Oct. 9, 2024
A silent killer – have you checked your blood pressure lately?
Hypertension, also known as high blood pressure, is a chronic medical condition that can lead to other health problems. Dr. Ahmad Kamal from Lakeview Healthcare System in Summerfield, Florida explains this potentially deadly health condition and way to reduce your chances of developing it.
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Show transcript
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 former television broadcaster Gina Galaviz, will share information to improve your health and wellbeing. And now here are Gina Galaviz and Dr. Rajay Seudath.
GINA GALAVIZ EISENBERG
Welcome to the award-winning Docs in a Pod, presented by WellMed. I'm your host, Gina Galaviz Eisenberg. Ron Aaron is on special assignment today. I'm so pleased to have you with us on Docs in a Pod. Our program is available wherever you get your podcasts. We're also on the radio in several cities in Texas and Florida. Each week, we talk about a variety of health and wellness issues that impact Medicare-eligible seniors and others. Today is a very special day. We welcome our new co-host, drumroll everyone, Dr. Rajay Seudath. Welcome.
DR. RAJAY SEUDATH
Hello guys. Thank you for having me on.
GINA GALAVIZ EISENBERG
Because I know you're a very modest guy, I'm going to just let our listeners know a little bit about you. Feel free to jump in. You're a board certified family medicine physician. You're a Tampa native. Well, we're here in Texas, we won't hold that against you. You're currently a physician for Optum and you're at the university location in Tampa and you have a passion for primary care and guiding your patients to meet their health care goals. Why else would you be a doctor, right?
DR. RAJAY SEUDATH
That is correct.
GINA GALAVIZ EISENBERG
We're just so glad that you're here. But here's the interesting thing about you. You started as an English teacher abroad, right?
DR. RAJAY SEUDATH
Yes.
GINA GALAVIZ EISENBERG
The inspiration led you to the field of family medicine. So, congratulations and welcome aboard.
DR. RAJAY SEUDATH
Thank you so much for having me. I'm so excited.
GINA GALAVIZ EISENBERG
Tell us, what are your expectations about Docs in a Pod?
DR. RAJAY SEUDATH
I was on as a guest for Docs in a Pod, and we just had so much fun talking about healthcare questions and things that most people may not know. Delving into those little details, those little anecdotes. It's very much like being in the room with a patient, but instead of just having one person hearing this information, it's a whole captivated audience that we can bring great information and fun to. So, I'm really looking forward to all of the fun things we're going to be doing.
GINA GALAVIZ EISENBERG
I'm excited to learn from you and hopefully your patients will hear you and say, Hey doc, why don't you talk about this? So, please encourage them to send us ideas.
DR. RAJAY SEUDATH
Oh, yes. Definitely.
GINA GALAVIZ EISENBERG
Well, today we're going to talk about hypertension. We know millions of people suffer from it, and I'm sure many of your patients suffer from this, but too many of us have no idea what it is or how it affects our health and our wellbeing. It used to be called the silent killer. My father had hypertension. He died of from a stroke at the age of 62. So, I'm one year away from that age. That's why Dr. Seudath and I are so pleased to welcome Dr. Ahmad Kamal. You're a special guest on the award winning Docs in a Pod. Thanks for being here.
DR. AHMAD KAMAL
Thank you so much for having me. I'm excited.
GINA GALAVIZ EISENBERG
What is the first thing you do when your patients come in? I guess many of them don't even know they have hypertension, but can you tell when we walk in that you really need to test someone for this?
DR. AHMAD KAMAL
I introduce myself and then I tell them there's a thing called blood pressure. Have you ever heard of it? Have you ever checked your blood pressure? Almost everybody knows what blood pressure is. My medical assistant will take the reading and then we will go from there. Then, whatever questions they have. I first gather how much information does the patient has about hypertension, and then I fill in the gaps from there.
GINA GALAVIZ EISENBERG
Dr. Seudath, I guess it's the same for you when you see patients come in as well.
DR. RAJAY SEUDATH
Yes. For most of our patient population, they're over the age of 65. So, they've had some exposure to the word hypertension, high blood pressure, whether they're caring for their elderly parents or they've had issues before they became of the Medicare age. But typically, when a person is being diagnosed with blood pressures, I try to ask them, what do you think is causing your pressure to be high? And almost always they have a good sense of, Oh, well, my dad had high pressures. or I've been under a lot of stress lately, or I just eat too much bacon. They'll have some sort of insight on it. I think that's a good starting point to see where they're at. Like Dr. Kamal said, you kind of fill in the gaps as you go.
GINA GALAVIZ EISENBERG
And what do they say to you, Dr Kamal, when you're like, Hey, your blood pressure is pretty high. I think you have hypertension.
DR. AHMAD KAMAL
Sometimes they're really surprised and say, I never had high blood pressure. Or my dad had high blood pressure, but he was fine. He didn't take any medications. Some of the patients were like, Oh, my dad did have high blood pressure and he died from a stroke or a heart attack. So, it kind of like varies from patient to patient.
GINA GALAVIZ EISENBERG
I'm just going to reintroduce ourselves for those who just tuned in and then I have another question I'd like to ask you. You're listening to the award winning Docs in a Pod with our new co-host, Dr. Rajay Seudath. I'm Gina Galaviz Eisenberg. Our podcast is available wherever you get your podcasts. Our expert today is Dr. Kamal talking about hypertension. Can you cure hypertension? Are we just managing it for the rest of our lives?
DR. AHMAD KAMAL
We just manage it for the rest of our lives, because once you have hypertension, even if you are on a medication or dietary lifestyle, if you deviate from it, then you're going to develop the hypertension again. So, you are kind of managing it. Even if the numbers become normal again, it is called controlled hypertension, but the name still has hypertension.
GINA GALAVIZ EISENBERG
Does it happen overnight from one visit to the next? Maybe you're not exercising anymore because you don't feel like it or you feel good, and you don't want to exercise. Is that one of the reasons that it just appears?
DR. AHMAD KAMAL
There are a number of reasons, but it doesn't happen overnight. If you want me to count the risk factors, age is one of them. When you go above a certain age, it is tentative that your arteries become hardened and they're not that much compliant anymore. You develop hypertension. Obesity is a big one. Weight gain is a big one. Your family history, especially your father, your mother, or your siblings, if they have hypertension, you have a high risk of developing hypertension. Race is also a big one. Hypertension tends to be more common and be more severe and occur earlier in life and be associated with great organ damage in black patients, for example. Some people have reduced numbers of nephrons in their kidneys that can predispose them to hypertension, and that comes from genetic factors. Maybe they were developing in the uterus of their mother, they had low oxygen, they have nutritional deficiency, they had premature birth. That can cause it. High-sodium diet is a big one. We have a lot of patients that take more than three gram of sodium a day. We all like frozen foods, we all like salted chips, we all like salted potatoes, but three grams is not that much. We can easily go above that. Excessive alcohol consumption is another one. Physical activity you talked about. Here's an interesting one. Insufficient sleep, less than seven hours, has been associated with increased incidence of blood pressure. And last but not least, social determinants of health like low socioeconomic status, lack of health insurance, food and housing insecurity. Lack of access to safest housing spaces for exercise. They also are a contributing factor to developing hypertension.
DR. RAJAY SEUDATH
One thing I had on that that Dr. Kamal had said, again, the sleep issue. Having lack of sleep. Another thing would be quality of sleep. People who are obese can also have sleep apnea. So, if a person has untreated sleep apnea, if they're not on a CPAP machine, that's one of the things that can cause a person to have worsening of their hypertension. Those are some of the things we can do. Home sleep studies. We can send them into the actual sleep lab to have a sleep study. So, those are some of the things that we can do in addition to medicines, in addition to lifestyle changes, is treating other diseases that worsen your hypertension.
GINA GALAVIZ EISENBERG
What is good sleep? How many hours continuously? I know as we get older, we get up in the middle of the night for some pit stops. So, what is good sleep and how many hours should we have of it?
DR. AHMAD KAMAL
At least seven hours. Waking up at night two or three times is fine, but more than that, it's pathological.
GINA GALAVIZ EISENBERG
Then ask the doctor about that too, if you're getting up too much in the middle of the night. As you age and folks retire, you always see like, Oh, we're going to have wine and chips and wine and this. Now, as I get older, when I see something like that, I start thinking, wait a minute. That's maybe not what we should be doing. One of my friends says, I drink one glass of wine a day, and I'm like, I think that's a little bit too much, even though you're retired. What do you tell your clients when they're like, but I enjoy, you know, my glass of wine with my meal. Well, okay, but you go out to eat all the time. What should we be mindful of?
DR. RAJAY SEUDATH
The daily recommended values are two units of alcohol for men, and one unit of alcohol for women, but that's if you have zero diseases.
GINA GALAVIZ EISENBERG
They don't say that.
DR. RAJAY SEUDATH
How many people over 65 have zero diseases? So again, we say in moderation. You have to kind of come up with is one per day okay if you have kidney disease, if you have high blood pressure, if you have diabetes, if you have heart disease, heart failure. You and your provider can kind of come up with, well, doc, I've been in the alcohol industry all my life. Im a supplier for Napa Valley and wine has been part of my life. I'm not going to give that up. Okay. If that's your choice as a patient, we have to come in and ask, what is your values and what are the things you want out of life? How can we tailor your medicines and your lifestyle to at least give you the quality of life that you want but still keep you safe as best as we can? That's a conversation for you and your doctor to come up with that plan. How much is too much? Again, in some disease states, any alcohol is too much.
GINA GALAVIZ EISENBERG
Right.
DR. RAJAY SEUDATH
So, there's kind of a spectrum as to what is the amount of risk that you want and what is your patient willing to do or not do. That's where the art of medicine comes in.
GINA GALAVIZ EISENBERG
I guess you can tell when your patients come in and they have to get on the scale. That's the last thing anybody wants to do. I know women don't. For a while, I would not go to the doctor because I did not want to get on that scale. Now that we're managing our weight, so I'm like, yeah, I want to get on the scale. I want to show you doc what I've done.
DR. RAJAY SEUDATH
So often I hear, Oh, this thing again. It's going to be every time you go.
GINA GALAVIZ EISENBERG
But that's how you can tell what's going on with us. Is the goal to, if you have hypertension, to get off of medication? Is that the first option? Then of course, in managing it if you have to, and then you don't stop taking your meds just because you feel better, correct?
DR. AHMAD KAMAL
Absolutely. Basically, the goal is to get the numbers right. At first, we try the lifestyle modifications. As we talked about, we kind of dive into what is causing the hypertension. Insufficient sleep. Is it your obesity? Can you lose weight? Can you exercise? Can you control your alcohol intake? Can you do some potassium salt supplementation? Can you restrict your sodium? If all that doesn't work, then we jump on to the medications and then we kind of go from there. Medications are tailored to the specific needs of each patient if they have heart failure or diabetes or some other chronic diseases.
GINA GALAVIZ EISENBERG
We're going to take just a quick little break and we'll continue the discussion when we come back. I'm Gina Galaviz Eisenberg, along with Dr. Rajay Seudath, our brand new co-host of Docs in a Pod, and our guest, Dr. Ahmad Kamal. We'll be right back.
AD
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GINA GALAVIZ EISENBERG
Thanks so much for staying with us on the award winning docs and a pod. I'm Gina Galaviz Eisenberg. Let's continue our discussion on hypertension. Dr. Seudath, What were you saying before our break?
DR. RAJAY SEUDATH
We're talking about medications. If lifestyle interventions are not enough to control a persons numbers, we start them on medications. I think it's important that patients understand those numbers and what those numbers are for. So, for a patient who has diabetes, and they are systolic, the top number on their blood pressure cuff, if that's showing above 40, that is a risk for a heart attack and stroke.
GINA GALAVIZ EISENBERG
Wow.
DR. RAJAY SEUDATH
It's not like I'm trying to scare you, but eye on the prize. Light at the end of the tunnel. What's the reason for all of this? The reason is I don't want you to have a stroke so that now you're paralyzed on half of your body, or you have a major heart attack and now you're out of breath when you go from your bedroom to your bathroom. That's a major life change. If we only have to take a single pill or two pills, or we cut back on a hot dog, or we cut back on a slice of bacon, or we don't have two sausage patties in the morning, that can be a major impact on your future risk. Explaining it like that to patients, letting them know the why as to why these medicines are important. The second thing is some patients, like you said, well, my numbers are good, and I feel good. Why do I need to keep taking this medicine? The medicines are working. Thats one thing that you can say, but the other thing is the medicines give you a little wiggle room. If you're not the person who can go completely vegan to lower your cholesterol, or you can't give up all the salt because you have a pickles craving, the medicines give you that wiggle room. It allows you to have some of that quality of life in addition to lengthening your life. That's one of the trade-offs. We're always going to be talking about the quality of your life versus the length of your life. Those are two things that we have to balance and that's called goals of care, and as we're in our younger years, obviously our goal of care is to have the longest amount of life. But as we get into our twilight years, we always have to balance, is this life we're living worth living? That deals with the patient's values and making sure they have a quality of life as well as an extension of their life.
GINA GALAVIZ EISENBERG
Dr. Kamal, do you find that your patients listen, and you have seen some remarkable turnarounds?
DR. AHMAD KAMAL
Absolutely. Some patients are very good listeners, and they really want to take care of their health. Sometimes the patients don't understand what you said and you kind of have to repeat things on another interview with the second appointment or third appointment, you answer the question and the listen at that time. Of course, there are some of us who are rebellious of everything. I'm doing fine. I do not think it's going to cause any problems. I've seen patients young, like in the thirties. Can you imagine being on dialysis just because of high blood pressure?
GINA GALAVIZ EISENBERG
No, I can't imagine that. I mean, that kind of commitment just to stay alive, it just interrupts everything. Sometimes I think that people are just so used to doing things a certain way because food is comfort. Food is used in celebrations. Maybe a therapist can help as well because I think it's some people don't believe that it is happening to them. What do you suggest to some patients?
DR. RAJAY SEUDATH
One of the things that I often try to do is get the family involved. If it's a person with a new diagnosis of hypertension, typically it's the trifecta. So, it is high blood pressure, diabetes, hypercholesterolemia. It's usually those three together, but sometimes it's one or the other, but getting the family involved, because then you have two brains listening to the things we're talking about. We have someone who can be kind of that police officer. Do you really need that extra biscuit? Should you get the two piece instead of the three piece? Those kinds of things. So, you've got someone on the ground, your eyes and ears. I find that that's been one of the things that are helpful.
GINA GALAVIZ EISENBERG
Yeah, it's like behavior modification, right? Instead of the three piece, get a two piece because really you're full after one if you really think about it, but still. Dr. Kamal, talk about exercise. What advice do you suggest to patients who don't want to go back into the gym? What do you suggest they do to help that blood pressure?
DR. AHMAD KAMAL
Exercise is really important because exercise leads to weight loss. I just tell them you don't have to do it daily, you just have to get in the habit. Just do it two to three times a week. Not more than that. Not less than that. If you do it more than that, you're going to get yourself burned out. You'll be full of energy the first week, second week full of energy, third week, you're going to be, yeah, I've done enough. Then you break the habit. It's just getting into a habit. You have to do it 21 times and then you get into a habit. Exercise, especially the aerobic, dynamic, resistant and isometric resistance exercise can decrease your upper and lower number by an average of four to six. Thats independent of weight loss.
GINA GALAVIZ EISENBERG
Really?
DR. AHMAD KAMAL
Yes.
GINA GALAVIZ EISENBERG
You're talking maybe doing squats and the kind of that low-impact.
DR. AHMAD KAMAL
Yes.
GINA GALAVIZ EISENBERG
I see it on Facebook, use your wall for this kind of Pilates, and I didn't realize that that really had that big of an impact.
DR. AHMAD KAMAL
Absolutely.
GINA GALAVIZ EISENBERG
Do you guys ever show your patients how to do that type of exercise or has anyone ever asked? I guess if I was your patient, I'd say, show me, please. What do I do?
DR. RAJAY SEUDATH
I say the wonder of YouTube. It has transformed the world. We have Google, we have Oracle, we have all of the answers at our fingertips. Whether you want to show somebody stretches, isometric squats, different Pilates, yoga positions, there's a whole full breadth of things. I do recommend that if you're going to be showing your patients that you look at the video first. You shouldn't be discovering it while they're discovering it. You want to make sure you're getting credible sources and making sure that they're doing something. You can tailor that. This lady is really putting her legs behind her ears. That's a little too much for you. So, let's take a little forward and we'll do the one where you're leaning against the wall.
GINA GALAVIZ EISENBERG
You don't want to injure yourself trying to lower your blood pressure.
DR. RAJAY SEUDATH
Right.
GINA GALAVIZ EISENBERG
But I guess it is that simple. Watching what you put in your mouth and moving. Maybe they don't want to exercise, they're still going to be rebellious and maybe they just park farther away from the front door at the grocery store, and they have to increase their walking.
DR. RAJAY SEUDATH
I tell patients, every little bit helps. Even if it's only five minutes, whatever you can do, do it. Because oftentimes they'll find that in five minutes, that's really nothing. Then they'll end up doing more. But it's getting that, that first kernel of activity is really what it takes.
DR. AHMAD KAMAL
Yeah. I tell them you just need 15 minutes of brisk walking three times a week. That will change your numbers and you start to see results. When they start to see the results after two or three weeks, then the ball gets rolling on its own.
GINA GALAVIZ EISENBERG
And I bet they're telling you that their sleep has improved too.
DR. AHMAD KAMAL
Absolutely. Energy levels go high, sleep gets improved, mood gets a lot better, motivation gets improved. So, everything.
GINA GALAVIZ EISENBERG
It seems like everything is related to what we put into our body and weight control, really. You're not telling us to enjoy life. You're just saying, watch it.
DR. AHMAD KAMAL
Yes, I mean, there are alternatives to everything. Count your calories, measure your food and measure your exercise. That's what I suggest.
GINA GALAVIZ EISENBERG
There are apps now you could do that very easily.
DR. RAJAY SEUDATH
Absolutely.
DR. AHMAD KAMAL
Apple Watch. There's Fitbit. There are cheaper watches. It tells you when to get up, when to rest, go for a walk.
GINA GALAVIZ EISENBERG
It tells us everything. Do a lot of your patients have Apple watches? I guess maybe they need something like that for accountability.
DR. RAJAY SEUDATH
A lot of them do.
GINA GALAVIZ EISENBERG
Even for breakfast today, I wanted breakfast sausage, but I got some plant-based meat. That's what we had. And you know what? It tasted just like sausage and not as greasy.
DR. RAJAY SEUDATH
It sounds like you got the impossible.
GINA GALAVIZ EISENBERG
Yes. And it was good. I would never have done something like that and I thought with with eggs, it's a great breakfast. I didn't feel sick like I do if I go out to eat and I'm eating the real thing.
DR. AHMAD KAMAL
I want to emphasize a point. Counting calories is important because sometimes a salad with dressing has thousand calories, but a whole steak will have 500 calories. So, a steak will be a better choice than a salad with dressing. You would think that you were eating healthy with the salad. It's not healthy.
GINA GALAVIZ EISENBERG
That's a good point. I'm not going to promote this one restaurant, but there's this one restaurant in San Antonio that you go, and it tells you what the calories are and they even give you the options and they tell you everything that's there and it's fresh and you don't feel so bad. Even the desserts are teeny-tiny. We have about 30 seconds left. What do you say to your patients who have hypertension? Is there hope?
DR. AHMAD KAMAL
Absolutely there's hope. I just tell them nobody dies from hypertension; they die from the consequences of hypertension. If we try to control, and we have a good conversation, and you ask all your questions, have your questions answered, so we both have understanding for each other's brain, then we can work on it together, and we'll go from there.
GINA GALAVIZ EISENBERG
All right. Thank you so much. Thank you for joining us today on the award winning Docs in a Pod. Thank you to Dr. Ahmad Kamal. We really enjoyed this. I'm Gina Galaviz Eisenberg with our new co-host, Dr. Rajay Seudath. In the words of the late Charles Osgood. I'll see you on the radio. Bye, everybody.
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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