Breathless: Managing COPD

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.

RON AARON
Well, hello there and welcome to the award winning Docs in a Pod. I'm Ron Aaron, along with our co-host today, a nurse practitioner, Desarea Murray. We come to you every week with a look at a variety of health issues involving not only those who are Medicare eligible, but they and their families and others. We talk about medical conditions. We talk about health and wellness and diet and exercise. And occasionally, like today, we talk about our hearts and our lungs and how we can deal with those and keep them healthier. Desarea Murray is a nurse practitioner at WellMed at Mansfield. She has been there for quite a while with WellMed and tells us she always knew she wanted to help people and provide her patients with the care they need. She said it started with her parents, who bought her a Fisher Price doctor's kit. What a great idea. We'll have to have her tell that story. Desarea Murray also has been very active in beauty pageants, and she is a singer as well. When you hear her voice, you will know that. We're delighted to have her with us. Desarea Murray, how did that Fisher Price doctor kit get you to where you are today?

DESAREA MURRAY, NP
Just super impactful, Ron. From the first time I held the little blood pressure cuff and the little stethoscope, I knew this was my calling.

RON AARON
Interesting. We have to let the folks at Fisher Price know. I don't know if they still make those doctor kits. They probably do.

DESAREA MURRAY, NP
They might.

RON AARON
Well, we're going to turn to our guests now who's agreeing they probably make them as well. Rajay Seudath is a physician at Optum University at Optum's Clinic in Tampa, Florida. Earned his medical degree from the University of South Florida's Morsani College of Medicine in Tampa. Completed his residency at the University of South Florida, and he also has been board certified in family medicine. Dr. Seudath, thank you for joining us on Docs in a Pod.

RAJAY SEUDATH, MD
Thank you so much for having me on.

RON AARON
In your practice as a family practitioner, you see folks with a whole lot of issues. How frequently do you see people with things like COPD?

RAJAY SEUDATH, MD
We see that quite frequently. Very, very frequently. Most of my population is 65 and up. So, there is a large majority of the patients who either came from the era where smoking was part of military service, been your C rations or it was just part of the culture. In the fifties and sixties, you'd see doctors smoking in the office so COPD is very prevalent in that generation. So, we see lots of lung disease.

RON AARON
Well, give us the 411 on COPD.

RAJAY SEUDATH, MD
COPD is really a disease of elasticity. When you take a breath in and you exhale, really the exhaling all happens on its own. As COPD progresses, that elasticity basically decreases. So, you're able to get air in, but you're not able to get out. That's what COPD stands for. Chronic Obstructive Pulmonary Disease. Obstructive, meaning you can't get the old air out.

RON AARON
And if you can't get the old air out, you're stuck with a lot of carbon dioxide.

RAJAY SEUDATH, MD
That's correct. The carbon dioxide, if that can't get out, it makes it difficult for oxygen to get in, into your bloodstream, up to your brain, up to your heart. COPD affects your body in many, many different ways. You know, carbon dioxide is actually acidic as well so that can also affect your kidneys over time. It's a far-reaching disease in terms of the metabolic and the respiratory issues involved with it.

RON AARON
How far have we come in providing treatment for COPD and is there a cure?

RAJAY SEUDATH, MD
In terms of a cure, no short of lung transplant. Some patients who have developed COPD early on due to a genetic defect who really don't have any other diseases that would preclude them from a transplant, that could be considered a cure. For the majority of the patients it is a therapy that is to maintain your function, improve your quality of life. There's different levels and those are called the gold criteria based on how sick a person is, how often they go to the hospital. We basically come up with a treatment plan based on where they fall in that algorithm, in that criteria.

RON AARON
When you see a patient and diagnose them with COPD, do you refer them to a cardiologist or can you maintain them in your practice?

RAJAY SEUDATH, MD
For me, I'm quite comfortable with cardiovascular disease as well as pulmonary disease. In my practice, I'm really only sending to specialists for a very specific reason. If I feel this guy has coronary artery disease and he needs to get a stent, I'm sending him to the cardiologist.

RON AARON
Now a stent would be part of a bypass?

RAJAY SEUDATH, MD
Yes, similar to bypass. Bypass you actually remove the artery and put in a new artery from somewhere else in your body. A stent is where they go into a blocked artery, open it up and put basically something in to keep it open. That can, again, be worsened by COPD, be worsened by high blood pressure, cholesterol, poor diets, lack of exercise. I'm sending to a specialist to do that, but the medical management for most of the patients is done by me, the primary care provider. Additionally, for pulmonary disease, I'm really only sending to the pulmonologist if I feel this person needs to have an endoscopy into their lungs, right? So, bronchoscopy is sending a camera into their lungs because I think there's something that's dangerous going on. But for the most part, COPD is managed with medicines and inhaled medicines and therapy for your lungs.

RON AARON
Now asking for a friend, what's the relationship between COPD and pulmonary hypertension?

RAJAY SEUDATH, MD
COPD can worsen and even cause pulmonary hypertension. Especially if the cause of COPD is from cigarette smoking. Cigarette smoking thickens the lung tissue and that in turn will increase the blood pressure inside of the lungs because the lungs are basically like big sponges, right? A sponge has air in it, but it can also have water in it as well. That water in the lung is, you could consider that your blood pressure. The more that's stuck in there, the more that blood pressure, that pulmonary hypertension can worsen.

RON AARON
We're going to pick this up in just a moment, but I want to let folks know who may have just joined us. You're listening to the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. We're also on the radio in Texas in a number of markets, and Florida as well. I'm Ron Aaron. Our special guest today is Dr. Rajay Seudath, who is a physician with the Optum clinic in Tampa, Florida. Our co-host is nurse practitioner Desarea Murray, who is in Mansfield, up near Dallas. We're talking about COPD and related issues. Dr. Seudath, when a patient comes to you first visit, no real background, what is it you're looking for with respect to their overall health, their hearts, their lungs? You name it.

RAJAY SEUDATH, MD
Usually, I'll give them a kind of open-ended question like how do you feel your health is doing? I always kind of start off with, hey, before we begin this visit and we get to the things I want to get to, is there a burning question that you have? Is there something that you want to make sure I address before you walk out that door? That's the first thing, so I know what's their agenda, you know, what is the thing they want? Then within that, I'll ask them, as we're going through things, are you having any chest pain? Are you having any difficulty breathing? Are you having any times where your heart is racing or beating out of your chest? Those are kind of three major screening questions. If they say, yeah, Doc, I'm having a little difficulty breathing. Or, I'm smoking, I think I should cut back. I wonder if that's hurting my lungs. Those are things that zero you into really wanting to help that person to meet those goals.

RON AARON
Do you still have patients who smoke?

RAJAY SEUDATH, MD
Oh, yeah. Yes, and there are patients who smoke and vape as well as cannabis. They're doing burned cannabis as well. All those things have effects on the lungs. Now I can't tell you if you vape for 40 years what's going to happen because vapes haven't been around for 40 years.

RON AARON
It can't be good for you.

RAJAY SEUDATH, MD
Exactly. It's definitely not oxygen and nitrogen, you know, regular air from the environment.

RON AARON
And It's mainlining caffeine.

RAJAY SEUDATH, MD
Yes. Oh, nicotine as well.

RON AARON
I mean, nicotine.

RAJAY SEUDATH, MD
Yes, nicotine as well. And again, that's a stimulant. So, that has effects on blood pressure, which can affect your heart, which can affect your lungs.

RON AARON
Wow. And Desarea, do you have patients who still smoke?

DESAREA MURRAY, NP
Oh, absolutely.

RON AARON
You know, they all lie. Every patient that smokes lies when you say to them, how much do you smoke? Maybe a pack a week. Yeah, right.

DESAREA MURRAY, NP
There's definitely a downplay sometimes and then over time as our relationship develops, I find out the truth.

RAJAY SEUDATH, MD
When it comes to asking about smoking, I'll usually ask them in a nonjudgmental way and I'll kind of build on that. What's your brand? Oh, well, you know, I get the cheap ones. Oh, the Pall Malls or the 305’s? They’ll go oh, you know what cigarettes there are and you know which ones are the cheap ones. So, if I hear somebody say, I'm getting the 305’s, you’re probably smoking every day. If somebody says, I'm getting a pack of Marlboro Reds, that's $10 a pack. You're probably not smoking that every single day cause that's $70 a week.

RON AARON
When I was a kid, those were 50 cents a pack.

RAJAY SEUDATH, MD
Yes, I remember those days. Gas was 30 cents a gallon.

RON AARON
It’s interesting when it comes to smoking because, I confess, I'm a born-again non-smoker. I quit in 1976, and at the time I quit, I was smoking three packs a day. You had to get up early and stay up late to get all those cigarettes in. Now, a lot of years later, there still are after-effects from smoking, even though my lungs are probably better. For the person who says to you, I quit 30 years ago. There's still concern.

RAJAY SEUDATH, MD
Yes, absolutely. And there's screening guidelines for low dose CAT scans to screen that person's lungs. That's one of the things that we want to do because there's always the risk of cancer. We hate to say the big C word and it scares patients to hear that but to be up front about that to empower them to really try to take their future into their hands. If we find something early, outcomes are always better.

DESAREA MURRAY, NP
I agree.

RAJAY SEUDATH, MD
As opposed to, I don't want to know what it's going to be. Oftentimes you hear that I don't want to know what it's going to be. If it's going to take me, let it take me. It's not like God strikes you down. It's a long-lingering experience. So, those low dose CAT scans and there's a guideline for that, I believe it's over 55. I think it's over 50 or 55, you can check me on that. That's if you've had more than 100 cigarettes in your lifetime. That person is eligible for a low dose CAT scan.

RON AARON
100 is like nothing.

RAJAY SEUDATH, MD
Yeah, that’s only five packs.

RON AARON
Five packs, boom you're there. Stay with us just a minute. We're going to come right back to you. We're having too much fun. I'm Ron Aaron. We're delighted you're with us today are co-host is Desarea Murray, who's at Mansfield near Dallas at the WellMed clinic. And our special guest is Dr. Rajay Seudath, who is with the Optum clinic in Tampa, Florida. I'm Ron Aaron. You're listening to Docs in a Pod.

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RON AARON
We are so pleased you are with us today on the award winning Docs in a Pod. I'm Ron Aaron, along with our co-host, Desarea Murray, a nurse practitioner at Mansfield near Dallas at the WellMed clinic. And Rajay Seudath is our specialist. He's a physician with the Optum Clinic in Tampa, Florida. We're talking about COPD and related heart and lung issues. Dr. Seudath, for those who are certainly concerned about their health who think they may have a problem but mostly men who just say, well, I'm not going to the doctor. Why should people come see you?

RAJAY SEUDATH, MD
It's important for us to find issues before you start to have a problem. I hear this all the time, doc, I know my body. I know when something's going wrong with my body. I want to encourage that. When you're feeling something wrong with your body, I absolutely want you to come in. But there are problems that can occur, and we want to catch those early. There's a saying in medicine an ounce of prevention is worth a ton of response. That's really what we want to do. We want to make sure we're giving you the best possible future by doing things now to prevent disease. When it comes to your lungs, what are your lungs' functions, right? Pulmonary function testing, how much are you able to get in and out of your lungs? And then how do we try to improve that next year or the year after that? That's a way that we can measure that to see how you're doing with therapy and with the different interventions that we're doing.

RON AARON
Are there are things we ought to be doing at home to strengthen our lungs?

RAJAY SEUDATH, MD
Oh, absolutely. Even for people who don't have COPD, but especially for people who do have COPD, deep breathing exercises are a mainstay. The way I usually teach my patients is five seconds in, five seconds out, five times a day. You're taking a slow breath through pursed lips in, out.


RON AARON
What he's doing, you can't see this on the radio, is demonstrating and counting. It's perfect.

RAJAY SEUDATH, MD
You can count with your fingers, but five seconds in five seconds out. What you're really trying to do is empty those lungs in a slow, controlled fashion. You're thinking about getting that old air out of your lungs. We think about waste products and excrement. Well, you pee, you poop, you sweat, right? That old air is a waste product. If you think about it, when you're on autopilot, you really don't ever take deep breaths. Everything's kind of just shallow breathing. You rarely get that air at the bottom of your lungs out.

RON AARON
No, the only time you take a deep breath is when the doctor has a stethoscope on your back and says, take a deep breath.

RAJAY SEUDATH, MD
That's right. Or if you're doing something strenuous, right? Or if you do a yawn. A yawn is actually your body telling you, you need to get rid of some of this CO2 and put in some of that oxygen and it forces you to.

DESAREA MURRAY, NP
I thought that was just because we were sleepy.

RAJAY SEUDATH, MD
Well, that's part of it, too. But sometimes when you take that deep breath, you kind of wake up a little bit, actually.

RON AARON
Why is it that yawns are contagious?

RAJAY SEUDATH, MD
Now, I've heard a lot of different things why that is. I've heard that it's a kind of an evolutionary bonding thing. I've heard that it's kind of a social thing. I don't know the full answer on that one, but there's a couple of different media where you can look into some things with some speculation about that.

RON AARON
I mean, even when my cat yawns, I yawn.

RAJAY SEUDATH, MD
That means that you are a social person.

RON AARON
So, when we talk about COPD, I watch television probably more than I should, and I see all these ads where, grandpa couldn't take one step, and suddenly he's got this new medication, and man, he's at the Olympic trials.

RAJAY SEUDATH, MD
Right. Now, those are some of the newer medicines that mix three different types of drugs. There are combination inhalers. Previously we would have one medicine, then we had dual combinations and now we have triple combinations. So, medicines that open the lungs, medicines that decrease inflammation and medicines that help to prevent your lungs from not opening all the way so they actually help your lungs to open a little bit better. Having those types of combination medicines, they can make a big difference. There's certain criteria that you have to talk with your doctor about. Which criteria do I fall in? Which is the medicine that's right for me? Because all medicines are poisons. At the wrong dose, medicines are poisons and at the right dose, they are medicines. The poison becomes a medicine. So, you want to make sure that if you don't need a medicine, we're not giving you something you don't need. But if it's appropriate for you and we feel it's going to help you, we want to make sure you get the right medicine.

RON AARON
Desarea, how do you keep up with all these medications?

DESAREA MURRAY, NP
Lots and lots of reading, Ron. Lots of reading and studying. There are new drugs constantly coming out. I try to make sure I maintain those relationships with specialists, like a pulmonologist, for example, in COPD, and have some colleagues in that area that can continue to help educate me on the drugs that are available. I mean, Dr. S., what are your thoughts on that?

RAJAY SEUDATH, MD
No, I totally agree. It's kind of one of the nice things that we are forced to do continuing medical education to maintain our licenses. A lot of those continuing medical educations are state requirements, but a good portion of those are any general area. So, we can get a lot of what's completely up to date. Then there's different services where we can always look for what's new, what's appropriate, algorithms. There's a lot of different things that we do. The AI have not taken over as of yet.

DESAREA MURRAY, NP
No.

RAJAY SEUDATH, MD
They can try, but really and truly when you're doing individualized medicine, you're not just looking at the person. You're looking at the person, their lifestyle, their social situation, what their family can do to support them, are they VA members, do they get services other places, how is their insurance. I mean you're looking at the whole picture of a person to come up with that plan. These inhaled medicines are just one piece of that.

DESAREA MURRAY, NP
We were discussing earlier how we do things like screenings and things like finding things as early as possible. I wanted to touch on that with those low dose CT scans of the lungs and smokers specifically. I actually have captured lung cancer very early on those screening tests. Have you as well?

RAJAY SEUDATH, MD
Oh, yes, absolutely. It's important to have the follow-up because the first one didn't show it, but I think it was maybe the third or the fourth one about two or three years later where there's a nodule. There's something that doesn't look right. They went for a biopsy, it came back abnormal, they had radiation. And lo and behold, it's been gone for the last five years.

RON AARON
That's a good news story.

RAJAY SEUDATH, MD
Yes.

RON AARON
Without that early screening, that nodule might have become an aggressive cancer too late to protect that patient.

RAJAY SEUDATH, MD
Absolutely. Seeing that nodule, seeing that spot was actually one of the things that spurred that patient to quit smoking, ultimately. They were able to stop smoking because any day you're not smoking is in your benefit.

DESAREA MURRAY, NP
Yes.

RON AARON
I used to work with a guy who had emphysema. He was on oxygen, still smoked. He'd take the little tubes out, turn the oxygen off, have a cigarette, put the tubes back and turn on the oxygen. I said to him one day Ricky, why don't you just quit smoking? He said well, it's not hurting me. Really? You're a guy on oxygen.

RAJAY SEUDATH, MD
There's a lot of misconceptions, too, that people think that, well, if I stop smoking, I'm going to get sick. There's the idea. They say well, I had a friend who stopped smoking and he got cancer. Somehow the smoke is preventing cancer and it's absolutely the opposite. But it's hard to change those minds and those deep-seated beliefs because it happened to their friend. I saw it happen to them, that must be what's true.

RON AARON
Talk to me a little bit and we've only got about a minute and a half left, sleep apnea, which seems to be everywhere now because it's finally being diagnosed. What is it? And does it involve your lungs and your heart?

RAJAY SEUDATH, MD
Yes, sleep apnea is where your body basically stops breathing for whatever reason. There's central sleep apnea and obstructive sleep apnea. Again, carbon dioxide builds up in your blood. It makes your blood more acidic, it makes your heart work extra hard. It can cause different types of heart failure, and it can make your heart beat in an abnormal rhythm. Treating sleep apnea benefits you on multiple levels and multiple organ systems. In a metabolic sense, in a respiratory sense, in a cardiovascular sense, treating sleep apnea appropriately with a CPAP machine or an implanted device or one of those mandibular devices, that can absolutely help a person to improve their health and maintain their health.

RON AARON
It certainly raises a question. If you wake up and you can't breathe and your spouse or whoever's laying there next to you says, hey, man, you do this every night?

RAJAY SEUDATH, MD
Absolutely. That's called an apnea spell. That's something to bring up with their doctor because that is almost an immediate referral for a sleep test.

RON AARON
Wow. Unfortunately, we’re flat out of time, but I really appreciate you being with us. Dr. Rajay Seudath, thank you so much in Tampa, Florida, the Optum clinic. Once again, Desarea Murray, you are a great co-host. Thanks for joining us.

DESAREA MURRAY, NP
Yes. Thanks for having me.

RON AARON
I appreciate both of you joining us today on the award winning Docs in a Pod.

OUTRO
Executive producers for Docs in a Pod or Dan Calderon and Lia Medrano. Associate producer is Cherese Pendleton.
Thank you for listening to Docs in a Pod presented by WellMed. We welcome your emails with suggestions and comments on this program at radio@WellMed.net. Be sure to 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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