Combating Health Information and Communicating with your Doctor

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Transcript

Chrissy Billau:

Welcome to prescribed listening from the University of Toledo Medical Center. On this podcast, we interview our experts to get the answers you need and can trust. On this episode with internal medicine specialist, Dr. Srini Hejeebu, we dive into some common themes that came out of our last season. For example, should you be talking to your doctor about taking a medication you saw someone take on TikTok?

Dr. Andre Aguillon:

There is also a concern if you take too much melatonin.

Chrissy Billau:

And are you really helping yourself by taking pain medication for your bad back?

Tyler Schinharl PT, DPT:

It can be used well as an adjunct to activity.

Chrissy Billau:

Hello, I'm Chrissy Billau. Dr. Hejeebu, thank you for joining me. Did you listen to the last season at all? And it's okay if you didn't, it's probably better if you didn't.

Tyler Schinharl PT, DPT:

I have not.

Chrissy Billau:

No, that's totally fine. So I am not a doctor or a scientist, but I like to think I know enough to be dangerous to help solve the mom things at home, or trying to urge my parents to take better care of themselves. However, during the last eight episodes, talking with UTMC providers from a wide variety of specialties about anything from sleep or going to the bathroom or wine or cholesterol or exercise, I was surprised by some of the common themes that came out. So I'd like to have a conversation with you, to kick off our new season, unpacking a handful of them.

So one big takeaway is how some medications can impact you in ways that you did not intend for, like melatonin. Our sleep specialist, he stressed how you really need to be careful on how you use it. And the physical therapists, they said during our episode about whether short workouts work, they talked about how pain medication after you've been taking it for a while and you're still having the pain, can really be covering up symptoms of a problem that really needs to be addressed.

So have you had patients do something similar, where they're trying medications that aren't helping them the way they thought? What is your experience with this issue?

Dr. Srini Hejeebu:

Well, I think the biggest thing is that there's so many medications that are available over-the-counter. And as a provider, I make sure we go over everything that they are taking. And that includes herbal supplements, anti-inflammatories, anything that they might have received from family members. And it's very important because of, there's so many drug-drug interactions with all these medications, we want to know if something is causing a problem, causing a side effect. And so it is ... the number of medications out in over-the-counter space nowadays is immense. So our number one job as physicians, especially in the primary care field is that we go over everything.

And we actually tell our patients to bring in all the bottles of medicines that they're taking with them and say, okay, now we're going to go over, what are you taking? How much are you taking? When are you taking? Because certain medications actually, if taken together may offset each other. For example, thyroid medication is one example where you have to take it on an empty stomach with no other medications. Another common medications that people take are Prilosec, which are for heartburn and things like that. That interacts with thyroid medication and you want to make sure you separate those two.

So it's important to listen to your doctor when they tell you, take this at daytime, take this at nighttime. And there's others a little bit more complex, where you strictly have to take the medicine on an empty stomach, wait 30 minutes before you eat or drink. And you have to stay upright, meaning you can't go back to sleep. If you go back to sleep, that can actually cause GI problems, like esophageal issues if you lay down. So it's a never ending battle, but that's one of our battles in primary care.

Chrissy Billau:

Is it often that they come in and they're like, I had this issue but don't worry, I started taking this. And you're like, what?

Dr. Srini Hejeebu:

Absolutely. Well, and there's a good and a bad. People can get a lot of education on the internet. So you have Google search, WebMD that gives you lots of good information. The bad is people will tend to try to experiment. And the most serious ones are the way they take your family member's prescription medications, and that's when they get into trouble.

Chrissy Billau:

Why does it matter if you start taking some medications before consulting your doctor?

Dr. Srini Hejeebu:

Again, the biggest issue is the side effects. And one medicine can affect another disease process. So if, for example, you take a family member's blood pressure pill and then you're starting to get dizzy. And you come in to see me for dizziness and you don't tell me you're taking your family member's blood pressure pill, then we have an issue.

So it is very important. It's almost like you should have it on your phone or device, have the list with you at all times. If you go to the ER, have that list with you. If you go to a specialist, have that list with you so that they can go over all the medications you're taking.

Chrissy Billau:

I remember my mom did that for years before my grandmother died. So now my mom, she has a lot of things going on. I was like, why don't you do what you did for grandma? And she's like, oh, I never thought of that.

Dr. Srini Hejeebu:

You're right. The pill box is great. Everyone should have a pill box of all their medications, what they take in the morning, lunchtime, dinner time. That helps a lot, but the list is actually very important. And we joke in our field, the patient comes in and says, oh, I take that white pill. There's thousands of white pills.

And so technology's gotten where I can actually look at a pill and search it and I can actually find exactly what it is. Not all of all the time. But it's time intensive. If it's a capsule, sometimes they have something written on them. But for the most part, the lists are very useful when you go see your doctor.

Chrissy Billau:

Can taking too many pain pills, like Tylenol or ibuprofen cause a problem?

Dr. Srini Hejeebu:

So it's two issues. Tylenol is a different class and ibuprofen is a different class. The old adage of, too much of anything is not good for you, is absolutely true. You can actually overdose on Tylenol. So for example, if you take more than 4,000 milligrams of Tylenol in one day, you can start affecting your liver. So it is dangerous. If you're needing that much pain medication, then you really need to come and see your provider.

Now, ibuprofen's a different class of medication. So it can cause ulcers, it can affect your kidneys, it can interact with other drugs. Like say if you have heart disease, it can affect your heart medicines. It can actually raise blood pressure too. So there's a lot of things ... again, a small burst of these pain medications are very good. If you're taking it repeatedly, that's something that you should bring up to your doctor and make sure he's aware that, I'm doing this. And maybe there's something underlying, like the physical therapist said. You may be hiding something that we're not treating. We want to know everything that's going on so that we can get to the bottom of it.

Chrissy Billau:

I know we're talking about a lot of the side effects someone would experience if they're misusing or overusing medication, right? I want to make sure I have that right.

Dr. Srini Hejeebu:

Correct.

Chrissy Billau:

Okay.

Dr. Srini Hejeebu:

Correct.

Chrissy Billau:

So at what point can you be abusing a medication? I know we talked about Tylenol a certain amount, but is there a threshold that you see?

Dr. Srini Hejeebu:

So every medications, there's a difference. Some people tend to overuse even something like a Prilosec for their stomach. You can actually overdose on Tums, believe it or not. Tums is something that is readily available. People, when they have a heartburn or they ate something that didn't agree with them, they'll pop a couple. Two Tums is almost 2,000 milligrams of calcium a day. So you can imagine if you take two of those every six hours, you're overdosing on calcium. So too much calcium can be bad for you too. You can overdose on multivitamins, you can overdose on vitamin D, and too much of that can cause problems.

So, absolutely. You want to take what's recommended, prescribed, what's on the label if it's an over-the-counter medication, and try not to go over that. Again, if you're needing more than that, then you need to bring it up with your doctor and say, okay. There's something I'm not ... I'm using this, this often. And I'm still having this issue.

Chrissy Billau:

What about NyQuil? I always joke with my husband, I can't fall asleep. I'm going to take a shot of NyQuil and it's going to be great. How much is too much of that?

Dr. Srini Hejeebu:

Well, so that's an interesting one. If you look at the ingredients of NyQuil, there's a little bit of alcohol in there. There's a little bit of an antihistamine or Benadryl in there, so that's what's making you sleep. So again, you should probably come back to, why am I not able to sleep? Rather than just taking it over and over again.

And there may be other issues, some other stressors that we could talk about. Some other anxiety. Is it work related? Is it school related? Is it home life? Come to the bottom and try to treat the underlying problem, not just giving more medication.

Chrissy Billau:

Common themes just keep coming out. Because our sleep specialist, his big thing was if you have something on your mind or whatever, one of the things is make a list.

Dr. Srini Hejeebu:

Correct. And I often do this with my patients, where, everyone gets a headache. And people that get repeated headaches, I always say, keep a diary. Tell me what you're doing when you get this headache. Are you watching TV? Are you in front of the computer for hours on end and the just staring at a screen is causing a headache? Believe it or not, the diaries help for anything. If you're having a lot of GI upset, okay, what are you eating? What are you drinking? How much caffeine are you taking? All of those matter. It can be something simple as a sports drink. People don't realize that you can actually ... there's a little bit of a laxative in certain sports drinks. That if you take too much of it, you'll start having a lot of diarrhea, and you don't realize it.

So I think athletes in the world, they're very careful in what they put in their body. We should be the same way. We should approach this as athletes and try to take care of this body, because we only have one body. If we don't take care of it, it's going to start failing.

Chrissy Billau:

Let's talk about good bacteria and bad bacteria. How can taking pills without talking to your doctor first impact the bacteria in your body?

Dr. Srini Hejeebu:

So one of the things that ... antibiotics are very good. They treat infections. But if you take too much or don't finish it, some of the bacterias, we can actually kill the bacteria in your gut. And you can actually develop diarrhea from killing the good bacteria in your gut. So antibiotics, you should always take them like prescribed, and finish the medicines until they're gone. Don't ever stop in the middle and start in the middle. Take it from one to seven days, one to three days, whatever the recommended dose is.

Chrissy Billau:

Okay. So even if you're like, you know what? I'm feeling better so maybe I'll save the rest of these for the next time I guess.

Dr. Srini Hejeebu:

Correct. Yes. And so your infection may not be completely treated, and so it may come right back. So the antibiotics that we have nowadays, they're very broad spectrum. And we try, in the hospital at least, we try to narrow it as quickly as possible because we don't want to kill all the bacteria. There's lots of bacteria in our gut. We have bacteria on our skin that's always there. So we're not going to try to kill everything. We just want to kill the one that we are pointing towards, like a pneumonia or sinus infection, things like that.

Chrissy Billau:

This one's the million dollar question. Is there a magic pill?

Dr. Srini Hejeebu:

Is there? I wish there was. And I wish I can invent one, because ... No, there's no such thing as a magic pill. I think eating healthy, exercising will keep you healthier, better than taking more and more pills. There's no pill for every issue. And sometimes because of drug-drug interactions, these pills actually cause more problems. So if you can try to avoid medications, that's the best way to take care of your body.

Chrissy Billau:

What's funny is across the spectrum ... and you said it right off the bat. Whether we were talking to the cardiovascular surgeon or the sleep specialist or the physical therapist, they all said exercise is your magic pill.

Dr. Srini Hejeebu:

Absolutely. It's funny, a lot of patients come in ... everyone's working hard. I mean, everyone has a difficult job. We like to say we work eight to five and then we turn everything off. And it's not true at this age. We're working 10, 14 hours, and your body needs rest, and your body needs exercise. Exercise actually gives you more energy, believe it or not. And I can't stress that to my patients enough.

Your body enjoys it, it needs exercise. You can't just sit in front of a computer for 12 hours and then go to sleep and then do it all over again. It's not going to function well. Eating a healthy diet is very important. People with fancy cars, they get the highest octane gasoline. Why do they do that? Because the engine runs a little bit better. It's the same philosophy. Your engine is going to run depending on what you put into it.

Chrissy Billau:

Now let's look at the opposite effect of when we're talking about medications, those who aren't taking the medications prescribed to them. Why do you think people stop? Why do they stop listening to you or following the path?

Dr. Srini Hejeebu:

Stop taking the medications that you prescribed?

Chrissy Billau:

Yes. They said, you know what? It's not working for me. I'm not doing it. He doesn't know what he is talking about.

Dr. Srini Hejeebu:

So I think we want immediate response, or immediate effect nowadays. We're in social media, we have immediate information or immediate results in our palm of our hands. Medications take a while. Certain medications may take up to three to four weeks to reach their maximal effect. And if you don't reach that effect, then we need to titrate further. So you can't give up on a medication.

It goes back to having a good conversation with your physician to say, okay, this is my response to this. I don't know if it's working. Is there other options? Other options meaning changing the medication or titrating it.

Chrissy Billau:

When you say titrating, what do you mean?

Dr. Srini Hejeebu:

Titrating means increasing the dose. So whenever we prescribe the medication, we want to start with the lowest possible dose so that there are the least chance of side effects. So if you go too high immediately, the chances of side effects are higher. So we start slow and then titrate slowly up. And certain medications, there's higher doses that are available that people are unaware of.

Chrissy Billau:

For people who have the complaint of, I don't think my doctor's really listening to me. I'm going to take care of this myself, I'm going rogue. How can you help someone make the most of their doctor appointment and communicate what's happening?

Dr. Srini Hejeebu:

So I know as physicians we get frustrated when there's this laundry list of things that they come in with, but actually, that's actually a good way to do it. Write things down. A lot of my elderly population, their children actually write things down for them. So when I'm talking to them, they'll say, no, mom. This is what's been going on. So actually, writing things down in a list and bringing that. And it's better to have one really good visit that lasts 20 minutes to 30 minutes, rather than coming three, four times in three to four weeks repeatedly, trying to figure out what's going on.

So, absolutely. Write everything down and take this list. Now, the doctor may say, you know what? Number one and number two are the most important, let's focus in on those two. We'll talk about number three and number four the next time, as they're not as pressing. I actually like the list, nowadays. And when I first went into practice I'm like, oh my gosh, they have a list. But I actually like it. I think it's a good thing.

Chrissy Billau:

I am that person who goes with my mom. I am the overcommunicator. But that has helped ... the experience of, they prioritize. Because I don't know what I'm talking about and I can't fix this. I need help.

Dr. Srini Hejeebu:

So again, we're not alone. So when you come into my office, you'll see my nurse first and then she checks a few vitals. But as much communication as you can give, it is actually helpful. One of my nurses that worked with me for about 14 years then she retired, often, she would actually come up with a diagnosis before I even saw the patient. She would say, I talked to her about this last week and I told her. Now she doesn't remember anything about it. Guess what? We just diagnosed dementia. Or early Alzheimer's.

I mean, so it's important to not only have a good relationship with your doctor, but also the staff, because the staff gives us a lot of information. Even when you call on the telephone, the staff is always communicating with us. So we actually get lots of information.

Chrissy Billau:

That's good to know. Especially for ... I don't know the listeners. But for the people who, I just want my mom to feel better. But knowing that everybody's listening and everybody's trying, that is wonderful.

Dr. Srini Hejeebu:

And that's our number one goal. People don't realize that. I mean, we want you to feel better. The whole reason ... you may not take all my advice when I say diet and exercise. But that's our goal. I mean, why are we in medicine? To make you feel better. To live as long as you can in a healthy environment. I love taking care of people in the hospital, but I want you out of the hospital. I don't want to see you in the hospital. I want to see you in my office twice a year. That's it. And I feel like I've done my job then.

Chrissy Billau:

Now I'd like to switch gears, and talk about where people are taking their medical questions. In a study done, I think the National Library of Medicine, COVID-19 ... also being called the info-demic. Has flooded the internet with false information about COVID and vaccines. And it's just a slippery slope. But you also have other social media influences. Did you hear about the Benadryl challenge on TikTok a few years ago? And there's also self-diagnosing ADHD with a TikTok algorithm. What is going on?

And then you have some people using ADHD medication as a study aid. Like for high school and college students thinking that these stimulants might help me focus for a last minute project or cram for an exam.

Dr. Srini Hejeebu:

And get to that university that you had number one on your list.

Chrissy Billau:

Oh my goodness. And then the big whopper, which could be a whole thing in itself, the impact of social media on mental health. So people develop a relationship with people on social media who say, this stuff is safe or it works. And this influencer can be really engaging and they might appear trustworthy. How can you verify it so you don't hurt your body?

Dr. Srini Hejeebu:

So again, this is the biggest problem in our field right now, is there's information, and then there's all of this other stuff. Now, I know you're in front of a microphone, but if you have a microphone or a camera and you put it on the internet, what you say is gospel, all of a sudden. And that's happened over the years. And it's a hard battle. You truly should get information from medical providers and not ... I mean, you can bring it up. If you see something on the internet, bring that up with your medical provider. Don't just take it because they said so. COVID was really difficult, people asking for different types of therapies because they saw it online, or I think ... what was it? Joe Rogan from XM Radio said it on his radio show. That that's what he took and he felt better.

Well, everyone reacted to the virus differently. Some people had a mild illness, some people had it in between. I was sick in bed for four or five days. Some people got really sick and they were in the hospital for nine months. So one blanket statement does not fit all. My suggestion is, sure, you can review the information, but I would go to reputable articles. There's actually medical articles available on Google now, where you can look these things up, look at the studies. Look at American College of Physicians, New England Journal of Medicine, Journal of the American Medical Association. These are more reputable. And I tell my patients ... especially when the vaccine came out. They were asking me, is it safe? And I said, well, it was available December 22nd and I got it December 23rd. So if I put it in my body, I feel it's safe. This is my recommendations. I read the studies.

So it goes back to talking with your provider. I think that's your source. And that's what primary care is there for, to answer all these questions. There was something on the internet that they said that if you're a diabetic and if you took cinnamon, it would cure diabetes. This was a few years ago. People were taking cinnamon tablets. And I said, okay. Yeah, that's fine. It shouldn't hurt you, but I don't feel like it's going to help you. And I always talk about there's no evidence, there's no studies to show that this is a benefit. Now, that doesn't mean that it won't work, but it's unlikely that it will benefit you. Now, when I see things that are harmful, then we have a little bit more of a conversation about, I truly believe you shouldn't do this. And here are my reasons.

Chrissy Billau:

Are there any reliable sources on the internet? Say if I can't ... I'm not the person who's going to read a study and be able to understand the detail. Like say, WebMD comes up. Is there anything?

Dr. Srini Hejeebu:

Yeah, those are really good. You're absolutely right. The average person does not understand how to read a study. In med school, we are taught how to read studies. And even, you have to tease out even the simple things as who paid for the study before you start reading. Because there's biases in everything, in every study that's published. So you have to make sure that there's not a lot of biases. Did you only include 20 to 30 year olds in your study and then all of a sudden, you had really good outcomes? So you have to look at that. And that's what we're taught in medical school of how to read a study.

So going back to the average person, absolutely, I think WebMD is a good start. There's other sites, even some of the national organizations, they do have for health healthcare providers and the average person. If you're looking at a medication, actually the company's website does have some information that you can get some good information that is accurate.

Chrissy Billau:

Nothing beats a conversation with your own doctor. But in that moment of, do I call my doctor? Let me see.

Dr. Srini Hejeebu:

These conversations can't happen over the phone, right? It's not a call. You have to make an appointment and try to figure out why we're talking about this. And then come back to, okay, what's the best method?

Chrissy Billau:

Now, technology and your health. So I have my Apple watch. And there are other health and fitness trackers out there. But for my TMI of the day, I find the most useful, the period tracking. The menstrual cycle. That makes a huge convenience in my life, that I love this thing. But there's so much more. Your heart rate at any moment. You can do an ECG at any time. What kind of technology, or do you recommend any kind of technology to people who are looking to improve or somehow benefit their health?

Dr. Srini Hejeebu:

Well there's so many out there. The EKG one is a really good one for the elderly. I mean, it all adds up. Sometimes a lot of these things will sit in the corner, and so you want to use something that would be most beneficial a majority of the time. The trackers that monitor your steps, monitor your heart rate, monitor blood pressure, those are very good. The apps are very good.

In my diabetics, I actually have a food app that I recommend, that you can actually see what you're eating. How many carbohydrates you're putting into your body at each meal.

Chrissy Billau:

What is that app?

Dr. Srini Hejeebu:

On the app store, just look at diabetic diet, and then a bunch of them come up. I think this one was from Novo Nordisk, which was one of the companies ... it was a free app. And so it actually tells you at restaurants, it'll pull up restaurant information about how much fat is in a, let's just say a cheeseburger in that restaurant. How much carbohydrates, how many calories it is. And it actually puts everything on a plate and it tells you the total number of calories at that meal that you're going to take.

And again, you don't want zero calories, but you don't want 2000 calories at a meal. You want something in the middle. And so if your goal is to try to lose weight, you want to reduce the number of calories you're eating.

Chrissy Billau:

Dr. Hejeebu, as we talk about common themes, what is the most common question you get asked by your patients, and what do you tell them?

Dr. Srini Hejeebu:

Ooh, that's a good question. So I guess since we're talking about diet and exercise, I guess they always ... the first question is, how much exercise can I do? And my starting point is 150 minutes a week, which isn't very much, right? And when we talk about exercise, people think, oh, I need to go run a marathon. I need to go to the gym and lift weights, bench press 300 pounds, things like that. It's as simple as going for a walk for one to two miles. You start at one to two miles and increase. And I always tell them the difference between walking two miles and running two miles is you'll get done faster if you run it. Walking two miles, getting your heart rate up, is just as good. So you want to start there.

And then increase as your body allows it, as you ... timeframe, do you have the time for it? Those are the things that ... But I start with 150 minutes per week, and then go up. Now when we talk about diet, there's so many. Obviously, fad diets. The question is, what's the perfect diet? If there was a perfect diet, we would not be talking about this. Everyone would be perfect weight, we'd be ideal, we wouldn't have any health problems. The reason they're called fad diets is because they make you yo-yo. You go up and down. It's not sustainable. I think there was one time there was rice cake diet, where people just ate rice cakes for two meals and then ate a full meal. But how long can you keep that up?

Chrissy Billau:

That sounds awful.

Dr. Srini Hejeebu:

Yeah, it doesn't have to be a structured fad diet. Just look at what you're eating, is what I tell them. Look at your meal. Breakfast, lunch, and dinner. Look at the types of foods that you're choosing and look at the amount. And if you want to diet, if you want to lose weight, you reduce your calorie intake between 10 to 25%. So it's a smaller portion of that piece of meat, a smaller amount of those french fries. If you're a dessert person, a smaller piece of dessert. That's all you need to do. And exercise. You will lose weight. And then it depends on how much people want to lose. But even our diabetic patients, we talk about portion sizes. And when we eat our meals, we tend to eat with a plate and we just pile things on and we try to get everything on it. And look at that plate. And if you take away 10 to 20%, you'll probably consume less calories and you'll be on the right track.

Now, the other thing we tend to do when we eat is we eat too fast. We're all in a hurry. If we sit down to have a meal, if you eat slower, drink water, you'll tend to eat less, you'll actually consume less. Because your body, your stomach has to catch up to your brain to say, okay, I am full. If you consume 2,000 calories in less than five minutes, and by the time it comes back, you've overeaten. Your brain's like, ugh, I ate too much. That's because you ate too fast. So it's slow, methodical, less portions, and then exercise.

Chrissy Billau:

Okay. And would you like to talk about your practice at all, anything you've been working on lately?

Dr. Srini Hejeebu:

My area of interest, obviously, is cardiovascular disease and diabetes. I do a lot of research in this area. We've been doing clinical trials at the university for the last 28 years in diabetics, and I enjoy that. And we're also working with other schools in Ohio and we're targeting diabetes and high blood pressure. It's called Cardi-OH. We're all working together to try to improve the education in the population, so we're trying to put out information. And also talk to providers about the latest and greatest in treatment options.

So that's what I do. And also, obviously I take care of my outpatient, and then I also do inpatient. So it's a mixed bag. And then, obviously, I teach medical students and residents.

Chrissy Billau:

So you're really busy, and we really appreciate your time. Thank you so much for being here.

Dr. Srini Hejeebu:

Oh, thank you. It was fun.

Chrissy Billau:

If someone wants to see you, how can they schedule an appointment with you?

Dr. Srini Hejeebu:

The Comprehensive Care Center, located on Glendale. Reach out and make an appointment to see one of our providers. I think in our practice of internal medicine, we have about 17 providers. Physicians, physicians assistants, and nurse practitioners readily available to take care of you.

Chrissy Billau:

Thank you for listening to Prescribed Listening. If you like this episode, subscribe for more on your favorite podcast platform. See you next week.