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
Welcome to the award winning Docs in a Pod. I'm Ron Aaron. Our Docs in a Pod podcast is available wherever you get your podcasts. We're also on the radio in several markets in Texas and Florida as well. Dr. Tamika Perry, our co-host, is an associate medical director for WellMed. As associate medical director, her goal is to support providers at a number of WellMed clinics. She earned her undergraduate degree from Prairie View A&M University, where her daughter now is following in her footsteps. She then went on to graduate from Philadelphia College of Osteopathic Medicine, and she was National Health Service Corps Scholar. Next, Dr. Perry completed her family medicine residency at Methodist Charlton Medical Center and is a family physician. She works hard to keep her patients well. She earned a master's in public health as well, and Dr. Perry is a diplomat of the American Board of Obesity Medicine. She and her daughter live in Dallas, and in their free time, they like to travel to every continent in the world. So, Dr. Perry, it is great to have you with us again. I know the last time we talked, you were whittling down the number of continents that you have visited. What's left?

DR. TAMIKA PERRY
What's left, Ron, is Australia and Antarctica. Believe it or not, I turned 50 in 14 months. I know that is hard to believe. I was planning on possibly going to Antarctica, so now I'm in the planning stage, and I realized that to charter a plane or a boat to Antarctica from South America is $8,000 to $10,000 per person, just that portion of the trip. I was like, I can't ask my friends to do that, so maybe we'll be in Australia for my 50th birthday.

RON AARON
Well, we'll look for your GoFundMe.

DR. TAMIKA PERRY
Right. Please help Dr. Perry get to Antarctica.

RON AARON
We will be talking with our special guest, Shantrelle LaVigne, who is a nurse practitioner in your clinic. We're talking about pain and Pain Awareness Month, which is all of September. My guess is a lot of patients that you and Shantrelle see walk in and say, Dr. Perry, I hurt it everywhere.

DR. TAMIKA PERRY
That is probably our most common complaint, wouldnÕt you say Shantrelle?

SHANTRELLE LAVIGNE, NP
I do.

DR. TAMIKA PERRY
Yeah, it is absolutely our most common complaint. First, we like to narrow down where is the pain at and where is it coming from? Because there are several entities that can cause pain. For example, diabetes, right Shantrelle?

SHANTRELLE LAVIGNE, NP
Yes. Diabetes is one. Because with diabetes, we experience neuropathy, and most of our patients have diabetic neuropathy. So, they can experience the pain in the numbness in the fingers and in the toes. So, that's something that they have.

RON AARON
Let me let me take a moment and introduce you so folks know a little bit more about you. Shantrelle LaVigne, a nurse practitioner, is dedicated to family work at WellMed at Redbird Square, where Dr. Perry works. She provides compassionate, patient centered care to individuals and families. She earned her Master of Science in nursing from Purdue University in Davenport, Iowa, and holds a certificate as a nurse practitioner. Shantrelle is also certified in Basic Life Support, underscoring her commitment to clinical excellence and patient safety. I asked her, what does she do when she's not working as a nurse practitioner? And the answer is she's a mover, a mom Uber driver. She's got three kids living at home, two girls, 12 and 14, and a seven-year-old boy. You are carpool crazy, right?

SHANTRELLE LAVIGNE, NP
Yes, yes.

DR. TAMIKA PERRY
Those kids, not only her, but I think all moms realize that kids can be a pain in your you know what, right Ron? As I was speaking about pain, Shantrelle was talking about neuropathy or nerve ending pain, which is one of the most common types of pain that we see most often in family practice or primary care office. What is neuropathy? It is literally nerve pathology or nerve pain from damage. Most certainly there's all types of pain. So, what are some of the other pains that we see in the office?

SHANTRELLE LAVIGNE, NP
We do see acute pain. That can be something that comes from something like an injury from a car accident or somebody falling. We can see chronic pain, so that is pretty much most of our patients that we do see, and that's the type of pain that's been greater than three months. So, that can be arthritis, anything from fibromyalgia, patients that experience migraines. I saw a patient this morning who has fibromyalgia and she's been in chronic pain for years, and she has a specialist, a rheumatologist, that she actually sees regarding this specific diagnosis.

RON AARON
Now, hold that thought. Tell me in just a minute what fibromyalgia is because for a long time, it wasn't really recognized as a condition that people could have. I'm Ron Aaron, along with Dr. Tamika Perry, and Shantrelle LaVigne is our special guest, a nurse practitioner. You're listening to the award winning Docs in a Pod. If you just joined us, we're happy to have you with us. Take a moment if you love what you're hearing, give us a review on Google and Yelp and let folks know Docs in a Pod is here for you so that we can continue to build our incredible podcast audience. We're also on the radio in several cities in Texas and Florida as well. Shantrelle, you mentioned fibromyalgia, and I can remember, I've been on the radio a long time doing shows, not too many years ago where patients would say, I have fibromyalgia, but my doctor won't recognize it.

DR. TAMIKA PERRY
Fibromyalgia is really, what I like to call it, and I'll let Miss Levine give us more detail on it, but it is a diagnosis almost of exclusion. It has really strict, specific criteria. One, we look at tender points and in certain tender points in the area, and you have to have a certain number of those tender points. For example, the back of the neck, the back of the elbows, in the groin area, the back of the knees, these are specific tender points. We've ruled out things like trauma, neuropathy from diabetes or prediabetes or B12 deficiency. We've ruled out other entities, and what's left is fibromyalgia. So, it is this nonspecific pain stimuli that we don't know where it's coming from. Some entities think that it is possibly autoimmune in nature. Is your immune system causing these nerves to be stimulated that causes to have this diffuse pain all over our body. What are some treatment options for fibromyalgia?

SHANTRELLE LAVIGNE, NP
Treatment options are most of the time specific pain medications. Most patients are on narcotics like hydrocodone, then we have patients that are on Lyrica or Gabapentin, which those tend to of course help with like Dr. Perry said, those trigger points. Those certain points where they are having pain. Some people experience the pain all over. With fibromyalgia, they can have cognitive issues like brain fog and things like that. It can also heighten their anxiety because they're in constant pain and just do not know how to let their pain scale down. Stress also exacerbates or makes it worse with fibromyalgia because that's adding tension on to whether it's the trigger points or a headache. Things of that nature.

RON AARON
You mentioned hydrocodone and some of these other drugs. Isn't there a risk, Dr. Perry, that they can be addictive?

DR. TAMIKA PERRY
Oh, absolutely. There's more than one way to skin a cat, as my grandma would say. Hydrocodone isn't the only kid in town to treat pain, and most certainly it's a narcotic blanket pain medicine. It just kind of covers up the pain without addressing what the pain may be coming from. And before we started talking about addiction with hydrocodone, for some patients that is a good viable option when they have no other choice. However, these medicines do come with implications we should know about. So, the medicines in the narcotic class of medicines not only blanket pain, but they can make us feel good. They make us feel real good.

RON AARON
Give me some more of that.

DR. TAMIKA PERRY
Right. Then our brain gets used to that, and eventually our body gets accustomed to that. And once it gets accustomed to that and it gets used to that, now we're spilling over into the addiction range. When we talk about addiction, has our need for the medicine started to spill over into disruptive practices or emotional health? Have you started to do things that are, well, quite frankly, illegal to get the drug? Now we have to say, when a doctor prescribes these types of medicines for pain, we really have to do it in a very, very smart manner. Is this for acute tissue injury? Is this for post-op or is this going to be a long-term situation? Examples of a long term situation in which we may want to use narcotics is if there is a patient who's 95 who has severe osteoarthritis of both knees in which they cry every time they walk, but I'm not going to replace knees on a 95-year-old. I'm not going to give them long term NSAIDs because I could precipitate an ulcer in their tummy that will end their life. Now for that patient, 1 or 2 hydrocodone a day is totally medically appropriate. For me who has a papercut, hydrocodone is not appropriate.

RON AARON
I can remember when I had my knee replacement surgery, they prescribed hydrocodone post-operatively, and I did not like the way it made me feel. So, I finally said to my doctor, look, I got to stop this. I don't want it. I'd rather have pain than the way this makes me feel. So, I was probably less at risk to be addicted.

DR. TAMIKA PERRY
You were very much less at risk.

SHANTRELLE LAVIGNE, NP
To piggyback on you talking about arthritis is a patient who has bone cancer. In fact, if someone that has bone cancer, hydrocodone on its own may be a choice of medication to help that patient. Now, they didn't ask for the cancer and then so forth, is it that they're experiencing the pain from the cancer? Most times patients take chemotherapy or radiation, and with taking chemotherapy and radiation, those lead to post-complications of pain and jumping back into neuropathic pain. We have a patient currently now experiencing very much so neuropathic pain because of her cancer treatment.

DR. TAMIKA PERRY
Sometimes when you get that post-chemotherapy neuropathy, that that nerve is damaged, it doesn't come back. You have the pain all the time. We play this fine line of what is appropriate for the patient. Because we're always taught first do no harm. So, we want to do no harm to begin with. That's why it's very important that we really identify what is the source of the pain and what is the appropriate way to treat the pain in this patient? Whether they're a cancer patient, arthritic pain, neuropathy, whatever the case may be, what is appropriate for this patient?

RON AARON
We're going to find out in just a moment. We're going to talk more about this. I want to take just a moment to do a little business on our end. We're talking about pain. This being Pain Awareness Month, and if you have pain, you don't need a month to be aware of it. You know you have it. It may be important for others to understand that people in pain may not show symptoms on their face. They may not show symptoms the way they walk or talk, but they could be in pain. I'm Ron Aaron, our co-host Dr. Tamika Perry is with us, and we're talking with our special guest, nurse practitioner Shantrelle LaVigne. You're listening to the award winning Docs in a Pod.

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RON AARON
We are so pleased you're sticking with us right here on the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. We ask you if you want to take the time to give us a positive review, I said positive, which I hope it is, on Yelp and Google and elsewhere, so we can encourage others to sample Docs in a Pod. We're on the radio in several cities in Texas and Florida as well. Dr. Tamika Perry, our co-host, is here and we're talking with nurse practitioner Shantrelle LaVigne. We're talking about pain, this being Pain Awareness Month. Shantrelle, I mentioned that you don't always know someone's in pain, and they don't show physical symptoms necessarily, which is even more difficult for those who are in pain who say to their spouse, to their loved ones or their kids, I'm hurting everywhere, and they say, well, you don't look it. What do you do about that?

DR. TAMIKA PERRY
Everyone's expression of pain is different, right? Some people say potato, some people say patato, right? Some people say couch, some people say diamond, but it all means the same thing. So, everybody's expression is different. I took over for Shantrelle on this question because I am an advocate for the PCP, and this is where you have an appropriate relationship, you have a good relationship with your PCP, and they get to know you where they can elicit what you're trying to express from them. You should feel comfortable enough to say I'm in pain. I may not look like it. My pain may be just a grimace on my face. or it may be that I'm walking a little funny, but I'm in pain. This is where you should have that appropriate relationship where that provider knows how to treat you appropriate for pain. Whether it's your PA, your nurse practitioner, or your primary care physician. So, everybody's expression is different, and it should not be discounted, and patients should not be made to feel bad for a different expression of pain.

RON AARON
Most folks who go to the doctor try to put their best foot forward.

DR. TAMIKA PERRY
Yeah. This is not the place to do that.

SHANTRELLE LAVIGNE, NP
No.

DR. TAMIKA PERRY
This is a place to show us all your medical insecurities. Show them to us so we know how to treat you appropriately.

RON AARON
For the patient who says, I don't want any more prescription drugs. Are there other things I can take? Are there are alternatives to those medications?

SHANTRELLE LAVIGNE, NP
Yes, there is. When we talk, if there are patients that say what are other routes? There's therapy. We have physical therapy. We have occupational therapy. We also have, if we if they're able to do so, massage, yoga and acupuncture. Some people even see a chiropractor. Then there are stretches. If patients are able and physically to do and move their body, stretching is very important for the body. Stretching before and after. It doesn't matter your age. It's like limitations of how you can do it in other words. Also, meditation, like rethinking your brain to say, yes, I'm in pain, but how can I move past the pain?

DR. TAMIKA PERRY
She brought up a good point about the difference between physical and occupational therapy. Occupational therapy is just as it sounds. It redirects you on how to do your activities of daily living in your home or your everyday life. So, if it is painful for you to walk to your kitchen because of arthritis, occupational therapy is going to say, this is how you get up, this is how your stride is, these are the modalities in your home that you're going to use to get to your kitchen or put on your shirt. Physical therapy will focus on strengthening up the muscles that are good, the bones that are good around the joint space that may be affected, and how to properly use that joint space after an injury or the long term sequela of regular osteoarthritis. On a side note, think of your body as a car. Over time, parts of that car may need to be tinkered with. They may need to be changed, tuned up, a little better gas, a little better oil, because it's just not like it was when you were 16.

RON AARON
Can you get back to how it was?

DR. TAMIKA PERRY
I think at some point we should settle into that I'm a classic, and I need to be treated like a classic. I tell patients all the time, not to get too far off the subject, I dye my hair on a regular and consistent basis, but underneath it is still gray. When dye washes away, it's still gray. So, we need to treat our body as it is in this moment in time.

RON AARON
When the patient comes in and you ask them, because that chart hangs in every doctor's office, a pain chart 1 to 10, what's your pain level? And they fudge it to say, well, I don't know, maybe 2 or 3.

DR. TAMIKA PERRY
Sometimes we can tell. We can tell by the way they are presenting.

SHANTRELLE LAVIGNE, NP
Sometimes their blood pressure. Blood pressure affects pain.

RON AARON
What does pain do to blood pressure?

SHANTRELLE LAVIGNE, NP
The blood pressure is elevated or increased. Their heart rate is, same thing, elevated or increased. So, if we have somebody that a patient deals with osteoarthritis and they are coming in today for knee pain, so they walk from the front of the lab to the room, most times our blood pressure is going to be elevated or increased because they're in pain. So, we want to wait a few minutes, talk to them, have them relax, and then of course, reassess that blood pressure to see if that made a difference in their reading and if their pain level, of course, came down.

DR. TAMIKA PERRY
Just because you're used to a certain type of pain doesn't mean you should be living with that pain. Just like the example that she gave, some people are used to that severe pain that causes their blood pressure to go up from osteoarthritis of the knees. Well, that doesnÕt mean you're used to it, and your body doesn't hear why your blood pressure is up. If you have other risk factors, even if it's from pain, you still have a heart attack or stroke. So, we still need to address that pain. That pain still needs to be addressed to the best of science ability, medical ability that we can address now, too. I think it's important also to point out beyond medications that there are a lot of fairly new devices that are out that can be semi-implanted into the patient. There is a device called the Curonix device, and it's a little square device and it has little leads on it and the leads go right underneath the skin to the in the direction of the nerves that are most problematic for you. You actually get an app on the phone, or the company will give you an iPhone if you don't have one, or they'll put an app on your phone where it will send a signal to that nerve that tells it, hey, calm down, leave her alone, and you can control what your pain level is. So, instead of feeling pain, you feel like this vibratory sense in your back. Instead of feeling neuropathy, you feel this vibration. Some people say, I'm training one for the other. Many of the patients I have who have had this placed by pain management specialists, it's changed your life. They've come out of narcotics, they start golfing again, they can go run errands at the grocery store. So, we've made a lot of strides. Is this indicative for everyone? No. Does it work for everyone? Of course not. But it works for a great number of people.

RON AARON
So, if I get one, I could play golf.

DR. TAMIKA PERRY
I'm not saying that, Ron, it depends on your game.

RON AARON
I don't play golf.

DR. TAMIKA PERRY
That's why I say I'm not saying that. But what I'm saying is that when appropriate, it helps a lot of people.

RON AARON
Is that like a tensor unit that sends an electrical charge?

DR. TAMIKA PERRY
It's like a fancier, more modern unit.

SHANTRELLE LAVIGNE, NP
Yeah. If I can piggyback to Dr. Perry, my father actually has that device. We've had maybe three failed backs surgeries, so he has been in constant pain, lower legs, very much an active hunter, fisher, all the things. He had his device implanted about probably six months ago and I will say it is pain free.

RON AARON
Wow.

SHANTRELLE LAVIGNE, NP
So, he goes for his checkups with his pain management specialist about every three months, and he's doing well. He's climbing in trees and all of the things.

RON AARON
He's climbing trees?

SHANTRELLE LAVIGNE, NP
Yes, he hunts.

RON AARON
Oh, itÕs better to shoot the deer with?

SHANTRELLE LAVIGNE, NP
To shoot the deer, yes. ThatÕs very exciting, I guess, for him.

RON AARON
That's what's kind of a miracle device, Dr. Perry. If folks haven't heard of it, what do you ask your doctor to look at?

DR. TAMIKA PERRY
You ask your doctor, first of all, to send you to a pain management specialist, which are usually an anesthesiologist or a physical medicine rehabilitation specialist. They are certified to implant those devices. They'll start with a trial where it's not implanted, it just kind of sits on your skin and it's adhered to it. If that trial works, they'll go with implanting it. It's an office procedure, right Shantrelle?

SHANTRELLE LAVIGNE, NP
Yes.

DR. TAMIKA PERRY
You dad didn't have to go to the hospital or anything to get it put in. So, the pain management specialist can very much so do that. I always encourage patients to be an advocate for themselves. Feel free to look up things. I know most physicians hate Dr. Google, but I don't mind. I like conversations with the patients to say, okay, these are your options. I'm glad you looked that up. This is why it's indicated for you or not indicated for you.

RON AARON
How do the two of you keep up on all these new developments?

DR. TAMIKA PERRY
We have no life. WeÕre nerds. We read all the time.

RON AARON
ThatÕs probably true.

DR. TAMIKA PERRY
Yeah, a lot of it is true. But in the primary care office, that is our job. That is simply our job. To know what the options are for the patients to be able to speak with them back and forth. In addition to that, our governing bodies require us to keep taking classes.

SHANTRELLE LAVIGNE, NP
Continuing education.

RON AARON
I have a good friend who has rheumatoid arthritis, which triggers a tremendous amount of pain.

DR. TAMIKA PERRY
Yes. I'm glad you brought that up. RA is a type of arthritis where your immune system attacks the joints. Is your friend a male, if you don't mind me asking?

RON AARON
Female, who happens to be a physician.

DR. TAMIKA PERRY
It happens four times more than it does in males. When it does happen in males, it's usually a little bit worse. But it's where your immune system attacks the small joints first, like the small distal or outer joint of your hand, your wrist, it is usually bilateral both sides of the body, but it can cause joint destruction. But the most confounding point I want to make here is that ÒarthurÓ means joint, ÒitisÓ means inflammation of the joint, and the components of inflammation, and I learned his very first lesson at Prairie View A&M University, is pain, redness and swelling. That's all inflammation, regardless of where it comes from. But those are the components of it. Pain is the main component of it. So, we say, what medicines treat pain? There are maybe four or five broad classes. One broad class is NSAIDs. Nonsteroidal anti-inflammatory drugs.

RON AARON
Like Aleve.

DR. TAMIKA PERRY
Like Aleve. That's why Aleve works. Aleve, ibuprofen, and Motrin.

SHANTRELLE LAVIGNE, NP
Advil.

DR. TAMIKA PERRY
Yes. They work well for inflammation like associated with arthritis, but they are not benign. Just because it's over-the-counter, does it mean it's benign.

RON AARON
Well, we are flat out of time, and we didn't even get to touch on something that a friend of mine wanted me to ask. Speaking for a friend, gout and the pain that comes with gout.

DR. TAMIKA PERRY
Maybe we should do a show just on arthritis, because we could.

RON AARON
I think we can. Well, thank you both. I want to say, Shantrelle LaVigne, you did a great job. I appreciate having you on board. She is a nurse practitioner at WellMed at Redbird Square in Dallas. Of course, our co-host, Dr. Tamika Perry. I'm Ron Aaron. Thank you so much for joining us on the award winning Docs in a Pod podcast.

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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