Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well-being. And now here are Ron Aaron and Dr. Tamika Perry.


CARMENN MILES
Hello and welcome to the award winning Docs in a Pod, presented by WellMed. I'm your host, Carmenn Miles, sitting in for the distinguished award winning veteran broadcaster, Ron Aaron Eisenberg, who's on assignment today. Our Docs in a Pod co-host today is the vivacious people's doctor, Dr. Tamika Perry. How are you?


DR. TAMIKA PERRY
Hey, Carmenn. I'll send you your check for that introduction in a second. Thank you. I appreciate the vivacious part.


CARMENN MILES
I'll be on the lookout. Dr. Perry is an associate medical director at WellMed, overseeing several large clinics in the Optum Care North Texas region. Dr. Perry is board certified in family medicine by the American Osteopathic Board of Family Medicine. Dr. Perry, I don't know how you do it, but you do. You do it all, and you do it well, I might add. What's your secret?


DR. TAMIKA PERRY
I don't think I have a secret. I think it's just straight up girl power. I think probably everyone on the podcast can attest to that. We need to ask Dr. Stephens what’s her secret, to be honest. She takes care of it a lot. I think what keeps all of us grounded is finding something that we like in life, and I like traveling, so that's what I do. So, in a few weeks, I need no one to bother me for a week because I will be in Paris. Doing what? Seeing who? My favorite artists of all time, Beyoncè.


CARMENN MILES
Oh my gosh, that's fantastic. Not only do you get to travel to Paris, but you get to experience, beyond, say, the phenomenon we call Beyoncè. I'll tell you what, we're just thankful that you take time out of your busy schedule and your busy travel schedule to have these important conversations. Today's very important topic of discussion is arthritis and inflammation. Arthritis is a condition that seems to affect a large part of the senior demographic, especially. I would be shocked, honestly, to meet someone or anyone who doesn't know at least one person who suffers with arthritis. But before we get too far down the tracks on this important subject, Dr. Perry, let's welcome today's guest. As you mentioned, our guest today is no stranger to Docs in a Pod. Dr. Amber Stephens is a board certified family medicine physician. She received her medical degree from Drexel University College of Medicine in Philadelphia, Pennsylvania, and completed her residency at Bayfront Family Medicine in Saint Petersburg, Florida. Dr. Stephens is affiliated with Optum - main clinic. She's married, and is a self-proclaimed baseball mom to two boys. She has two dogs, two cats, a bearded dragon, and 40 snakes. Well, I just learned maybe 44 snakes. Now, I really wanted to end that, Dr. Stephens, with a partridge in a pear tree. But 40 or 44 snakes is way more interesting, I must say. How are you? And welcome to the podcast.


DR. AMBER STEPHENS
Oh, thanks for having me. We're doing well. Actually, I think that number is quite a bit higher than that now, to be honest. I think we're probably topping somewhere in the 120 range.


CARMENN MILES
Oh, my goodness.


DR. AMBER STEPHENS
We actually have three dogs now.


CARMENN MILES
Well, we will definitely make some changes.


DR. AMBER STEPHENS
I was just telling Dr. Perry that we moved our office, so it's now Optum - Pinehurst. That literally just happened over this last week, so it's been wild and crazy and there's lots going on on every facet.


CARMENN MILES
Sounds like an exciting home life and exciting work. Good balance, right?


DR. TAMIKA PERRY
Dr. Stephens, you could technically put a sign up that says, like, watch or petting zoo and charge people to come to your house to look at all of your animals. I mean, kindergartners could have field trips to your house.


DR. AMBER STEPHENS
Potentially. I have a feeling the HOA might have an issue with the school bus pulling up, but the possibilities there.


DR. TAMIKA PERRY
Yeah. I was like, this is amazing. But nonetheless, as I digress. Talking about arthritis. What's the deal, Dr. Stephens?


DR. AMBER STEPHENS
What's the deal with arthritis? Well, most of us, I feel like, that work for WellMed and Optum, the vast majority of our patients are over 65. Obviously, the demographic that's listening to us also generally falls into that category. But because of that, we just see a lot more joint degeneration in general. I think we see a lot of chronic pain issues related to this for multiple reasons. Some people had very exciting younger lives and had sports injuries, and they're dealing with fallout from that now. Some people have maybe carried a little bit more weight than they maybe should, and that's been causing issues. Some of it's just genetic, bad luck. For whatever reason that it's occurring, it's occurring. For a lot of patients, you can see arthritis on imaging and it doesn't cause pain. It doesn't cause any issues. But for obviously a very large portion of the population, they do have joints that bother them, and we're here to talk about what we can do that doesn't necessarily involve drugs and prescriptions, if I'm correct.


CARMENN MILES
Yeah. Dr. Stephens, most are familiar with the term arthritis. But let's step back a few steps and talk about that. Arthritis is not created equal, right? There are hundreds of different forms of arthritis, if I'm not mistaken. If you'd explain that and maybe share with us some of the more common forms of the disease.


DR. AMBER STEPHENS
The most common form is going to be osteoarthritis. It's going to be the degenerative joints where over time or post injury, it's a reaction in the joint space where the bones are trying to protect themselves or they're degrading a little bit because they've lost cushion or have had excessive pressure or injury. So, the resulting change within the joint itself can cause pain because of the bones rubbing against themselves in a way that shouldn't be happening. That's the most common. That's what we see the vast majority of the time. However, yes, there are other kinds of arthritis. Usually you classify arthritis as osteoarthritis, or you're classifying it as some sort of autoimmune inflammatory arthritis. That's where we start talking about things like rheumatoid arthritis, psoriatic arthritis, a whole slew of other things. Lupus, ankylosing spondylitis. I can throw out lots of names, but they don't mean a lot if you don't know what they are. And it really doesn't change the picture because they're inflammatory and the process is autoimmune. So, because the process is so different, the treatments are somewhat the same, but also very different because you're treating inflammation, but you're also trying to treat the root cause, which is what that autoimmune process? Whereas with osteoarthritis, a lot of it's geared at treating function and just reducing inflammation and pain. So, our approach is a little different. The end result for patients, you can have a progression of that arthritis much quicker if it's autoimmune. However, osteoarthritis tends to just be an over time situation unless there's a really strong genetic component. But like I said, a lot of that has to do with how you approach treatment plans, and the medications that we used to treat tend to be more geared towards, you see commercials on TV and stuff, a lot of that's more geared towards those autoimmune issues.


CARMENN MILES
Dr. Stephens, this is great information. I want to allow you to continue, but let's just take a moment to say hello to some of our listeners that may have just joined us. You're listening to the award winning Docs in a Pod with our co-host, Dr. Tamika Perry. I'm Carmenn Miles sitting in today for Ron Aaron Eisenberg. Docs in a Pod is available wherever you listen to podcasts. Dr. Stephens is our guest today, and we are talking about arthritis and inflammation and sharing lifestyle tips for relief. Dr. Perry, let me ask you, how common is this disease, and can other issues like infections and injuries bring on arthritis?


DR. TAMIKA PERRY
Yeah, absolutely. Like Dr. Stephens was explaining earlier, arthritis is extremely common, particularly osteoarthritis. What does the word arthritis mean? It literally means inflammation of the joint. So, you can get that inflammation from a plethora of things, most commonly wear and tear. The thing I think I remember most is, Dr. Stephens and I are from the Shaquille O'Neal era, and when he retired, he started doing Bengay commercials. Because it's wear and tear on your joints. I always explain to my patients, my patients will be like, well, I never had arthritis before, but you've never been 70 before either. The time that we come out of our mother's womb, we're using our joints, we're wailing around and we start crawling, then we start walking. Particularly the large joints, shoulders, hips, and knees. We use these weight-bearing large joints. So, we start to say, okay, what are the types of arthritis, like Dr. Stephens alluded to. So, you can get inflammation of the joints, not just from wear and tear. Because remember, we use our joints every day like the brake pads on our car. They go out, they start squealing, you need to change them because we use it every day. You can also get it because your body attacks your joints. That's what Dr. Stephens was alluding to earlier. There are certain types of arthritis you can get because you get an infection. I remember early in my career there was a very pretty cheerleader who came in and she thought that her ankle was hurting because she was doing a cheer routine. Home girl, it’s because of a disease. Because you may be behind the bleachers with a young man you shouldn't have been. Sometimes with chlamydia, you can get mono articular arthritis. It can be concentrated in one particular joint. So yes, our infection can cause arthritis. Yes, eating maybe the wrong foods in the wrong environment like gout. Eating foods high in proteins can cause a type of arthritis. It’s extremely common, so when you come and talk to me or Dr. Stephens, we're going to ask you a battery of questions to figure out what type of Arthur is it? We're going to look at what type of patient. Is this a teenage girl, or is this a 70 year-old man who's been a truck driver his whole life?


CARMENN MILES
That's a thing that's interesting that you touched on. When we think of arthritis, we think of older adults, and how it can be so debilitating to them. I'm curious to know, can it also affect children and young adults? And are there some people who are just genetically predisposed to some forms of arthritis like that?


DR. TAMIKA PERRY
I’ll let Dr. Stephens take that one away.


DR. AMBER STEPHENS
I mean, for sure you can have a genetic predisposition. If you have a family history that's full of, even if it's osteoarthritis, it can start occurring earlier in life. There are some autoimmune arthritis issues that can actually affect younger people, particularly things like juvenile rheumatoid arthritis. Some of those patients are very young, under 10.


CARMENN MILES
We're talking about arthritis and inflammation today with co-host Dr. Tamika Perry and Dr. Amber Stephens. We'll be back right after this message.


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CARMENN MILES
Welcome back. I'm your host, Carmenn Miles, sitting in for Ron Aaron Eisenberg on Docs in a Pod. I'm here with co-host Dr. Tamika Perry and our special guest, Dr. Amber Stephens, talking and discussing arthritis and inflammation. Dr. Stephens, when you have a patient who voices concerns about maybe experiencing dull aches or joint pain, inflammation, or maybe they're just feeling sluggish, these are symptoms that can signify a lot of medical conditions. How do you, as a medical expert, determine when a patient's symptoms are actually due to arthritis?


DR. AMBER STEPHENS
Well, as you mentioned, hearing history is easily 90% of that. So, talking about how long things have been going on, what joints are affected, what specifically they're feeling like, does it feel like it's creaking or crackling. Is it more swelling pain? Do they get redness? Like we had mentioned gout earlier, that usually has a very different presentation than some of the other arthritis options that we have to look at. Family history definitely plays a role. If you've got a lot of people in the family that all have rheumatoid arthritis or lupus or even just any autoimmune disorder, that puts you at risk for those immune disorders. So, taking a really good history is the first part of that. Not just trusting the Dr. Google's answer, I would argue, would be a good point, too, because it's a big-picture situation. So, if I have someone who comes in and they're over 65, and maybe they are having pain in their toe, I'm not going to immediately think that this is osteoarthritis. This I'm going to be going, okay, well, maybe this is gout. Was there an injury? Maybe there's tendonitis. Maybe it has nothing to do with arthritis. So, the picture is not as clear cut as people sometimes assume it's going to be. So, I would argue taking that history and then looking at the picture from an exam, doing an exam of the joints that are affected. That's something that Dr. Perry and I are trained to do. If the imaging is appropriate, ordering whatever imaging would be beneficial. And it's not just, hey, something hurts, we x-ray it. It's is something going to happen with that information that we get? I saw someone this morning who had knee pain. I did an exam. I don't know that the x-ray is really the benefit. I think we're having a tendonitis issue. So, we discussed exercises. I said we can revisit an x-ray in the future, but I don't think that that's going to give us the information we need because as I mentioned, a lot of people have arthritis on imaging. It doesn't mean it's causing the problem. So, just because we see it doesn't mean we have to deal with it because you don't want to do something that's not necessary either.


CARMENN MILES
Correct. That's great information. That's why we rely on the experts.


DR. AMBER STEPHENS
If you do the imaging, if you do your exam and you're concerned about autoimmune disorders, there are blood work tests that we can do in addition to that, depending on the image that we see with x-ray. Maybe there's a role for MRI follow up or CT depending on the part of the body. So, there are a lot of different avenues we can go for a diagnosis. Then once we get that diagnosis, there are pharmaceutical options. There are over-the-counter options. There are physical therapy topics. There's a whole slew of things we can look at doing. But one of the other things I talk to my patients about is, what can we do that you have control over, especially when you start talking about osteoarthritis. Optimal body weight, joints, hips and knees and feet and ankles do not like having a lot of extra weight on them. Trying to get down to an optimal body weight. Keeping mobility. When you look at the recommendations for osteoarthritis, the very first thing is weight loss. The second thing is regular exercise. Then depending on the joint, potentially some sort of intra articular steroid injection, if it's necessary. I wouldn't necessarily jump to that right away. It's something I do a lot of in my office and I'm very comfortable doing, but we usually try non-aggressive or non-invasive options first if possible. And then looking at sometimes even diet. I've had patients that they've pulled out certain things in their diet and they felt better. I personally feel better. I have less joint pain. I'm in my 40s. I have some arthritis and some of it's from family history. My family just has some of that stuff going on. I have a history of a surgical intervention in my wrist when I was very young. I have arthritis in my left wrist. It's not even weight-bearing, but when I eat too much dairy, everything hurts more. And that's across the board. So, realizing that maybe there's things that can be addressed from a patient standpoint can go a long way and then avoid things that potentially have side effects or risks.


CARMENN MILES
As we're having this conversation, I'm thinking about my aunt. She's better at predicting the weather than any weather man or weather woman. And I'm not kidding. She never, ever steers us wrong. And when I ask, how do you know? She says, oh, Mr. Arthritis told me. What, Dr. Perry, does my aunt mean when she claims that Mr. Arthritis informs her when inclement weather is approaching. You help me out.


DR. TAMIKA PERRY
Our friend Arthur, when he moves into the joint space, he usually brings his wife, his side girlfriend, all of his outside children and it is hard to evict him from the joint space. But when there's changes in the bariatric pressure outside, it really gets him riled up. There's inflammatory markers that are kicked up and increase in your body, and that's why you can kind of predict whether that's happening. You become a barometer when you have arthritis. My grandma used to say all the time, it's about the rain because my shoulder hurts. And I thought, oh Lord, my grandma is getting dementia. It wasn't dementia.


CARMENN MILES
It's not just my family.


DR. TAMIKA PERRY
Yes, I had to go back and apologize to my grandma. You're right. I'm sorry. I learned this in med school. That's absolutely, positively correct. Dr. Stephens said something earlier about Dr. Google and warning the patients against Dr. Google. I had a patient once who came and told me that Dr. Google told him that he had forehead cancer because he had a big cyst on his forehead. It was just specious that we cut it open and his forehead cancer was elevated immediately. So, do not rely on Dr. Google. Come see myself, Dr. Stephens, your PCP, so we can put all the clues together to let you know this is osteoarthritis, not rheumatoid arthritis. Dr. Stephens and I, we ask you which joints? Because if it's the weight-bearing joints, we start leaning towards osteoarthritis. If it's the small joints in your hands that are bilateral, meaning both sides of your body and you're a girl, and you said my grandma had these same types of arthritis, these funny looking hands. We're going to be like, oh, it's maybe rheumatoid arthritis, and we're going to do some of these blood tests. Because even though this is all inflammation of the joint, like Dr. Stephens said earlier, what does this inflammation come from? And it's so important like Dr. Stephens alluded to that you get to know your body. So, if there are foods there invoking inflammation in your body. That's not the food for you. We don't want to do that anymore. Not only does your weight have to be optimal because, I'm a country girl, so if I say for reference pickup trucks, y'all forgive me, but you can't have a little bitty pickup truck and then put a Ford F-150 frame on top of it, right? It's not going to work. Same thing with your joints. You're going, help me, right? And on top of that, fat cells themselves, Adipocytes, release inflammatory proteins, inflammatory markers. So, this is a whole ugly cycle that goes on. So, you have to eat the right thing. You have to be the right body size. You have to exercise. I'm not telling everybody to be 120 pounds. I'm saying like she said, what's optimal for you? But you have to know your body to find that out. What is optimal for you?


DR. AMBER STEPHENS
I will never be 120 pounds less. Let’s just put that out there. I am 5’9”. There is no frame here that will ever be 120 pounds.


DR. TAMIKA PERRY
Right? Never, ever, ever. I think I was born at 120 pounds.


CARMENN MILES
Exactly.


DR. TAMIKA PERRY
I was like, what's optimal for you? Because we really need to know. When my patients say, I know my body, you do know your body, so you give me the clues and tell me, and then we're going to figure out together what's going on. Not me, you and Dr. Google, but me and you.


CARMENN MILES
Dr. Stephens, once a patient has been diagnosed with arthritis, is there a possibility of being cured?


DR. AMBER STEPHENS
I'm going to go out on a limb and say no because the process is still there. This is very similar to the conversation I have with my patients who are diabetics. You can control problems with lifestyle changes and weight loss and doing all the right things. But sometimes things just progress and there's nothing we can do. Even when you're doing all the right things, they can still progress. Sometimes they're well controlled, but if you start doing the things that you used to do that made it worse, it's going to get worse again. So, I would say a better way of putting it, saying not cured, but I would say, under control, optimized.


CARMENN MILES
That makes sense.


DR. AMBER STEPHENS
I wouldn't even say having a knee replacement, that's not cured. That's treated because that has other issues associated with you. So, I would not say that there is a cure for any of this, which I realize is very demoralizing for some patients. But the reality is there are things that you can do to improve your quality of life. So, I wouldn't throw in the towel just because it's not going to go away.


DR. TAMIKA PERRY
Absolutely not. I tell patients all the time, like Dr. Stephens was saying earlier, we may see arthritic changes on x-ray, but it doesn't mean it is changing your life, but those changes are going to come and they're going to be there. We're going to see joint space narrowing over time. We're going to see sclerosis around the bones. And these are arthritic changes that we may or may not feel. You age on the inside, just like you age on the outside. I can't ungrey my hair. I can cover the gray, but it's still there. And I'd like to thank the good people at Miss Clara because they helped me turn back the time of father time. At least the illusion. I love your streaks, by the way, Dr. Stephens.


DR. AMBER STEPHENS
I was going to say I got about five different colors going on right now here between reds and blonde and browns. So, I don't even know what color it's supposed to be anymore.


DR. TAMIKA PERRY
Yeah, what color is my real hair?


DR. AMBER STEPHENS
That's what I'm saying. It's still there. Your problem is not gone. It just means that we're addressing it one way or another.


CARMENN MILES
With that said, what are some of the tips that you can share today as time is winding down? What are some tips to managing arthritic pain that you can share with us?


DR. AMBER STEPHENS
In terms of managing your pain, I think the ones that we already discussed are the most accessible to patients, which is to optimize your body weight and be active. Every single morning when I wake up, my feet hurt. It doesn't mean I stay in bed. It means I get up and I walk around because as I walk around, my pain gets better and it starts to go away and I feel better. I get up, I go exercise every day because the days that I don't exercise my back hurts. But the days I do exercise, my back feels better. Movement helps this process, and whatever that means for you as a person. Start slow. Nobody's asking you to go to the gym if you're not ready for that. I think we've done podcasts before about getting exercise and being active. There's lots of ways to do this that are not overzealous. Optimizing your body weight, being active, talking to your doctor. I don't want to tell patients to just start taking medicine. I want you to talk to your doctor first, because a lot of the things that are available over the counter may not be the best choice, depending on your health issues, particularly as we get older. Topicals are pretty good. So, things like we mentioned Bengay and bio freeze. There are other things out there like that. Those are always really good safety and safe options. Alternating heat and ice if it helps. Those are things that we can do on our own. Managing your diet goes a long way. Trying and figuring out what things make you feel worse. Keeping a food journal. Food journals aren't two days long. Food journals are 2 to 4 weeks long, and then assessing and looking back. If you're not sure how to do that, talk to your doctor about how to do that.


CARMENN MILES
Thank you.


DR. TAMIKA PERRY
Talk to your doctor. I think that was a great ending point there.


DR. AMBER STEPHENS
Start there, talk to your doctor.


CARMENN MILES
Yes. Talk to your doctor. Well, we are out of time. Thanks to you both for sharing your expertise. I'm Carmenn Miles, along with Dr. Tamika Perry and today's special guest, Dr. Amber Stephens. We'll talk with you again soon on the award winning Docs in a Pod. Thanks for listening.


OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod, presented by WellMed. Be sure and listen next week to Docs in a Pod, presented by WellMed.


DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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