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 Docs in a Pod. I'm Ron Aaron. Delighted to have you on board. Dr. Tamika Perry, our co-host, is also our special guest today. We'll be talking about a topic that all of us need to know more about. Dr. Perry is an associate medical director at WellMed. She oversees several large clinics in the Optum care in the North Texas region in the southern sector. Dr. Perry earned her undergraduate degree from Prairie View A&M University and then went on to graduate from Philadelphia College of Osteopathic Medicine where she was National Health Service Corps Scholar. Next, she completed her family medicine residency at Methodist Charlton Medical Center, and she served as chief resident there. Dr. Perry's board certified by the American Osteopathic Board of Family Medicine. She subsequently earned a master's degree in public health with an emphasis on health management and policy at the University of North Texas. In addition, and this is the part I love, Dr. Perry is a diplomat of the American Board of Obesity Medicine. Man, every New Year's resolution, I'm going to lose 10 pounds. It's Dr. Perry's expertise. Tamika, it is great to see you. It's the new year and in health care clinics across the country, people go in for their annual, their follow-up and they give a lot of blood and then they get a lot of results back. As a patient, I don't know what that means.

DR. TAMIKA PERRY
Absolutely, Ron. A lot of times patients will hear back from their clinician that everything was okay, right? What exactly is everything? People often assume that everything is everything and it is not. So, you need to be very specific and intentional when you ask your doctor, what was I tested for? Let's talk about some of those very specific tests they do. Not in too technical terms, but so the general population understands what they're getting tested for. One of the main tests that we do once a year is something called a comprehensive metabolic panel. That's the CMP and comprehensive meaning encompassing metabolic, what's going on in the inside of you panel. Usually this has 13 or 14 values on it. These values include blood sugar, which is different than A1C, which we'll talk about in just a second. So, the glucose or the blood sugar that's on here really just tells me at that point in time, when I got my labs drawn, what was my sugar. Kind of like you do at home when you stick to yourself, right? That's what that glucose on there tells me.
RON AARON
If you have diabetes and you stick to yourself?

DR. TAMIKA PERRY
Correct, sir, absolutely correct. If you look at that value on your CMP and that random value, let's just assume that you were not fasting. Most of these labs we want you to fast on but let's just assume you were not fasting and that random value was over 200 then you can look at that value and say I have diabetes. If you were fasting and that random glucose value was at 125 or greater than that's a diagnostic of diabetes. Glucose is the first value that we see on it. That is the blood sugar value, but that is just at that particular point in time that you took the test.

RON AARON
What should it be?

DR. TAMIKA PERRY
We want that value post-prandially. Post-prandially simply means after we eat, we want it to be less than 125. We want that value, if you're nondiabetic, and we want that value if you're fasting to be between 70 and 100 if you're fasting.ÊThose are the normal values for that glucose. Now most certainly glucose is not the only value on that CMP 14. If we digress for a little bit and talk about what is the difference between that and hemoglobin A1C? This is the value, Ron, that you are the expert at, right? The hemoglobin A1C is how much sugar is bound to that hemoglobin module protein in your blood. It gives us an average of over three months of your blood sugar. Remember, the glucose on the CMP is just at this point in time, and the glucose in the hemoglobin A1C gives me a three-month average.

RON AARON
So, I never understood how that A1C measure can give you a three-month value. How does it know to do that?

DR. TAMIKA PERRY
So, it looks at what is the average of that molecule that's bound to that, what is the average that sugar is bound to that hemoglobin molecule over a period of time. It uses a calculation. When it uses that calculation, it says, based on how much is bound here, it tells me about, on average, what is your sugar. So, for example, if your A1C is about 6 to 6.4, I know your average blood sugar is anywhere from 125 to 135.

RON AARON
That number indicates diabetes?

DR. TAMIKA PERRY
It can indicate diabetes. The value that I just told you was actually in the prediabetes range. If we're trying to diagnose diabetes based on A1C, what we need to do is look at a value of 6.5 or greater on two or more occasions. Not an isolated one, but two or more occasions. 6.5 is an average blood sugar of 140.

RON AARON
I am so competitive. The last time I got my A1C, it was 4.7. I did cartwheels down the hallway. Yippee.

DR. TAMIKA PERRY
I mean, youÕre killing it.

RON AARON
We're going to come right back to you. If you just joined us, you're listening to Docs in a Pod. The award-winning program is available on podcast as well as over the radio in a number of Texas and Florida cities. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry. We're delighted to have you on board. We're talking about something that most of us never spend enough time doing, and that's understanding what all of those lab test results mean when you go into your clinic and get your annual or semi-annual clearing. So, at 4.7 A1C, Dr. Perry, it's worth doing cartwheels.

DR. TAMIKA PERRY
It is absolutely worth doing cartwheels. So, what that's telling me, Ron, is that your chances of the long-term effects of diabetes, the negative long-term effects like amputations, heart attacks, strokes, it's virtually nil. You are doing a great job of putting yourself in a position where that stuff doesn't happen to you.Ê

RON AARON
So that's good?

DR. TAMIKA PERRY
Good. That's excellent.

RON AARON
As you pointed out, you got to look at the three or four of those A1Cs over time to see where you really are.

DR. TAMIKA PERRY
Absolutely. Now, maybe I should be a better student, but you taught me a term earlier where don't jinx it. Because we don't want anything bad to happen, right? What was the term you taught me?

RON AARON
It's a Yiddish term, a Chora, causing a jinx. It's a Chora.

DR. TAMIKA PERRY
I don't want to cause a Chora on you, but you're doing a great job.

RON AARON
Thank you.

DR. TAMIKA PERRY
You're doing a great job with your A1C. Keep up the good work. Most certainly, friend.

RON AARON
Should you get that A1C value taken at every one of your labs? Is that something if your doctor isn't doing it, should you ask for it?

DR. TAMIKA PERRY
Not necessarily. The A1C is at every two-to three-month average. If you've been rocking along really well, then your doctor may stretch it out a little bit further. Now, if your A1C is above what your preset goal is, and for the general population, and if you're diabetic, we want that A1C to be less than 7. If you're not diabetic, we want it to be less than 5.6. See how you're killing it, Ron? What yours is being 4.7? So, once again, kudos to you.

RON AARON
YouÕre making me feel good. Thank you.

DR. TAMIKA PERRY
What we want to do is say, what are my goals for checking my A1C based on my health status now? On the side note, there's another value called the fructosamine level, which is a two-week average of your blood sugar. So, if we've started a new medication on you or you started a new exercise program or diet, we may do the fructosamine level on you. Now, when we look at the other labs, because everyone is always most interested in sugar, most certainly, but there are other labs that go along on that CMP, as well as some other labs we talk about. So, one of the things we want to look at is our potassium level. Potassium is an electrolyte that has to do with muscle contractility, relaxation, bringing substances in and out of the cells. Most certainly the potassium, like many of the labs, we don't look at alone. We look at it in concert with other labs. For example, if you're on a medication like a diuretic, certain diuretics can deplete your potassium which will make you not feel so great.

RON AARON
Because it's washing it out of your system?

DR. TAMIKA PERRY
Exactly. There's other diuretics called potassium sparing diuretics that keep excess potassium in your system. This is important to know because some medicines deplete potassium. Some medicines increase potassium. Some foods increase potassium. And you have to have the right amount. Too low of potassium or too high of potassium can have cardiac effects. So, heart rhythm abnormalities. The right amount of potassium is essential to the patient.Ê

RON AARON
And yet most of us don't pay attention to it.

DR. TAMIKA PERRY
We do not, but it's a very, very, very important number.

RON AARON
If you get that number back and it shows you're low, do you gobble down a bunch of bananas?

DR. TAMIKA PERRY
Well, your doctor should be on it, but if it shows you're low and the doctor has not reached out to you, reach out to them and say, is it a dietary supplement? Do I need to have more bananas, papayas, foods that are rich in potassium? Do you need to call me in potassium? Do I need to take off the diuretic that's causing my potassium to be depleted? Ron, you and I have been doing this dance together for several years now, and the thing with me is I always have that good, open relationship with your PCP, and this is where your PCP should be reaching out to you to say, hey, we're going to fall back on your furosemide, or we're going to increase your prescription potassium, or you're going to eat more bananas. However, we need to adjust that potassium level.

RON AARON
If your potassium came back low, should you have a follow-up blood test after you begin taking potassium supplements or chugging down bananas?

DR. TAMIKA PERRY
Absolutely. Everybody's different. We don't want to over or undershoot you. So absolutely, you should, absolutely.Ê

RON AARON
Potassium affects the heart. What else?

DR. TAMIKA PERRY
Potassium affects heart metabolism, how we process drugs. I mean, it does a lot in our bodies. Remember, we talked about muscle contractility. What is the heart? It's a muscle. So, some people say my potassium may be low. I'm cramping in my legs. ThatÕs because you're having muscle contractility issues. You can have those same issues in the main muscle that's in your chest.

RON AARON
Boy, there is nothing like a leg cramp in the middle of the night. We'll talk about it in just a minute. Stay with me, Dr. Perry. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry. We're talking about something that all of us should pay attention to as the new year begins and that is the lab results you get when you go into your clinic and they draw a little blood. You're listening to the award winning Docs in a Pod.Ê

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RON AARON
We are so pleased you are with us right here on the award winning Docs in a Pod. Our program available on podcast wherever you get your podcast. We're also on the radio in a number of cities in Texas and Florida as well. But if you're not there, you can get any show you want on podcasts. I'm Ron Aaron along with Dr. Tamika Perry. We're talking about what happens with your 2025 doctor visit. They draw some blood. They get a bunch of results back and you have no idea what it means. We're helping you understand that. Dr. Perry, I mentioned leg cramps.

DR. TAMIKA PERRY
Yes.

RON AARON
Knock on wood. Again, I'm jinxing myself. I haven't had one literally in years, but that pain can be excruciating, and you link it to perhaps low potassium.

DR. TAMIKA PERRY
Yes, leg cramps are killer. IÕve had some frequently. Just on a side note for my ladies if you have leg cramps, did you wear your really cute shoes that day? The ones that made you taller than you sould be? Did you do something where your muscles say we don't really appreciate that. Later on, those muscles will let you know that was not appreciated. Now, if we get back to lab work, remember we talked about before, potassium has to do with muscle contractility.ÊSo, if your potassium levels are not appropriate, those muscles will cramp up. In addition, there are other causes of muscle cramps that we can identify on labs. For example, if you're on certain medications like statins, now statins do a whole lot of good, so I'm not trying to bad-mouth statins at all.

RON AARON
Now they're for high cholesterol?

DR. TAMIKA PERRY
Absolutely. If you're on a statin, the nature of those medicines in some individuals can cause muscle cramping. We can look at that value on your labs through a lab called the CKMB.ÊStands for creatinine kinase muscle enzyme. If that is elevated, then your statin could be the reason for your muscle cramps.

RON AARON
But you need to take the statin to prevent clogging your arteries if it's cholesterol related.

DR. TAMIKA PERRY
Yes, absolutely. There's things we can do to get around that. Statins are fairly long-acting drugs, so that means they stay in your system for a minute.ÊSo, what we could do is do it Mondays, Wednesdays and Fridays, or Tuesdays, Thursdays and Saturdays. Decrease the incidence of muscle cramping, still have the benefit of the medicine. The other thing that a statin can do, it has nothing to do with the CKMB, is it can decrease an enzyme called coenzyme Q10, and we can measure that in labs too.ÊIf that's the case, you just simply may need to replace your coenzyme Q10 over the counter.

RON AARON
Now that's all these TV ads I see for someone who says she's a cardiologist. When I prescribe a statin, I always prescribe a Co-Q10 supplement.

DR. TAMIKA PERRY
That's exactly right. That cardiologist is being progressive and they're already trying to combat what potentially could happen. It's not going to hurt the patient if they didn't need the extra Co-Q10.

RON AARON
How do you know if you need it? If you got leg cramps?

DR. TAMIKA PERRY
Leg cramps could be one of the things. It isn't necessarily the CKMB. Like we talked about before, it could also be the Co-Q10. These are not like screening labs; these are labs your doctor is going to do if you're having this issue.

RON AARON
What else are they doing with that annual blood test?

DR. TAMIKA PERRY
Great question. We're also doing labs that are not only measured but calculated. So, when we're looking at your renal or your kidney function, we measure your BUN, we measure your creatinine, but from those values we use a math equation to get something called your estimated glomerular function rate. You'll see it on the labs as EGFR. Think of this as if it's a race. It's a speed. Think of it like miles per hour. In fact, we measure it in milliliters per minute, and it's the rate or the speed at which your kidneys, the little engines in your kidneys called your glomeruli, filter blood to make urine.Ê

RON AARON
How does one little blood test measure that?

DR. TAMIKA PERRY
We measure certain proteins in your blood and we measure levels of urea and nitrogen in your blood and we take those levels and we put it into a math equation that takes into account your age, your sex, and that gives us that miles per hour or milliliters per minute, actually, rate or speed. ItÕs not like it's an actual measured value. ItÕs a calculated value based on other numbers that we measure in your blood.

RON AARON
What should it be to indicate you're okay?

DR. TAMIKA PERRY
That's a great question, because it's going to be person dependent. Generally, over 60 or 70, but I say that lightly. If you're like Cherese, our producer, you're like Catherine, who's super young, super healthy, their number is going to be like 100, 120. They're killing it. But as you start to decrease in age, like me, Ron, as you start to decrease in age, that number goes down because our body ages on the inside, just like it ages on the outside. You guys have seen me with probably 50 different hair colors. Why? Because my natural color at this point is white. You see me with 50 different glasses. Why? Because they're all progressives. My kidney function slows over time and at about 70 years of age, that number should be about 70. Now for every year over 70, we take about one point away. So, if you're 71, your number normally should be about 69, but things can prematurely speed up that slow down. They can make the GFR drops faster than it should.

RON AARON
And that's not good?

DR. TAMIKA PERRY
It's not good because if your kidneys slow down too much, they mean they stop. And if they stop, what do you need? You need kidneys outside of your body. What is that? Dialysis. That's what we don't want. We want to avoid that. So, what else besides sheer time makes your kidneys slow down? In this country, diabetes and high blood pressure. So, if I see the GFR is going down faster than time dictates, the other labs I'm going to start to look at are your blood sugar. Vital signs are blood pressure. We're going to talk about your lifestyle, what exactly we're doing. It's not just one number we look at. We look at that GFR over time. So, when you come into the office, not only am I going to look at your rate this year, I'm going to look at it last year, the year before last and see what your trends are. For example, Ron, if your number two years ago was 90, great, youÕre killing it. Just like youÕre doing with your A1C. But the year before last it was 80, last year it was 70 and this year it's at 60, which is still in normal range but see how weÕre declining? I'm going to say why? What's happening? Why are we declining?

RON AARON
And that's a good question?

DR. TAMIKA PERRY
Yes, it's a very good question. So, I'm going to go back to your A1C. I'm going to go back to your blood pressure readings. Here's a caveat for most people. Over the counter medications can really take a toll on that GFR, like ibuprofen, naproxen, Motrin, Aleve.ÊSo, if you take these medicines, even as written over the counter on a regular basis, it will decrease that GFR because they're clear to the kidneys and you're making those kidneys work harder than they should work. Now, something I've noticed, Dr. Perry, and others may have as well, I'm in a cardio program with WellMed and I take my blood pressure every morning and it goes to my cardiologistÕs screen to see how I'm doing. I've noticed that if I've got a little ache and pain and I take an ibuprofen, it raises my blood pressure.

RON AARON
Ibuprofen is one of those medicines that clears the kidneys.

DR. TAMIKA PERRY
Remember, behind your heart, your kidneys are the main organs that help control your blood pressure. Just because the medicine is over the counter does not mean it's benign. ThatÕs why the caveats on every bottle says consult your physician before you take this medicine.

RON AARON
But there's a trade-off because acetaminophen, the other pain reliever doesn't work as well.

DR. TAMIKA PERRY
That's right. Acetaminophen is a pain reliever. The other medicines are anti-inflammatory drugs, and the components of inflammation are pain, redness, and swelling. When you talk about aches and pains, especially in the morning, especially as we become more distinguish in age, that's straight up inflammation and those medicines work well for inflammation like ibuprofen, naproxen, Motrin, Aleve. However, those medicines do not do right by our kidneys when taken consistently for long periods of time.

RON AARON
Why the aches and pains when you wake up in the morning?

DR. TAMIKA PERRY
Think of your body as a luxury car. Even though it's a luxury car, it still wears out over time. And those parts just don't work as well. They need a little longer to get started. They need a little longer to warm up.ÊSometimes they even need to be replaced. They need better oil. They need better gas. The same thing happens with the parts of our body.

RON AARON
I get out of bed in the morning, we've got 11-year-old twin boys and a 13-year-old daughter, and they'll say, dad, are you okay? Because without realizing it, I'm going, oh, oh, oh, hey, yeah, I'm fine. Don't worry about it.

DR. TAMIKA PERRY
No, I'm good. This just happens over time, but you know what decreases the incidence of that Ron is regular exercise. Do you exercise on a regular?

RON AARON
Hello? Hello? I'm losing her. I don't think I can hear her. Hello?

DR. TAMIKA PERRY
Let's try a little regular exercise. This is not a sad story. There are other things we can do because low doses, intermittent steroids, because they have their ultimate anti-inflammatory drugs can help with these aches and pains. We don't want to use them on a regular basis, but they will absolutely not take a toll on your kidneys in the way that the drugs we just mentioned will.

RON AARON
Like prednisone.

DR. TAMIKA PERRY
Yeah, like methyltrienolone, like prednisone, dexamethasone, these steroid-type drugs can definitely take away inflammation. I recently started exercising again and my body was like, girl, what are you doing? We're not used to this now. You know what I mean? I was aching in the morning and I had my physician give me a low dose of steroids, and my body woke up and said, okay, we're ready now because it took the inflammation away.

RON AARON
Oh, I like that.

DR. TAMIKA PERRY
Yep. It says we're ready now. We are ready.

RON AARON
Now, you said something that's really important because as a physician, you do not treat yourself.

DR. TAMIKA PERRY
No, I do have a doctor that I go and see, and I listen to whatever she says and I put out of my head whatever I think I should do for me. Even as a physician and a mother, my daughters always had her own doctor, too. So yes, absolutely. I go to someone else to be treated.

RON AARON
We've got about a minute left. What are some of the other blood values you look at in that annual exam?

DR. TAMIKA PERRY
Absolutely. We look at your liver function tests and make sure your liver is doing okay. Medications haven't affected it, you know drugs, et cetera, et cetera. We look at your electrolytes, like your potassium, your sodium, your chloride, your cholesterol is extremely important that we look at. For guys, we look at things like your PSA. Your prostate-specific antigen.

RON AARON
Which often gives false positives.

DR. TAMIKA PERRY
It does. That, that is very person specific. Once again, that PCP relationship will let you know if that value is needed for you.

RON AARON
Well, I really appreciate you going through all this. It's something that most of us never pay attention to. You get that printout. The doctor says here's your labs. Great. It goes in that circular file.

DR. TAMIKA PERRY
Yes, it does.

RON AARON
Dr. Perry, thank you very much. I'm Ron Aaron. We are so pleased to have you join us today on the award winning Docs in a Pod. We do it every week and we hope you join us.Ê

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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