta blocker and now you'll feel like you have
ice running through your veins. Wow. And so it's something
(05:33):
that I've actually considered on occasion. Sometimes there are people
tell me, you know what, maybe you should consider taking
a beta blocker. Not for me to do a procedure,
but sometimes I give a lot of talks. I give
talks in front of bigger audiences, but I feel pretty
comfortable in that setting, and I think on a certain level,
I think it's decent to have, you know, have that
(05:53):
nervous energy, the excitement. The one thing that I do
need to slow down sometimes is the rapidity of my
of my speech. So sometimes I do wonder. You know,
sometimes Amber gets on me for this. You know, I'm
talking too fast. He tells me to slow down, and
so I actually wonder if I were to do these
shows on beta blockers, would then slow into a much
(06:16):
more reasonable cadence.
Speaker 4 (06:18):
I would love to try that because there's times where
I go on stage and I introduce a country artists,
like it happened recently, but it was like a spur
of the moment, get on stage, talk in front of
this crowd. They're all hyped up and introduce as country artists.
So I would love to try it because I get excited,
but I get very anxious in that setting.
Speaker 2 (06:34):
Somber do you say, when you get excited, do you
find yourself speaking faster? Louder or both.
Speaker 1 (06:42):
Yeah, and your heart's like pounding.
Speaker 4 (06:44):
Oh my god.
Speaker 1 (06:44):
Yes.
Speaker 4 (06:45):
I try to do the box breathing and all of
the stuff that they say to do to calm your nerves.
Speaker 1 (06:50):
But when you're in that.
Speaker 4 (06:51):
Setting, especially when it's like like this happened this past
week and hey, get up on stage, can you do it?
Like okay, and you're up there in front of thousands
of people and you have this artist that's coming out. Yeah,
that's it's I mean, it's hard to calm down from
that rush.
Speaker 3 (07:05):
It is.
Speaker 1 (07:06):
So I will say this for the vast majority of people,
including those of us in this studio, I think it's
acceptable if you wanted to take a beta blocker on occasion. Now,
what is the downside? So if you already have a
very low blood pressure and you take a beta blocker,
it could possibly lower it, lower it to the point
(07:27):
where you might potentially faint. So if you had a
very very low blood pressure and you took a lot
of it, then it could possibly have that impact. Now,
there's also been some cases of folks who are already
taking something like maybe they're taking xanax, they're taking valume,
and now they're throwing this on top of it, you
don't want to mix your your drugs.
Speaker 2 (07:48):
Well, doctor, what is the difference between or I mean
you set a valuume? Is it that similar to?
Speaker 1 (07:56):
Yeah, So the main difference and the main reason why
beta blockers are getting more attention and are more acceptable,
is because they're not benzo diazepines. So benzodiazepines are drugs
such as xanax valume where you could potentially actually have
bigger impacts. I've had to actually I've had a patient
(08:17):
to get weaned off of of taking a lot of xanax.
So with beta blockers, it's a very very mild form
of this anti anxiety medication. And so it is certainly
something that I'm seeing. I'm seeing a lot of it.
I'm seeing other people taking it. I'm seeing other doctors
mentioning you what I'm going to take it because I'm
(08:38):
going to give a talk. But I think if you
can control your own nerves, your own things, I think
it's a good good thing to be able to do
it on your own without having to rely on it.
But after this break, I'm going to get into something different,
which is another side effect that you might see, which
is a tremor, which is the shaking of your hands,
(08:58):
and I want to kind of get into that a
little bit and how sometimes beta blockers are used for that.
But a very new interesting application that I've seen for
a new technology that I actually offered to patience.
Speaker 3 (09:12):
You're listening to the Medical Hackers with doctor Sande brow
Board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four three
seven zero or by emailing raw at medical hackers dot com.
Speaker 1 (09:39):
Back here on the Hackers, and I wanted to get
into the topic of tremors. Tremors is basically whenever you
have whenever you're shaking, but usually we often see it
when your hands are shaking. Now, you probably don't want
your doctor if you're seeing, if you're having procedure done,
(10:01):
seeing somebody with the tremor, might might s carry off
a little bit or your tattoo artist exactly, And so
it's certainly something that is something that's it's not fully
understood though when you talk about what we call essential tremors,
and so there's a lot of different factors that can
go into it, genetic factors, environmental factors, but it's frequently
(10:24):
associated with another thing, which is something called a taxia.
Gate a taxia, so gate a taxi. It means your
gait is how you walk. If you have normal walking,
you know, you're just walking normal. You know you're not
slashed to a side, you're not walking in a different
weird you know, you're not swerving. But some people do
(10:45):
have this type of pattern where they walk where they're
not able to walk properly. Maybe they're sort of swerving
to one side. And I'm not talking about it after
you've had a few drinks or anything like that, but
there is an association with tremors and a taxia. And
that's kind of the reason why I wanted to get
into is that has pointed doctors to suggest that maybe
(11:10):
the source of these tremors that you may be having
maybe coming from a portion in your brain called the cerebellum. Okay,
cerebellum is if you can kind of feel the back
of your head, Okay, the very back portion of your head,
So it's everything blow back of your head, like almost
just above your neck, that's where your cerebellum resides, and
so folks are saying that, you know, there's probably a
(11:32):
huge link there. There's a specific little nucleus that sister
that has a lot of electrical activity, and if it's
abnormal electrical activity, it can send some signals to the brain,
to the cerebellum that can affect your normal control of
your hands, your normal motor control. So there are some
(11:52):
folks who say that there is a significant brain component
that is causing it. Now there's also, as I said,
there's some strong genetic links. There are folks who see
it run in families sometimes as people get older, which
is one of the most common things we see as
people get what we call neurodegenerative diseases. That could be
any sort of dementia. It could be whether it's you know,
(12:15):
I'm not talking about Parkinson's related tremors, because that's a
totally different thing where we we've been able to isolate
that to two specific areas in the brain. But any
of the other dementias, whether it's Alzheimer's, you just tend
to see as the brain overall starts to break down,
you can start to see a little bit more tremors
than those folks.
Speaker 2 (12:35):
Doctor Rowe, Is there a difference physically that we can
visually see between someone with Parkinson's versus Alzheimer's or just
nervous tremors.
Speaker 1 (12:47):
So there's different types of tremors. There's certain types of
tremors where we call intention tremors, where when you're trying
to specifically do something, that's when you might have it,
as opposed to sometimes when you're having a lot of
are you having it when you're doing everything? So for example,
when you're trying to eat something with a fork and spoon,
So when you're having a very intentional movement, do you
(13:08):
have a tremor when that's happening. But really, we don't differentiate.
I don't use a tremor to differentiate it between a
patient who has Alzheimer's or Parkinson's, although they do have
different types of tremors, different types of motions, and there's
totally different types of treatments for those. But really that's
not what we're getting into on this particular thing. I
just want to kind of introduce the topic of tremors.
(13:29):
And so the other thing is just environmental triggers, which
I think is probably going to be the biggest thing
for most folks out there who are listening to this program.
So stress and fatigue one of the most common things
I myself. You know, I might have on occasion, maybe
if you're really really stressed out, maybe I haven't gotten
much sleep. Yeah, maybe my hands will start shaking a
(13:51):
little bit more when I'm doing something. Also, if you
take in caffeine or alcohol, those can also I've seen
folks have associations clearly, as you know with alcohol is
very clear cut. With caffeine as well, I've seen folks
who when they take in a lot of caffeine, maybe
that worsens your tremors. And then there's some people say,
(14:12):
you know what, they maybe need a little bit of
caffeine to kind of calm them down, so it can
affect them on either way. Medications is another one. There
are a lot of medications out there that they'll say
that a side effect can be a tremor. And as always,
like substance abuse, alcohol abuse and you withdraw also is
a huge cause of a tremor. So one of the
(14:33):
areas where I get into it is hyperthyroidism. When you
have you know, your thyroid gland which sits right in
your neck. If it's really overactive, if it's really big, especially,
that can cause you to have a tremor in addition
to so many other different things overactive thyroids. Sometimes I'll
see patient shore they're sweating a lot, maybe they're heart
(14:53):
is racing a lot. So there's a lot of different
things associated with the hyperthyroi, but a tremor is one
of them. Same thing with low bloodsh if you have
low blood sugars, that can always especially patients or diabetic
Sometimes I have patients who come in they've been fasting
overnight and they come in the next morning and they
have that tremor going on. So that so those are
(15:15):
just some causes of different types of tremors. But really
what I want to get into is, so one of
the ways we treat these tremors is oftentimes when it's
with a beta blocker, which is what we started this
segment off with. So there are some folks who have
hot blood pressure and that blood pressure cannot just be
treated with the beta blocker, but also you can also
(15:39):
improve your tremor sometimes with a beta blocker. So that's
oftentimes something that some folks try because it's a very
easy cheap drug to be able to give folks. Another
one is gaba pentance. So gabapent is a drug that
I frequently give for a lot of different patients. It's
by definition it's what's called an anti convulsant drug, but
(15:59):
it's used for a lot of different things, especially for
patients of chronic pain in their back, which is where
I see it neuropathy. But we can also give that
for tremors. There's other things folks do. Some folks even
do injections of botox, especially if you have a head tremor,
so if your head is shaking a lot, or if
you have a voice tremor. There are folks who have
(16:20):
where you might hear their voices constantly. They're not able
to control their vocal cords and so that they have
to do direct injection of the vocal cords with botox
to calm that down.
Speaker 2 (16:36):
Can you provide an example of so.
Speaker 1 (16:38):
The only the only example I can think of when
you think about a voice tremor is and I don't
think he has this, but it will sound like this.
So you might be aware of our of Robert F.
Kennedy Junior, he's the Uh, what's his role in the
in the Department of Dement of Health healthon HHS.
Speaker 2 (17:01):
Right.
Speaker 1 (17:02):
And so when he talks, if you might have heard him,
he has a very it's not his voice does not
have that typical pitch, and he himself has said that
he had issues with his vocal chords from the past. Again,
I don't know the I have not doved into why
he has that. But typically folks who have that type
(17:23):
of a voice tremor. Whereas when you whenever you hear
him on the news, you'll hear that it kind of
goes up and down. That is the sign of typically
a vovo voice tremor, and folks often do botox injections
for that. Beyond these medications I said, there's beta blockers,
there are anti seizure medications, there's tranquilizers like Klonapen that
(17:44):
folks go. Those are all things that you can certainly
do for tremors. But after this break, I'm going to
kind of go into a very new technology called nerve
stimulation that is just coming out. That's almost it's almost
very to something that I'm currently offering for other parts
of the body. But I want to get into that
(18:05):
after this.
Speaker 3 (18:05):
Break, you're listening to the Medical Hackers with doctor Sandeep Row,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
(18:26):
three seven zero or by emailing raw at medical hackers
dot com.
Speaker 1 (18:34):
Back here on the Hackers doctor out here with Juny
and I wanted to get into the entire concept of
nerve stimulation or neuromodulation, and the way that relates to
what we've been talking about with tremors is there's a
totally brand new technology. It's an AI powered system that
just has been recently being evaluated and investigated. So I
(18:58):
don't think it's actually able right now this instant, but
it's called Felix AI wristband nerve stimulator. Okay. So this
Felix NEUROAI stimulator is basically designed to go and help
patients who are having tremors. Okay. So the way this
(19:19):
works is, let me just take one step back though
about the entire concept of nerve stimulation. So the way
it applies to me kernel is I frequently put in
nerve stimulators, whether it's for patients have a lot of
patients who have chronic knee pain, patients who have chronic
foot pain, They've tried different things, maybe they've arthritis in
(19:41):
their knee. Or let's go a little bit further. Let's
say if there's folks who have neuropathy, patients who have
numbness and tingling in their feet. There's very good systems
out there where you can tackle all these problems which
before you do with medication. Before we'd give gabapentin to
a patient of neuropathy and they would fail that, or
you just give a patient who has ne arthritis, you'd
(20:05):
give them you know, maybe coxto inhibitor celebrates just anti
inflammatory medications, hopefully not going down the roll of opioids,
but it would be a drug way of treating patients.
But now there's a way we can actually go after
the nerves that are covering that particular body part. And
(20:28):
so there's nerves that cover your whole body. Right, So
if you have pain in your feet, if you have
pain in your knees, pain in your back, pain in
your arms, pain in your neck, I can actually try
to tackle that pain by going directly for the nerves.
So what I'm doing is I'm masking that pain. So
the way I like to discuss it is it's as
(20:49):
if your nerves in your body are almost like telephone lines,
and right now pain is occupying that telephone line. But
imagine if I can bump pain from traveling on that
telephone line and I can put some other signal, then
your body's only going to appreciate the other signal. And
(21:09):
so I'm the one sending this other signal. And the
way I do that is with nerve stimulation. So let's
just go into it in what I'm currently treating before
I go into this aspect for tremors. We'll get into
tremors a little bit. But the way I use it
all the time right now is I can put two
little wires. If you have neuropathy in your feet, I
(21:30):
can try to do one procedure to capture all the
burning and tingling and pain that you have. A lot
of patients wake up in the middle of the night
with pain and tingling that come to me they say
they have difficulty walking. So I can put two little
wires just in the lower back in close proximity to
the nerves that are entering the spine.
Speaker 2 (21:51):
Doctor Rolt, what do you mean by neuropathy for those who.
Speaker 1 (21:54):
Is just a fancy term meaning neuro and pathy means
that you just don't feel, You just don't have feeling
in your feet. I have patients who also can't have
who don't have feeling in their arms. And the reason
why that's so common here in OPAS is that almost
ninety percent of patients who have diabetes, at some point,
(22:15):
if it goes unchecked, will develop neuropathy. The neuropathy will
first start off as numbness and tingling. Then eventually you
might you might get so overburned with that numbness, all
of a sudden it'll start causing burning sensation constantly in
your calves, in your ankles, and then that will wake
you up at night. And so I've had patients who
(22:36):
have that in their arms and in your feet, and
so we have been able to identify a certain part
of the spine which contributes to neuropathy, and so by
stimulating that with two little wires, this is a quick
outpatient procedure takes about twenty minutes to do. I'm able
to thereby scramble that pain signal and put a different signal,
(23:01):
thereby getting rid of your neuropathy. So what's interesting is
that this little treatment that we do, it's actually one
of the most unique treatments because we can actually try
it for about five to seven days before deciding to
commit to it, and so it's actually almost a no
brainer for folks to try. Well, one thing I've noticed
is that almost what we've seen with our patients, ninety
six percent of patients who try it actually say they
(23:22):
want this as like a permanent little wires to cause
this nerve stimulation.
Speaker 2 (23:28):
Doctor ell is their managed care processes that you have
to follow before you go that route.
Speaker 1 (23:33):
Yes, So that's why I always duel thoroughistory. I need
to make sure that patients already tried conservative therapy with
medication like gabapentin. And I can tell you the commonly
most used drug for this, which is like gabapentin or lyrica.
Most patients have failed that about forty It only works
about forty five percent of the time, and there's also
a lot of side effects. I have a lot of
patients who say they have a lot of dizziness, confusion.
(23:54):
Maybe with those medications and it's not even really helping
their symptoms of burning. So once you failed that, if
you have five greater than five out of ten pain,
that's another thing that's a qualifier for this procedure. Now
also have patients who also had what we call failed
back surgery. They've had some back surgery in the past
(24:14):
and it did not help them, and then they come
to me with this, and so that's that indication for
me to do this procedure, not actually for neuropathy, it's
I just have patients with low back pain. So this
entire concept of nerve stimulation, as you can tell as
I'm going with this, is that I can go after
pain wherever it is in the body. Almost at the
(24:37):
I'm intercepting the pain as it's being transmitted, So I'm
not going after the root cause. So the root cause
of your back pain may actually be something going on
with your bone, but you've already tried fixing that, You've
already tried surgery, You've maybe the root cause of your
neuropathy is the damage to the nerves from diabetes. So
we can't control your diabetes. So I'm not going after
(24:57):
your root cause, which you might have already tried, but
I'm now trying to intercept the pain as it's being
transmitted through your body. Now here's where i want to
get into this felix Ai wristband because I'm not I'm
offering this other treatment for pain in your body, which
whether it's in your knees from arthritis or the neuropathy.
(25:18):
But here's where this system is very exciting because this
is a new study just came out in San Diego.
So what they did is they did over a ninety
day period, they took a bunch of patients who had
essential tremor, which is what we started talking about, patients
who have shaking in their in their hands. And so
what they did is they put a little stimulator device
(25:40):
and they just wore it over their wrist. And so
what they found was that with the patients who had
essential tremor, they found sixty nine point four percent of
patients who had the tremor actually were improved, which is
a huge deal because in the sham group where they
(26:00):
didn't do anything, it was like only forty percent. So
it's at least twenty five percent more found to have
improved with this thing. So what they are suggesting what
they're suggesting is that they're thinking that tremor is due
to a issue involving this brain circuit, like we were
discussing earlier, and so there could be something going on
(26:22):
from your brain sending down this signal down your arm
to your hands causing this tremor. So they are again
this application is they're intercepting this this circuit and decreasing
your tremor. Now, there have been people who've actually done
stuff for tremor. So there's this thing called deep deep
(26:43):
brain stimulation. Earlier, Juni, you asked me about Parkinson's. One
of the most common treatments that's really widely accepted is
what's called deep brain stimulation. That's actually a very that's
a much more invasive process where I see these patients
coming to the hospital all the time. I have neurosurgery
call leagues who send me patients to evaluate for this.
They have little wires that actually enter the brain and
(27:06):
the wire ends inside your brain, so they have two
little wires and that those little wires stimulate this little
nucleus inside your brain that's causing the tremor in Parkinson's.
But with the beauty about this new technology, this felix Ai.
This wearable peripheral nerve stimulation system is that this is
not invasive. This is something you just wear it on
(27:28):
your wrist and it stimulates you to your radial, your
median or your owner nerve, and there's a smartphone app
that it sends the data to and so again, so
this was a group of patients. There's average as it
was about sixty five years old, and they had had
tremors for almost eleven years. And so they were able
(27:48):
to take these patients off at least one medication for
tremor and hopefully going forward they're able to get more.
So right now the system is not available. It's undergoing
FDA review and awaiting clearance. So something that I'm eager
to maybe possibly use for my patients, but it's something
that it's a variation off a technology that I'm currently using.
(28:12):
So I think it's good to be aware that potentially,
if you have tremors that are gone untreated, you might
have an option for you without having to go the
deep brain stimulation route. So unfortunately, our time this Saturday
is up. If you are interested in any more information
on any of the mentioned minimally invasive treatments. You can
always call to get more information at nine to one
five five hundred forty three seventy that's five zero zero
(28:35):
four three seven zero. You can also reach me by
email at raw that's my last name, r AO at
medical hackers dot com. I hope these healthcare hacks have
helped you navigate our complex medical system. If you've been
tuned into us this whole time, bless your heart and
your health. I'm doctor Sandy Brown. You've been listening to
the medical actors. The patos started as representing apism to
(29:06):
the representing the pap
Good afternoon. It's another weekend here in the heart of
the dusty hue and desert in West Texas. You're listening
to the Medical Hackers. However, you may be tuned in
this week and I'm your host, Doctor Sandy Brow. I'm
here to bring the border Land the latest information in healthcare, medicine,
and technology on the show. I consider myself a hacker,
A hacker in the positive. It's a hacker using my
intimate knowledge of the medical system to breaking down so
(00:27):
the bears, to accessing new medical technologies and current healthcare information.
So I got Juni here in the studio with me.
Speaker 2 (00:35):
Hey, Doc, it's always good to be here with you.
Speaker 1 (00:37):
Brother, it's good to have you. I also have Amber,
and the reason I want to bring both of you
into this is I want to start this thing off
by asking you, guys, since you are on the air,
do you ever feel nervous? Do you ever feel nervous?
I know, Amber, you're on on the country music side,
you're a DJ when you're not doing producing for us.
(00:58):
Do you ever feel nervous when you're on the air
all the time, all the time? Okay, how about Junie,
do you feel nervous?
Speaker 2 (01:04):
Only when I talk to CEOs.
Speaker 1 (01:07):
Not when you're not when you're on with us.
Speaker 2 (01:10):
No, No, I'm good.
Speaker 1 (01:11):
We're just the little folks here.
Speaker 3 (01:14):
Now.
Speaker 1 (01:14):
The reason I want to bring that up is so
this is kind of making the rounds and I saw
this in the news recently, So there are a lot
of influencers who are bringing this more into the spotlight.
They're using their tiktoks, their instagrams to highlight the potential
use of a medication to calm your nerves. I'm sure
(01:35):
have you Are you familiar with beta blockers? Have you
heard of beta blocks? I've heard the term, yes, yes,
So beta blockers are a category of drug that in general,
I'll get into a little bit of it, but it
basically it's called beta blockers because there are these beta
receptors on your heart in elsewhere for your body, including
(01:57):
your brain, and what they do is they block this drug.
The most common one is pro panelol. That's a very
commonly prescribed drug. What it does it blocks those beta receptors,
and what it does is it helps in general. The
overall goal is if it's on your heart, it's designed
to decrease your blood pressure. So this is a common
(02:19):
drug we give for patients you just have high blood
pressure and when the effect on the brain is that
it decreases your anxiety. Okay, Now, the reason I bring
this up is there's a lot of it's getting a
little bit more attention. This is a very old drug though.
This drug's been out since nineteen sixty seven. Okay, he's
been out for a very very long time, over almost
fifty years now, and it's really you know, it's classically
(02:44):
prescribed for high blood pressure, yes.
Speaker 2 (02:48):
Doctor Row. Is it still prescribed a lot because I
remember data blockers being not heavy in the eighties.
Speaker 1 (02:54):
Yeah, So I tend to use and prescribe beta blockers.
Actually I don't use it myself, but I prescribe it
for patients who have elevated blood pressure in a very
what we call in an emergent type of setting. Sometimes
I'll have a patient who comes in, maybe they didn't
take their home medications, and all of a sudden, we
(03:15):
find that they have blood pressures like one eight. And ideally,
when I'm starting a procedure, I don't want their blood
pressure to be sky high, so I give them I
hit them with some medications. Beta blockers are among them.
Sometimes you can give them that drug. I also have
them to take their own home medication. So it's a
very commonly used medication still to this day. It's now
(03:38):
it's a generic drug. It's inexpensive, so it's actually it's
a it's been out there for a long time. It's
been generic for a very long time. But if you
look at it, prescriptions for beta blockers are on the rise,
and it's up almost thirty percent just in the last
five years. And I think it's because of a couple things.
(03:59):
When is your a lot more attention to it from
a lot of these influencers. Some people there are actors
who talk about the fact that they took a beta blocker,
maybe when they're giving a speech for winning an oscar.
I know Robert Downey Junior, he mentioned that he had
just taken a beta blocker when he won a Golden Globe,
and so he said, you know, I'm very calm now
(04:20):
because I popped a beta blocker.
Speaker 2 (04:22):
I think iron Man takes a little more than just
a beta blocker.
Speaker 1 (04:26):
That's true. Sure, that's true. There's there's a lot of
different drugs and a lot of a lot of them,
are you know, as I said, a lot of people
are using them for different indications. And what's now happening
is with the rise of telemedicine, you don't necessarily have
to go see a doc. So if you there are
companies out there that if you had this concern you
wanted to get worked out for this, you could just
(04:47):
get a doc on the phone and they can, you know,
just tell them, you know, you feel a little anxious,
maybe maybe you have high blood pressure. They will prescribe
you this medication. And some people say it might be
being over used.
Speaker 4 (05:01):
Now, someone very close to me was just prescribed it
like a couple of years ago. I think I might
still have some left over. Is that how that works?
Speaker 2 (05:08):
Is that one?
Speaker 1 (05:08):
Right?
Speaker 2 (05:09):
So you think people are using it for anxiety?
Speaker 1 (05:12):
So exactly So where I saw this was there were
a couple of TikTok brides who are talking about for
their big day. They were very anxious, nervous, and they
were advocating, you know what, why don't you pop in
a beta blocker and now you'll feel like you have
ice running through your veins. Wow. And so it's something
(05:33):
that I've actually considered on occasion. Sometimes there are people
tell me, you know what, maybe you should consider taking
a beta blocker. Not for me to do a procedure,
but sometimes I give a lot of talks. I give
talks in front of bigger audiences, but I feel pretty
comfortable in that setting, and I think on a certain level,
I think it's decent to have, you know, have that
(05:53):
nervous energy, the excitement. The one thing that I do
need to slow down sometimes is the rapidity of my
of my speech. So sometimes I do wonder. You know,
sometimes Amber gets on me for this. You know, I'm
talking too fast. He tells me to slow down, and
so I actually wonder if I were to do these
shows on beta blockers, would then slow into a much
(06:16):
more reasonable cadence.
Speaker 4 (06:18):
I would love to try that because there's times where
I go on stage and I introduce a country artists,
like it happened recently, but it was like a spur
of the moment, get on stage, talk in front of
this crowd. They're all hyped up and introduce as country artists.
So I would love to try it because I get excited,
but I get very anxious in that setting.
Speaker 2 (06:34):
Somber do you say, when you get excited, do you
find yourself speaking faster? Louder or both.
Speaker 1 (06:42):
Yeah, and your heart's like pounding.
Speaker 4 (06:44):
Oh my god.
Speaker 1 (06:44):
Yes.
Speaker 4 (06:45):
I try to do the box breathing and all of
the stuff that they say to do to calm your nerves.
Speaker 1 (06:50):
But when you're in that.
Speaker 4 (06:51):
Setting, especially when it's like like this happened this past
week and hey, get up on stage, can you do it?
Like okay, and you're up there in front of thousands
of people and you have this artist that's coming out. Yeah,
that's it's I mean, it's hard to calm down from
that rush.
Speaker 3 (07:05):
It is.
Speaker 1 (07:06):
So I will say this for the vast majority of people,
including those of us in this studio, I think it's
acceptable if you wanted to take a beta blocker on occasion. Now,
what is the downside? So if you already have a
very low blood pressure and you take a beta blocker,
it could possibly lower it, lower it to the point
(07:27):
where you might potentially faint. So if you had a
very very low blood pressure and you took a lot
of it, then it could possibly have that impact. Now,
there's also been some cases of folks who are already
taking something like maybe they're taking xanax, they're taking valume,
and now they're throwing this on top of it, you
don't want to mix your your drugs.
Speaker 2 (07:48):
Well, doctor, what is the difference between or I mean
you set a valuume? Is it that similar to?
Speaker 1 (07:56):
Yeah, So the main difference and the main reason why
beta blockers are getting more attention and are more acceptable,
is because they're not benzo diazepines. So benzodiazepines are drugs
such as xanax valume where you could potentially actually have
bigger impacts. I've had to actually I've had a patient
(08:17):
to get weaned off of of taking a lot of xanax.
So with beta blockers, it's a very very mild form
of this anti anxiety medication. And so it is certainly
something that I'm seeing. I'm seeing a lot of it.
I'm seeing other people taking it. I'm seeing other doctors
mentioning you what I'm going to take it because I'm
(08:38):
going to give a talk. But I think if you
can control your own nerves, your own things, I think
it's a good good thing to be able to do
it on your own without having to rely on it.
But after this break, I'm going to get into something different,
which is another side effect that you might see, which
is a tremor, which is the shaking of your hands,
(08:58):
and I want to kind of get into that a
little bit and how sometimes beta blockers are used for that.
But a very new interesting application that I've seen for
a new technology that I actually offered to patience.
Speaker 3 (09:12):
You're listening to the Medical Hackers with doctor Sande brow
Board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four three
seven zero or by emailing raw at medical hackers dot com.
Speaker 1 (09:39):
Back here on the Hackers, and I wanted to get
into the topic of tremors. Tremors is basically whenever you
have whenever you're shaking, but usually we often see it
when your hands are shaking. Now, you probably don't want
your doctor if you're seeing, if you're having procedure done,
(10:01):
seeing somebody with the tremor, might might s carry off
a little bit or your tattoo artist exactly, And so
it's certainly something that is something that's it's not fully
understood though when you talk about what we call essential tremors,
and so there's a lot of different factors that can
go into it, genetic factors, environmental factors, but it's frequently
(10:24):
associated with another thing, which is something called a taxia.
Gate a taxia, so gate a taxi. It means your
gait is how you walk. If you have normal walking,
you know, you're just walking normal. You know you're not
slashed to a side, you're not walking in a different
weird you know, you're not swerving. But some people do
(10:45):
have this type of pattern where they walk where they're
not able to walk properly. Maybe they're sort of swerving
to one side. And I'm not talking about it after
you've had a few drinks or anything like that, but
there is an association with tremors and a taxia. And
that's kind of the reason why I wanted to get
into is that has pointed doctors to suggest that maybe
(11:10):
the source of these tremors that you may be having
maybe coming from a portion in your brain called the cerebellum. Okay,
cerebellum is if you can kind of feel the back
of your head, Okay, the very back portion of your head,
So it's everything blow back of your head, like almost
just above your neck, that's where your cerebellum resides, and
so folks are saying that, you know, there's probably a
(11:32):
huge link there. There's a specific little nucleus that sister
that has a lot of electrical activity, and if it's
abnormal electrical activity, it can send some signals to the brain,
to the cerebellum that can affect your normal control of
your hands, your normal motor control. So there are some
(11:52):
folks who say that there is a significant brain component
that is causing it. Now there's also, as I said,
there's some strong genetic links. There are folks who see
it run in families sometimes as people get older, which
is one of the most common things we see as
people get what we call neurodegenerative diseases. That could be
any sort of dementia. It could be whether it's you know,
(12:15):
I'm not talking about Parkinson's related tremors, because that's a
totally different thing where we we've been able to isolate
that to two specific areas in the brain. But any
of the other dementias, whether it's Alzheimer's, you just tend
to see as the brain overall starts to break down,
you can start to see a little bit more tremors
than those folks.
Speaker 2 (12:35):
Doctor Rowe, Is there a difference physically that we can
visually see between someone with Parkinson's versus Alzheimer's or just
nervous tremors.
Speaker 1 (12:47):
So there's different types of tremors. There's certain types of
tremors where we call intention tremors, where when you're trying
to specifically do something, that's when you might have it,
as opposed to sometimes when you're having a lot of
are you having it when you're doing everything? So for example,
when you're trying to eat something with a fork and spoon,
So when you're having a very intentional movement, do you
(13:08):
have a tremor when that's happening. But really, we don't differentiate.
I don't use a tremor to differentiate it between a
patient who has Alzheimer's or Parkinson's, although they do have
different types of tremors, different types of motions, and there's
totally different types of treatments for those. But really that's
not what we're getting into on this particular thing. I
just want to kind of introduce the topic of tremors.
(13:29):
And so the other thing is just environmental triggers, which
I think is probably going to be the biggest thing
for most folks out there who are listening to this program.
So stress and fatigue one of the most common things
I myself. You know, I might have on occasion, maybe
if you're really really stressed out, maybe I haven't gotten
much sleep. Yeah, maybe my hands will start shaking a
(13:51):
little bit more when I'm doing something. Also, if you
take in caffeine or alcohol, those can also I've seen
folks have associations clearly, as you know with alcohol is
very clear cut. With caffeine as well, I've seen folks
who when they take in a lot of caffeine, maybe
that worsens your tremors. And then there's some people say,
(14:12):
you know what, they maybe need a little bit of
caffeine to kind of calm them down, so it can
affect them on either way. Medications is another one. There
are a lot of medications out there that they'll say
that a side effect can be a tremor. And as always,
like substance abuse, alcohol abuse and you withdraw also is
a huge cause of a tremor. So one of the
(14:33):
areas where I get into it is hyperthyroidism. When you
have you know, your thyroid gland which sits right in
your neck. If it's really overactive, if it's really big, especially,
that can cause you to have a tremor in addition
to so many other different things overactive thyroids. Sometimes I'll
see patient shore they're sweating a lot, maybe they're heart
(14:53):
is racing a lot. So there's a lot of different
things associated with the hyperthyroi, but a tremor is one
of them. Same thing with low bloodsh if you have
low blood sugars, that can always especially patients or diabetic
Sometimes I have patients who come in they've been fasting
overnight and they come in the next morning and they
have that tremor going on. So that so those are
(15:15):
just some causes of different types of tremors. But really
what I want to get into is, so one of
the ways we treat these tremors is oftentimes when it's
with a beta blocker, which is what we started this
segment off with. So there are some folks who have
hot blood pressure and that blood pressure cannot just be
treated with the beta blocker, but also you can also
(15:39):
improve your tremor sometimes with a beta blocker. So that's
oftentimes something that some folks try because it's a very
easy cheap drug to be able to give folks. Another
one is gaba pentance. So gabapent is a drug that
I frequently give for a lot of different patients. It's
by definition it's what's called an anti convulsant drug, but
(15:59):
it's used for a lot of different things, especially for
patients of chronic pain in their back, which is where
I see it neuropathy. But we can also give that
for tremors. There's other things folks do. Some folks even
do injections of botox, especially if you have a head tremor,
so if your head is shaking a lot, or if
you have a voice tremor. There are folks who have
(16:20):
where you might hear their voices constantly. They're not able
to control their vocal cords and so that they have
to do direct injection of the vocal cords with botox
to calm that down.
Speaker 2 (16:36):
Can you provide an example of so.
Speaker 1 (16:38):
The only the only example I can think of when
you think about a voice tremor is and I don't
think he has this, but it will sound like this.
So you might be aware of our of Robert F.
Kennedy Junior, he's the Uh, what's his role in the
in the Department of Dement of Health healthon HHS.
Speaker 2 (17:01):
Right.
Speaker 1 (17:02):
And so when he talks, if you might have heard him,
he has a very it's not his voice does not
have that typical pitch, and he himself has said that
he had issues with his vocal chords from the past. Again,
I don't know the I have not doved into why
he has that. But typically folks who have that type
(17:23):
of a voice tremor. Whereas when you whenever you hear
him on the news, you'll hear that it kind of
goes up and down. That is the sign of typically
a vovo voice tremor, and folks often do botox injections
for that. Beyond these medications I said, there's beta blockers,
there are anti seizure medications, there's tranquilizers like Klonapen that
(17:44):
folks go. Those are all things that you can certainly
do for tremors. But after this break, I'm going to
kind of go into a very new technology called nerve
stimulation that is just coming out. That's almost it's almost
very to something that I'm currently offering for other parts
of the body. But I want to get into that
(18:05):
after this.
Speaker 3 (18:05):
Break, you're listening to the Medical Hackers with doctor Sandeep Row,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
(18:26):
three seven zero or by emailing raw at medical hackers
dot com.
Speaker 1 (18:34):
Back here on the Hackers doctor out here with Juny
and I wanted to get into the entire concept of
nerve stimulation or neuromodulation, and the way that relates to
what we've been talking about with tremors is there's a
totally brand new technology. It's an AI powered system that
just has been recently being evaluated and investigated. So I
(18:58):
don't think it's actually able right now this instant, but
it's called Felix AI wristband nerve stimulator. Okay. So this
Felix NEUROAI stimulator is basically designed to go and help
patients who are having tremors. Okay. So the way this
(19:19):
works is, let me just take one step back though
about the entire concept of nerve stimulation. So the way
it applies to me kernel is I frequently put in
nerve stimulators, whether it's for patients have a lot of
patients who have chronic knee pain, patients who have chronic
foot pain, They've tried different things, maybe they've arthritis in
(19:41):
their knee. Or let's go a little bit further. Let's
say if there's folks who have neuropathy, patients who have
numbness and tingling in their feet. There's very good systems
out there where you can tackle all these problems which
before you do with medication. Before we'd give gabapentin to
a patient of neuropathy and they would fail that, or
you just give a patient who has ne arthritis, you'd
(20:05):
give them you know, maybe coxto inhibitor celebrates just anti
inflammatory medications, hopefully not going down the roll of opioids,
but it would be a drug way of treating patients.
But now there's a way we can actually go after
the nerves that are covering that particular body part. And
(20:28):
so there's nerves that cover your whole body. Right, So
if you have pain in your feet, if you have
pain in your knees, pain in your back, pain in
your arms, pain in your neck, I can actually try
to tackle that pain by going directly for the nerves.
So what I'm doing is I'm masking that pain. So
the way I like to discuss it is it's as
(20:49):
if your nerves in your body are almost like telephone lines,
and right now pain is occupying that telephone line. But
imagine if I can bump pain from traveling on that
telephone line and I can put some other signal, then
your body's only going to appreciate the other signal. And
(21:09):
so I'm the one sending this other signal. And the
way I do that is with nerve stimulation. So let's
just go into it in what I'm currently treating before
I go into this aspect for tremors. We'll get into
tremors a little bit. But the way I use it
all the time right now is I can put two
little wires. If you have neuropathy in your feet, I
(21:30):
can try to do one procedure to capture all the
burning and tingling and pain that you have. A lot
of patients wake up in the middle of the night
with pain and tingling that come to me they say
they have difficulty walking. So I can put two little
wires just in the lower back in close proximity to
the nerves that are entering the spine.
Speaker 2 (21:51):
Doctor Rolt, what do you mean by neuropathy for those who.
Speaker 1 (21:54):
Is just a fancy term meaning neuro and pathy means
that you just don't feel, You just don't have feeling
in your feet. I have patients who also can't have
who don't have feeling in their arms. And the reason
why that's so common here in OPAS is that almost
ninety percent of patients who have diabetes, at some point,
(22:15):
if it goes unchecked, will develop neuropathy. The neuropathy will
first start off as numbness and tingling. Then eventually you
might you might get so overburned with that numbness, all
of a sudden it'll start causing burning sensation constantly in
your calves, in your ankles, and then that will wake
you up at night. And so I've had patients who
(22:36):
have that in their arms and in your feet, and
so we have been able to identify a certain part
of the spine which contributes to neuropathy, and so by
stimulating that with two little wires, this is a quick
outpatient procedure takes about twenty minutes to do. I'm able
to thereby scramble that pain signal and put a different signal,
(23:01):
thereby getting rid of your neuropathy. So what's interesting is
that this little treatment that we do, it's actually one
of the most unique treatments because we can actually try
it for about five to seven days before deciding to
commit to it, and so it's actually almost a no
brainer for folks to try. Well, one thing I've noticed
is that almost what we've seen with our patients, ninety
six percent of patients who try it actually say they
(23:22):
want this as like a permanent little wires to cause
this nerve stimulation.
Speaker 2 (23:28):
Doctor ell is their managed care processes that you have
to follow before you go that route.
Speaker 1 (23:33):
Yes, So that's why I always duel thoroughistory. I need
to make sure that patients already tried conservative therapy with
medication like gabapentin. And I can tell you the commonly
most used drug for this, which is like gabapentin or lyrica.
Most patients have failed that about forty It only works
about forty five percent of the time, and there's also
a lot of side effects. I have a lot of
patients who say they have a lot of dizziness, confusion.
(23:54):
Maybe with those medications and it's not even really helping
their symptoms of burning. So once you failed that, if
you have five greater than five out of ten pain,
that's another thing that's a qualifier for this procedure. Now
also have patients who also had what we call failed
back surgery. They've had some back surgery in the past
(24:14):
and it did not help them, and then they come
to me with this, and so that's that indication for
me to do this procedure, not actually for neuropathy, it's
I just have patients with low back pain. So this
entire concept of nerve stimulation, as you can tell as
I'm going with this, is that I can go after
pain wherever it is in the body. Almost at the
(24:37):
I'm intercepting the pain as it's being transmitted, So I'm
not going after the root cause. So the root cause
of your back pain may actually be something going on
with your bone, but you've already tried fixing that, You've
already tried surgery, You've maybe the root cause of your
neuropathy is the damage to the nerves from diabetes. So
we can't control your diabetes. So I'm not going after
(24:57):
your root cause, which you might have already tried, but
I'm now trying to intercept the pain as it's being
transmitted through your body. Now here's where i want to
get into this felix Ai wristband because I'm not I'm
offering this other treatment for pain in your body, which
whether it's in your knees from arthritis or the neuropathy.
(25:18):
But here's where this system is very exciting because this
is a new study just came out in San Diego.
So what they did is they did over a ninety
day period, they took a bunch of patients who had
essential tremor, which is what we started talking about, patients
who have shaking in their in their hands. And so
what they did is they put a little stimulator device
(25:40):
and they just wore it over their wrist. And so
what they found was that with the patients who had
essential tremor, they found sixty nine point four percent of
patients who had the tremor actually were improved, which is
a huge deal because in the sham group where they
(26:00):
didn't do anything, it was like only forty percent. So
it's at least twenty five percent more found to have
improved with this thing. So what they are suggesting what
they're suggesting is that they're thinking that tremor is due
to a issue involving this brain circuit, like we were
discussing earlier, and so there could be something going on
(26:22):
from your brain sending down this signal down your arm
to your hands causing this tremor. So they are again
this application is they're intercepting this this circuit and decreasing
your tremor. Now, there have been people who've actually done
stuff for tremor. So there's this thing called deep deep
(26:43):
brain stimulation. Earlier, Juni, you asked me about Parkinson's. One
of the most common treatments that's really widely accepted is
what's called deep brain stimulation. That's actually a very that's
a much more invasive process where I see these patients
coming to the hospital all the time. I have neurosurgery
call leagues who send me patients to evaluate for this.
They have little wires that actually enter the brain and
(27:06):
the wire ends inside your brain, so they have two
little wires and that those little wires stimulate this little
nucleus inside your brain that's causing the tremor in Parkinson's.
But with the beauty about this new technology, this felix Ai.
This wearable peripheral nerve stimulation system is that this is
not invasive. This is something you just wear it on
(27:28):
your wrist and it stimulates you to your radial, your
median or your owner nerve, and there's a smartphone app
that it sends the data to and so again, so
this was a group of patients. There's average as it
was about sixty five years old, and they had had
tremors for almost eleven years. And so they were able
(27:48):
to take these patients off at least one medication for
tremor and hopefully going forward they're able to get more.
So right now the system is not available. It's undergoing
FDA review and awaiting clearance. So something that I'm eager
to maybe possibly use for my patients, but it's something
that it's a variation off a technology that I'm currently using.
(28:12):
So I think it's good to be aware that potentially,
if you have tremors that are gone untreated, you might
have an option for you without having to go the
deep brain stimulation route. So unfortunately, our time this Saturday
is up. If you are interested in any more information
on any of the mentioned minimally invasive treatments. You can
always call to get more information at nine to one
five five hundred forty three seventy that's five zero zero
(28:35):
four three seven zero. You can also reach me by
email at raw that's my last name, r AO at
medical hackers dot com. I hope these healthcare hacks have
helped you navigate our complex medical system. If you've been
tuned into us this whole time, bless your heart and
your health. I'm doctor Sandy Brown. You've been listening to
the medical actors. The patos started as representing apism to
(29:06):
the representing the pap
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