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. Rajay Seudath 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. Rajay Seudath.

RON AARON
Hello everybody, and welcome to the award winning Docs in a Pod. I'm Ron Aaron. We come to you every week with a look at a variety of health and wellness issues affecting people of any age, but we take a real look at those who are 65 and over in an aging society. Today our special guest is also our co-host, Dr. Rajay Seudath. We'll be talking about hearing loss and vision changes. What's normal and what's not? For those of you who don't remember, Dr. Seudath is a board certified family medicine physician, a Tampa native and current head physician for Optum. He's at the university location in Tampa. Dr. Seudath has a passion for primary care and guiding his patients in meeting their health goals while maintaining the patient's values. Dr. Seudath has also loves teaching, which is the reason we love having him right here on the award winning Docs in a Pod. Dr. Seudath, I did a quick search just out of curiosity, how many people in the United States turn 65 every day? That number used to be 10,000. It's now about 11,500 as the baby boomers age through the 65 and over category. That's a lot of people.

DR. RAJAY SEUDATH
That is absolutely. I did not know that statistic.

RON AARON
As you look at folks who age, a lot of people wonder what's normal, what isn't. I guess when you get near the age of 65 and over, those who deal in hearing loss suddenly flood your inbox and mailbox with offers and questions about your hearing. That led me to believe hearing loss is common among older people.

DR. RAJAY SEUDATH
Very much so. Hearing loss is one of the things you often hear people say, oh, he's got selective hearing. As we get older, we do naturally lose some of the higher tones. The higher frequencies. We do lose some of that ability to hear those. But I want to say hearing loss is not normal. That's one of the major things. If there's one thing I could tell people, hearing loss is not normal.

RON AARON
Why is it that all those hearing loss folks send us emails and mail?

DR. RAJAY SEUDATH
Because it happens a lot and there are things we can do for it. That's the reason why it's not normal. If it were normal, there'd be nothing we could do about it. It's just part of life. But there are many things we can do about that. One of the first things that I like to tell people is when you have moderate to severe hearing loss, you are three times higher to developing dementia.

RON AARON
Wow.

DR. RAJAY SEUDATH
That's a scary statistic when you think about it.

RON AARON
Do you know why?

DR. RAJAY SEUDATH
I think it has to do with the way that we interact with people. Social interaction, being able to do your activities of daily living, washing yourself, bathing yourself, being able to manipulate time, have a schedule, keep certain appointments. All of those things reinforce your memory, and if you don't have hearing, you can't reinforce those things. So, that's certainly one of the reasons why that happens.

RON AARON
Is hearing loss is something you would be aware of, or do you become aware of it as I did when my wife would say to me, you are deaf, go get help day after day. I finally went to an audiologist and indeed, I had hearing loss.

DR. RAJAY SEUDATH
That's the problem that we as health care providers face. It's kind of been ingrained for such a long period of time that guys just stop listening to their wives. Part of that is biological. Part of that is psychological. Part of that is societal. But really and truly, if the people in your family are telling your, why is the TV so loud? Can you not hear that? Or I've been calling you. I've been talking to you for the last five minutes, and you haven't said a word back. We need to do some investigation as to what's causing your hearing loss.

RON AARON
Well, I used to say to my wife, hey, you mumble, I can't understand what you're saying. You're mumbling. Speak up. Speak clearer. Assuming she was the problem.

DR. RAJAY SEUDATH
Well, yes. Absolutely. For all humans, it could never be me, I, the one I love to be the problem. You're the problem usually. So, sometimes there is a little bit of realizing that our bodies do age, but that hearing loss is not normal. That brings me to two types. There could be stuff in there, which is conductive. You have an ear infection. You have too much wax. There's something called ecstasies, which are basically a surfer's ear. So, people who are constantly repeatedly exposed to cold water, like surfers in the Pacific. They can get these bony growths in their ear, which can distort sound and give them hearing loss.

RON AARON
Hold that thought. WeÕre going to come right back to you. I want to let folks know who can hear us, 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 also are on the radio in several markets in Texas and Florida as well. Dr. Rajay Seudath is our co-host and guest today. You're listening to the award winning Docs in a Pod. Dr. Seudath, back to the bony stuff in our ears if I'm a surfer, but most people aren't surfers.

DR. RAJAY SEUDATH
Absolutely. The most common cause is sensorineural, or the nerves in your ear. Specifically, the cochlea. They stop working. Some of it is age-related. Some of it is genetics. Some of it is due to the type of work or exposures that you may have. That is called Presbycusis, which is a Latin word that means Òold hearing.Ó The mainstay, the way that we fix that are hearing aids. One of the things I tell my patients, and I try to tell this to everyone, hearing aids do not bring back your hearing. They simply prevent the decline. That is the goal is to prevent how bad your hearing is getting. That is what hearing aids are aiming to do. So, if you're already losing some of that hearing, saying, I'm not going to get hearing aids until it's really bad, that's not a good idea. We want to get them as early as possible to preserve as much as you have.

RON AARON
The other thing they do, and I happen to have hearing aids, they let you hear.

DR. RAJAY SEUDATH
Absolutely.

RON AARON
They're not perfect, but they certainly increase your ability to hear.

DR. RAJAY SEUDATH
Yes. When we get back to the cause, the nerves that are not working in the ears, there are no medicines so far that have any improvement of that disease. So, at this point, if your nerves are not getting those frequencies, they're not working correctly. We amplify those sounds to give you more of that stimulation to try and preserve that. The next step after that would be surgical implants.

RON AARON
Surgical implants meaning you get a new ear?

DR. RAJAY SEUDATH
No new year, but there are two types. There's middle ear implants and cochlear implants. Middle ear implants are actually inserted. They are almost like hearing aids inside of the middle ear. So, they're hidden and they're not as cumbersome as hearing aids. Cochlear implants are different. Those are directly wired into the nerves of your ear. There's an outside magnetic piece where you actually attach a cochlear implant sensor. Now, it's not perfect, but those can give people who have no hearing some of their hearing back. It's pretty amazing.

RON AARON
Do they put that implant on both sides of your head so you get stereo sound or just one side?

DR. RAJAY SEUDATH
It depends. Case by case. I have a patient who had hearing loss while she was at the hospital for another disease. They typically do it one side at a time. So, she had her right side done and then a few months later, she did the other side. So, there's kind of an oral rehabilitation listening, hearing. There's actually a playlist. One of the companies made a cochlear implant playlist on Spotify for people specifically with those. So, there's different ways to get back into hearing sounds. Trying to do acapella songs, solo songs and then kind of moving into more complex things as your brain starts to process this new way of interpreting sounds.

RON AARON
It's interesting when you talk about being in denial and trying to suggest, no, I don't need a hearing aid. ItÕs not my problem. I think the big tip off for me was being cognizant of having difficulty hearing in crowded rooms. I'd be in a restaurant or in a meeting, and I'm talking to someone like you and I are talking now. I'm hearing you through headsets, so there's not a problem. But in a crowded room, I found that I just couldn't pick out the person who was talking to me. They were lost in the clutter.

DR. RAJAY SEUDATH
Absolutely. That is a very, very common experience people have.

RON AARON
Then of course you tend not to go to those events. You decline invitations and you lose socialization and you get brain disease, and you die.

DR. RAJAY SEUDATH
That's correct. We've kind of come full circle in what we were talking about. Not being able to hear to communicate. It can get overwhelming if you hear all the sound and you're not able to process it. That can actually increase anxiety as well as push you towards dementia. So, when it comes to hearing, getting hearing aids as soon as possible. Hearing loss is not normal. Now, there's really no recommended screen for people unless they are over 65 and they're having hearing loss symptoms. But for every physical, I typically do what's called a whispered hearing test or a finger rub test where a provider will rub their fingers near your ears, and if you can hear it, that's a good screen. If you can't, we need to do something about that. That leads us to other screens as well.

RON AARON
We'll pick those up in a moment. We're talking about hearing loss. As Dr. Seudath said, it is not normal, which is good news because it can be treated. I'm Ron here and we're going to talk about vision as well as we age. You're listening to the award winning Docs in a Pod. Dr, Rajay Seudath is our co-host and guest today. We're delighted to have you with us on Docs in a Pod.

AD
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RON AARON
How many times do you find yourself saying, what did you say? Can you repeat that? And you blame the other person as the one who was mumbling or speaking lower than anybody could possibly hear. We're talking about hearing loss and ways in which it can be diagnosed and treated. We're on the award winning Docs in a Pod. I'm Ron Aaron and Dr. Rajay Seudath is our special guest and co-host today. We're talking about what's normal and what's not when it comes to hearing. Dr. Seudath, we haven't touched on hearing aids, which now are available over the counter, on the internet and through an audiologist. They're very expensive. Do the cheap ones work as well as the ones you get through an audiologist?

DR. RAJAY SEUDATH
That's kind of case by case. I'm not sure of the limitations of the over-the-counter ones. In my experience with my patients who've gotten them, their hearing has been restored, and they have had some improvement. Now, one of the things that having prescription hearing aids is those are almost always associated with the hearing test. So, you go to an audiologist, you're having a formalized audiology hearing test, and now they're looking at the data that was taken from your hearing test. Now they can tweak those prescription hearing aids to exactly fit what type of hearing loss where you have your hearing loss. I'm not certain that can be done with over-the-counter ones, or if specialists will do that with over-the-counter ones. Typically, they're going to want to do that with a prescription.

RON AARON
The cost, however, is differential between those that are available widely and those through your audiologist. My hearing aids think of around $4,000. ThatÕs real money.

DR. RAJAY SEUDATH
Yes. Absolutely. It is a ten-fold increase. $400 versus $4,000. You often hear patients saying, I spent all this money and it didn't even help my hearing. So, that is some of the outcomes we hear when people are waiting a very long time to get their hearing aids. They finally get them and they find that, oh, my hearing has really improved. So, the best way to preserve hearing is to act as fast as possible. Whether that's over-the-counter hearing aids or prescription hearing aids from an audiologist.

RON AARON
Now, before we move on to eyes and eyesight, as a PCP, you indicated that when you do an annual exam, you do kind of a mini hearing test. Is that something if your PCP isn't doing it, you should ask them to do?

DR. RAJAY SEUDATH
You can. Even a one screen question is acceptable for screening purposes. Are you having any difficulty hearing? Typically, a provider as they're having that conversation, if you're saying, Huh? Can you say that again? They can pick up on if you're hard of hearing, but specifically if you feel you're having issues or family members are pointing that out, bring that up. Bring that up to your provider. There's been many times I go through what my things on the agenda are, and the patient has the things on their agenda, and I would have never thought of what they had to ask, so it's important for you to bring that up.

RON AARON
Interesting. I share with my audiologist, I said to him when I went to see him, my wife said, you are home deaf. And he laughed and he said almost every guy who comes in who's married or has a significant other says that.

DR. RAJAY SEUDATH
Wow. That's amazing.

RON AARON
Let's move on to eyesight. Once again, you mentioned the Presby ear issue, presbyopia, an eye issue for folks as they age, have difficulty reading. My wife, before she got reading glasses, thought she had a brain tumor. She went to the doctor and said, I can't read, what's going on? Help me. I think I have a brain tumor. He laughed. He said, you're just over 40.

DR. RAJAY SEUDATH
That's correct. Farsightedness versus nearsightedness. What's the difference? Farsightedness, you can see far. Nearsightedness, you can see near. Presbyopia is the difficulty of seeing things that are close-up. So, that's one of the things. That is one of the aging changes that happens. That is a natural change. Is it normal to not fix it? No. It is normal to get glasses and to fix it. So, like hearing loss, vision loss is not normal because we can fix it. Having blurry vision when you're looking at things up close. You're finding you're putting the document closer and closer to your nose where you can smell the paper, you need to go see an eyeglasses doctor.

RON AARON
Or holding it further and further away.

DR. RAJAY SEUDATH
Right. That's another thing, too. Again, those kinds of things can be helped by an eyeglasses doctor, an optometrist. We do recommend people to get their eye exams over 65. If you're over 65, you should be getting an eye exam every single year by an eyeglasses doctor.

RON AARON
Not Ophthalmologist, an MD who specializes in eyes?

DR. RAJAY SEUDATH
An ophthalmologist is an eye disease doctor. An eye disease doctor is going to be looking for other causes of vision loss that are specifically caused by diseases, not the natural aging of your eyes. There are four different flavors of vision loss. We'll count them off together. There are macular degeneration, glaucoma, cataracts and diabetic retinopathy. Those are the four major ones. Of those, macular degeneration is the most common. What is macular degeneration? There is a spot in your eye in the center of your eye where most of the retina concentrate. For whatever reason, they start to die off. Macular degeneration comes in two flavors, wet and dry. Dry is the most common. It is a slow onset. It typically affects the central part of your vision. Wet is very fast. It's a fast onset. That's usually sudden central vision loss. Spots of loss in your eyes. Those are usually very, very fast when they develop. Now, what are the things that we do for these? What can we do to help these? For the wet, which is less common, there are things we can do like injections. Wet is called wet because the area kind of leaks fluid and that's why it's called wet.

RON AARON
I see TV ads for that all the time. Wet AMD.

DR. RAJAY SEUDATH
Yes. So, they can do injections to try and slow that. Sometimes, it can help it. When you do those types of injections, it can preserve vision almost 50% of the time. Half of the people who get these kinds of injections can preserve their vision.

RON AARON
Early diagnosis is key to better treatment?

DR. RAJAY SEUDATH
Absolutely. One of the things that a lot of people talk about or ask about are these vision supplements. I see these things all the time. They're pretty expensive. Is it worth the money? That usually goes by AREDS, which are vitamin supplements. That was a study that was an age-related eye disease study. There's AREDS 1 and AREDS 2. What's the difference? Which one do I need? Everybody should be using AREDS 2. AREDS 1 was an earlier study, and what they found is beta carotene for people who smoke was associated with more lung cancer. So, they did AREDS 2, which didn't have beta carotene. It had something called lutein and zeaxanthin. Those are two similar chemicals. In AREDS 2, there are six things. Vitamin C, vitamin E, zinc, copper, lutein and zeaxanthin.

RON AARON
That's an over-the-counter medication?

DR. RAJAY SEUDATH
That's an over-the-counter medicine. That does not necessarily stop macular degeneration, but it can slow the process. I got kind of curious when I was researching for this podcast, what about carrots? Carrots that give you good vision. Where does that fall on that spectrum of things? There are other vegetables that have more lutein and zeaxanthin. Going down the list from top to bottom. Leafy greens, like spinach, collard greens, kale. Those have the highest amount per 100g or per ounce. You know my theory, broccoli cures everything. Broccoli is on the list. We're going to get to that. Green leafy vegetables first, pistachios second, green peas after that, romaine lettuce, then yellow squash, then brussels sprouts, then broccoli, then asparagus, and finally carrots. So, really and truly, above the carrots are a whole litany of things that are very healthy for you. We've talked about this multiple times on the podcast. Healthy vegetables in your diet are healthy across the board. Those are definitely good sources of those kinds of vitamins. Yes, you can get them from a supplement but having them in their natural state from the grocery store, from the farmer's market, putting them into your diet is probably one of the best ways to help.

RON AARON
As you look at diet as a way to treat and perhaps prevent some of these issues, so many people have diabetes. Diabetic retinopathy. I've got a good friend who lost vision in one eye because of it and is threatened with losing vision and his other eye. He's diabetic. It's a long, convoluted story. I won't share all that, but diabetic retinopathy is very common among those who have obviously diabetes.

DR. RAJAY SEUDATH
Absolutely. Diabetic retinopathy, we usually see floaters in your vision. It's really when your sugars are higher than normal, it causes changes in the blood vessels of your eyes. That also comes in two flavors. Non-proliferative and proliferative. Non-proliferative meaning the blood vessels there are the same ones you've always had, but they are abnormal. Proliferative means we're getting a lot more blood vessels. So, yes, controlling your blood sugar helps to keep that under control. People who have diabetic retinopathy have shown improvement when their sugars improve. On top of that is blood pressure. Your diabetic retinopathy improves when your blood pressure improves. That can lead us to glaucoma. Glaucoma is associated with high cholesterol, high blood pressure. Again, those are some other things that can be improved by improving your chronic diseases.

RON AARON
Before we run out of time, for those who are listening who may have turned 65 and over, should your PCP be doing a mini eye test and send you to a specialist?

DR. RAJAY SEUDATH
I think you should have your vision checked in the office. That could be part of the screening. But more importantly, if you feel your vision is blurry, if you feel that your vision is not improving, tell that to your doctor and get your screen checked. That's definitely what you need.

RON AARON
We need another show on this because there's another eight hours and talking about hearing and vision. I appreciate it. Thank you, Dr. Seudath, our guest and co-host today. I'm Ron Aaron. Thanks for joining us on the award winning Docs in a Pod.

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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