Ep. 5 | Joseph Hayes, MD, Internal Medicine, SGMC Health

Transcript

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- Welcome to another episode of "What Brings You in Today?"

- I'm Erika Bennett.

- And I'm Taylor Fisher.

- And today we are here with Joe Hayes, MD, an internal medicine physician. Dr. Hayes joined SGMC Health in 2021 as a hospitalist, and then since then our health system has underwent an opportunity to become a teaching facility and a partnership to grow the future of physicians in our area, and he plays an active role in that as well. So we're excited to have him here today. But Dr. Hayes, what brings you in today?

- Oh, thank you for having me. I understand that you guys are gonna ask me some ridiculous questions, so I'm hoping that you can throw some stuff at me.

- I think we can definitely handle that.

- Okay.

- But first, maybe we'll start with just some regular questions. So I know you've had kind of an interesting journey to becoming a physician. You've talked to us a little bit about that. So can you tell me a little bit about your background and that kind of journey?

- Sure, sure. Well, I'm a Valdosta guy, you know, did the typical, graduated high school, didn't go to college, lived my life with my children. And then sometime around when I was 30 years old, I think, one of my children, my middle son was at school, and it was an ask your, you know, what do your parents do for a living, a career day kind of thing. And Jacob, my middle son, said, "Well, my dad sits in an office and people bring him money." And that's all my son knew about me. And I think it was around that time that you kind of start thinking about what's important in life, what kind of mark you're leaving, what you're doing. And so I had this kind of crazy idea that maybe I should do something that I think is important. And I think probably nothing more important than people's health, so I thought, "Well, maybe I'll be a doctor." So I, you know, I told my wife, and she's like, "Ha ha. That's ridiculous. You know, you were a C student in high school," you know, those kinds of things. And, you know, she was right. So I enrolled in community college here at Georgia Military College, took a few classes, you know, I learned what it takes to be a physician, which, you know, a lot of the selection, you know, is not necessarily just about personality. It's more about, you know, being able to learn things and put 'em together. And so I said, "Well, if I don't get A's I'll stop doing this." And well, I got a few A's, and then I said, "Okay, well let's keep going." And I ended up transferring to Wiregrass Technical College to do more core classes, you know, everything I could do to make things as cheap as I could, because, you know, you still gotta provide for a family. You still gotta work. Bills still come due. And eventually I took enough classes where I could transfer to Valdosta State University to finish my degree in biology. And I applied to medical school, and of course, the whole time my wife is just like, "Yeah, you go for it. You can do this." You know, but in reality, I don't think she was actually expecting it to happen. And then when we got the acceptance letter to Mercer University, things changed. And, you know, life is history at that point. I trained in Macon for one year, and was part of a new program called the Accelerated Track Program for Mercer where you can graduate in medical school in three years if you can, you know, demonstrate that you can keep the grades up. You know, I gave up summers and holidays for more time in the hospital, and transferred to Savannah, Georgia to finish the rest of my medical school training, and then did residency in Savannah before I came back home to Valdosta.

- So you up and decided at 30 to be a doctor?

- Mm hmm. Yeah, I did, I did.

- Wow.

- Yeah, that was challenging. And, you know, I had a lot of help and a lot of support, you know, from family, friends, other people. I got a lot of opportunities, I think, that maybe other people may not get, and I'm very grateful for that. It's not easy, but I think you're seeing more people these days not go to medical school, maybe right out of college, maybe taking a year or two.

- Non-traditional route. Yeah.

- Well, yeah, that's right.

- I took a non-traditional route. I'm a product of a technical college, Wiregrass, and then my bachelor's from VSU, so it was very non-traditional, just like you.

- Yeah. I love those schools. I mean, I got a taste of all three, kind of did the tour of Valdosta.

- Nice.

- Got the tour. Yeah, yeah. So I enjoyed it very much. And again, I'm very lucky, and I've gotten a lot of support from the hospital. The hospital helped me get through residency as well. You know, even bills come due even when you're in training. And, you know, I owe a lot to the community. I owe a lot to SGMC Health as well, you know, for getting me this far.

- Very cool. What made you decide to pursue internal medicine as your specialty?

- Well, that's a great question. Actually, when I-

- And for those listening, explain what internal medicine is.

- Okay, that's a good point, because when I enrolled in medical school, I had never heard of internal medicine. I didn't know what that was. And I think at the time I wanted to do family medicine or emergency medicine. Those were things that appealed to me. And internal medicine is a specialty where we focus on adults, and it's the kind of the base starting point for a lot of the specialties that other folks may be familiar with, like cardiology, endocrinology, rheumatology, pulmonology, nephrology.

- All the ologies.

- Yeah, all the ologies. And those folks that are in those specialties, they start with internal medicine training background. So we don't learn much about babies and children. You know, we get that in medical school, but we don't get specialized training in that through internal medicine. We do three years of residency after our four years of medical school, after our four years of college. And during those three years, we get specialized training in cardiology, for example, you know, I did two months of rotations in cardiology during residency where we are working with a cardiologist, we're doing cardiology consults, working in their clinic. We're taking the consults in the hospital. And that helps us be very comfortable managing complex conditions that typically refer to cardiologists. So, whereas in some cases, other specialties who learn a lot about a lot of things, you know, family medicine's a good one, right? Family medicine physicians know so much. It's immense the amount of knowledge that they have.

- Yeah, 'cause they do all ages. Correct.

- They do all ages, but they're not able to get quite as in depth into just the adult.

- Right.

- So we really shine, I think internal medicine really shines in complex patients with multiple organ issues, multiple things going on. And don't get me wrong, we absolutely love the very healthy folks and we like to keep them healthy too, but sometimes we get a lot of the very complex patients. And we can do things, I think, in internal medicine that may make other specialists or other specialties sometimes uncomfortable. But we're comfortable managing these things, because, as I mentioned, my experience with cardiology, that same experience happens in nephrology, in the ICU, for example, hospitalized patients, and complex patients, outpatient.

- Hmm. So what would you say is the most rewarding part of your specialty?

- Oh gosh. You know, one of the great things about internal medicine is we get inpatient experience, we get outpatient experience. We can take care of patients on both sides. I think it's very rewarding to take care of sick people, to get them better. You know, if someone comes in and their lungs are full of fluid and we get that off and we diagnose a problem and we help keep them healthy, that is very rewarding and it's gratifying right away, but in the primary care setting, keeping folks healthy, keeping those things from happening, that's extraordinarily rewarding too. And I think in our clinic, for example, where we teach the residents, we do a lot of procedures as well. We're able to manage complex issues, again, that oftentimes you may get referred out for. So when we have patients, some of our patients take a rolling walker up the sidewalk. I've told you guys that before. Literally one step at a time down the sidewalk to get to our clinic. And others have transportation, but they can't drive to the Mayo Clinic, for example. Or maybe they can't afford copays to go to other specialists. So it's very rewarding to be able to take care of the whole patient, multiple problems, very complex issues, and we can do that comfortably and we can do a really good job of it. And I think that brings me a lot of joy as well.

- Yeah, let's talk a little bit about the clinic, because it's fairly new, opened, what, maybe two years ago now?

- Yeah, about 18 months.

- But it is a continuity clinic, which most people don't know what that is, but that it's a partnership with our residency program with Mercer University School of Medicine. And so you actually lead and spearhead, you're the medical director there, and you also serve as our designated institute official.

- That's right. That's a mouthful.

- For Mercer.

- We can just say DIO.

- Okay. DIO. But for that clinic, kind of tell us a little bit about the role that it plays in our community.

- Sure. We do really twofold, two things that we really focus on. One is teaching our medical residents how to provide excellent care for our patients and take care of our community. They can practice medicine while learning in a supervised manner. You know, everything that they do is second guessed by me. And what that means is, is when they go see a patient and they get their history and physical and hear the patient and decide what treatment plan is best to keep them healthy or to fix a problem, they sit down with me. So patients don't see this. They come into the clinic and they see their young physician that's taking care of them, and then they leave the room, and they say, "I'm gonna go talk to my attending." And then we sit down and we go through everything. You know, the medical student or the resident physician will present the patient and tell me the physical exam, the vitals, the lab work, the imaging, everything that we have, and then start going through the assessment and plan. "Well, for this issue, this is what I'm going to do." And my job is to say, "Well, that's a terrible idea. Why are you doing that?" Even though they're very, very smart, and they make great decisions, they're all great, wonderful physicians, full-fledged physicians, they are licensed physicians, but they're here for additional training in the specialty of internal medicine. We go through these, and this is an opportunity for both. One, to ensure that the patient gets the same care from a trainee that they would get from me or any other board certified physician in that room with them, and also an opportunity for the residents to learn. So I think we provide excellent care for our patients. This is, we provide evidence-based care, the latest and the greatest. I mean, not just the residents are learning every day. I'm in conferences most days of the week. I'm continuing to learn as well, even though I've done lots of learning already. And we really make sure that the patient gets the absolute best care. And then they kind of get a second opinion every time they come in, because I see them too, usually, and we're always talking about the patients. From the patient side, it's not just about getting good care. It's also about expanding access to care. You know, for example, there's not enough physicians to go around. It everywhere. You know, Georgia's some of the least accessible physicians in the entire country. And what that means is, is we got great docs, but they're not easy to get in to see them.

- There's not enough of them.

- That's correct. And so the idea now that we have 16 resident physicians that we have brought on board, you know, to our health system, to our community, to help provide additional care for patients, I think we're doing a lot of good. And these patients, many of our patients are complex. We love, again, the healthy folks that don't have much in the way of medical problems, but we get some very, very complex patients. Our specialists will call us and say, "I've got this patient with four organs failing that we're doing all of these wonderful things to help," but they need somebody to put it together and keep this patient going. And we provide that access. When many of our patients that we get to establish in our clinic first landed in the hospital, and they were getting ready to leave the hospital, they had no one to go to. And we're here for them. And we're here to provide, again, exceptional care.

- Yeah, and one of our priorities as a health system is creating that unequaled access to care, which this plays very well to that, because you've got not only another avenue for people to get primary care, because, as you said, the national physicians, there's just a shortage, and it's dramatically increasing year over year as our traditional physicians retire. So definitely something that we have to keep an eye on. And then our hopes are, right, that these physicians will stay, many of them will continue to stay here and see patients and build their careers here after they graduate their residency.

- Oh, I certainly hope so. You know, there are statistics that show as many as half physicians stay within 50 miles of where they train, so we hope that exposing folks here to Valdosta-Lowndes County, our health system, our community, many of them will stay. Some of them have already signed to stay on with the hospital. And it's not just physicians. We also train medical students here too. We're a teaching facility all the way around. You know, when this residency came, it elevated the stature of our hospital to an academically affiliated institute with Mercer University School of Medicine. So we kind of go from a community hospital to an academically affiliated, which kind of raises the, I don't wanna use the word credibility. Our hospital's already credible. But, you know, the idea is if you can teach medical students and you can teach residents, you must know what you're doing, right? That's kind of the idea. And but now with this partnership with Mercer growing even more, we are gonna be, you know, a proper medical school campus. We are going to be at proper academic institute, which is on the same level, for example, as, you know, the Mayo Clinic. And of course we don't have the specialty services or some of the subspecialty training that places like Mayo have, but we hope to get there one day.

- Yeah.

- I think that's very cool. I mean, I think some people probably don't even know that we have that available here. Before I started working here, I had no idea. And I was like, "This is like Grey's Anatomy." There's residents running around.

- And I love some "Grey's Anatomy."

- Oh, yeah.

- And learning, and yeah. I mean, some of the things, not like "Grey's Anatomy," but I think it's very cool. So our next kind of thing we wanna talk about was why, can you tell our listeners why it's so important to have a primary care doctor, and to actually go to those checkups and follow up and do what your doctor tells you to do?

- Sure. Yeah, that's a great question. First I'll say, we have a wonderful urgent care. We have a wonderful emergency department. But the question, you know, that I really need to ask or we need to ask of folks is, if you were not feeling well or you were sick, who would you rather have see you? A wonderful physician in the urgent care or the emergency department, or a wonderful physician that knows your medical history, knows the medicines that you've been tried on, knows the reasons that you're taking or not taking certain things, that know about you? And I think that, certainly for me, you know, if I felt like I had the flu or I felt unwell, I would rather be taken care of by somebody that knows me. So that's one good reason. Another good reason is cost of care. It is much more expensive to go to urgent care or to the emergency department than it is to get seen in your primary care office. And not just for you personally, but for the entire health system as a whole. Medical care in the United States costs more than anywhere in the world, and part of that is because it's fragmented. And so what we like to do is we wanna try to take care of our own patients if we can. That's not always possible, right?

- You close at night, you know?

- We close at night.

- And Saturday and Sunday, so.

- That's right.

- There are times that urgent care or the emergency room, you know, is needed, but if you can avoid-

- That's right. The flu doesn't come on a schedule.

- Right.

- Right? It gonna hit you at any time, and oftentimes it's not during business hours. And so urgent care is a huge resource for us. And we also try to do as much good as we can in our clinic. And so we try to keep our schedule as full as possible with our patients. And there are times, even for us, that we don't have the availability to work folks in, and the urgent cares really, really helps us and is really there for us to help take care of our patients even when we're not able to.

- We did a survey maybe two years ago where we just asked people if they had a primary care provider, and 70% of them responded "No." And they were adult age. And that, I mean, I am victim of that, because I actually just got a primary care provider like a year ago.

- Congratulations.

- I know, right? It's like a rite of passage of becoming an adult now.

- Yes, yes.

- Okay. But it's come in useful already, like when it comes to managing all kinds of things, and we'll kind of get to that too, as to what you kind of treat in.

- I think people think, "Well, I'm not sick, so I don't need to go to the doctor." But getting those yearly checkups and that lab work, which if you have insurance, is generally covered under insurance to get. I know mine is, to get yearly lab work. Just see where you are, because if you have no idea where you are when you're well, how do you know when you're sick that something is wrong?

- Well, that's the trick. If you don't get checked out, there's nothing wrong with you, right? So I think folks are kind of beating the system here. But no, in all seriousness, in addition to taking care of you when you're not feeling well, our job is to keep you healthy, to keep you from getting sick. And that's, you know, vaccines, cancer screenings, you know, getting you referrals for colonoscopies or prostate cancer screenings, or other things that you may be due for, pap smears and so forth. And we do those in our office. We can also refer out to OB/GYN depending on complexity and comfort level and so forth. So we want to keep folks healthy. And, you know, I think for a lot of people, if we can catch these problems through screenings, we can prevent them from becoming a problem. For example, diabetes. I'll give an example of that. A lot of the problems that we deal with, multi-organ failures in our community, are often the result of diabetes. And diabetes doesn't happen overnight. Type 1 maybe. Okay, that's an argument there. But type 2 diabetes, which is the one that we most think of, the one that kind of runs in the family, that brews for many years. By the time we catch diabetes, by the time the metabolic syndrome, the insulin resistance is so bad that the pancreas just can't keep up anymore with insulin, by the time we catch it in screening labs, it's been going on for 5 or 10 years. And by the time someone has symptoms, maybe it's going on even longer. And longstanding diabetes can ruin the eyes, ruin the kidneys, ruin the feet. You know, folks are getting amputations, going to Jesus one piece at a time because of the amputations, and the idea, if we can catch this early, we can treat this, and we can prevent these problems from happening. And that's what we're looking for. That's what we're looking to do. We're looking to check your cholesterol, we're looking to check you for diabetes, we're looking to check your kidney function and your liver function and answer questions. Is this safe for you? Is this not safe for you? So that maybe you never have a heart attack or you never have a stroke.

- Right, I mean, even something as simple as my iron was low and I didn't know about it, and I was tired all the time, and I just thought I was tired because life. But once I got some iron in me, I noticed that I felt noticeably better and more energized. And, I mean, and that was such a simple little fix. But if I had not gone and got my lab work, I would've just unnecessarily been tired all the time.

- So here's question.

- I still am a little bit, but.

- Was your iron low if you never would've been checked?

- It was still low.

- Yeah.

- It was still low. That's right, that's right. So while you didn't have a diagnosis of iron deficiency, it was there, it was there, and you had symptoms that maybe weren't explained or you could've felt better. And imagine if you've got more energy, you can spend more time with your kids. You can throw 'em up higher in the air when you're playing with 'em. You can perform better at work. You know, these little things can really add up over time, and simple screening test or blood work would show that.

- Yeah, for sure. So I think we're ready to move on to our questions.

- Yeah, let's do some questions.

- We have some listener-submitted questions, so let's see where we're gonna start.

- I just wanna say I'm so excited for this, 'cause this is really what I wanted to come here for.

- We're excited too.

- Well, everybody loves free medical advice.

- Okay. Okay, let's just give a little disclaimer.

- Yeah. We gotta get the disclaimer.

- That I'm not treating you, and this stuff is all generic.

- Everyone's an individual. Everyone's needs are different. You should really see a-

- See your doctor.

- You should get a primary care. You can go see Dr. Hayes at his clinic.

- I would love to answer any questions. And by the way, there's no such thing as a ridiculous question. I say ridiculous because I want to have fun, but there's no such thing as a bad question.

- Okay.

- Well, our first one is, "What are your thoughts on patients consulting Dr. Google rather than making an appointment to speak with their physician?"

- Hmm. What do you think I'm gonna say?

- Bad idea.

- I love it.

- Oh, you do?

- Yes, I do, I do. But I gotta give caution, okay? Nothing makes me happier than somebody caring about their health. I enjoy nothing more than to have a good conversation and field these questions from patients, but you do have to be careful, you know? And with the access to information, you can get overloaded. We trained in college and medical school and residency, 10 plus years of training to be able to go through the information, put it together, understand it, and make a recommendation. There is no reality where someone at home's gonna be able to read Google and understand this stuff at the level that we do. And that's really our job. You go to a lawyer for law advice, you go to your tax guy for tax advice. We're here for your medical advice. But you gotta be careful. This is no more evidence than I've had several circumstances where a patient sees a lab the same time I do, and then they freak out, so-

- Well, that's your first instinct when your labs come back, 'cause now we have this wonderful MyChart portal that, I mean, those labs come back, you can see all the ratings, and then anyone that's abnormal, straight to Google.

- Straight to Google.

- We gotta see what it is. What does that mean?

- Yep. So, I had a patient call me. Very, very worried. Gets their labs back, again, the same time I get them. And those labs may come in while I'm seeing another patient. But they're at home. They're on the MyChart. And which there's good reasons why we give patients access to lab these days, you know, as opposed to letting the physicians be the gatekeeper. But imagine for a moment you come in for routine labs, and you see that your potassium is low, your potassium is 3.4, which shows, you know, abnormal in the chart, it's flagged as red, and you start Googling "symptoms of low potassium." What can happen if potassium is low. And you read sudden cardiac death, your heart can stop. You're freaking out. And then, you know, we say, "Don't worry about it. You're gonna be fine. You know, this is not an issue."

- Eat a banana.

- That's right. You could eat a banana. But, you know, I think these questions are good. I think it's great that patients bring these questions. And one of the hardest things that I have sometimes in my clinic are folks that latch on to technically correct information, but misses the mark. You know, they read something about a treatment, whether it's a side effect or a complication of a medical problem, or, you know, we're making a recommendation, and they read some literature from a mom blog that says, "Well, technically this isn't, you know, the actual problem"

- Mom blogs, those are 100% accurate, right?

- Everything on Google is 100% accurate. But no, seriously, I think what you will find with most information these days is there is a little bit of truth to what you read online, but you can miss the mark. You can miss the big picture, or you can miss the exceptions. And I think that's what physicians are good at. I think we're good at wading through that information to help you. So I love it nothing more when a patient comes to me with a list of questions that they can ask me. So I actually don't mind Dr. Google. But, I mean, everything is cancer.

- Yeah. Or death.

- Or death. And that's really not the case. And fact, many abnormal labs are probably perfectly normal for you, and it doesn't mean that that's gonna be a problem.

- Right, they're not that abnormal. That's what I've figured out. Unless if you're getting a call, if they're really bad, you're gonna get that call from the physician like very quickly, like if it's something truly urgent. In the realm of supplements, okay? So I've been working out, you know, trying to do my healthy life, and, you know, you gotta take protein, you know, you can take BCAAs, you can take, you know, everybody knows about vitamins, right, or any kind... But none of that stuff is really regulated by the FDA, right?

- If you mark it as a supplement, and you are clear that it does not treat any medical problems, then you're right. The FDA doesn't, they don't regulate it, meaning they don't inspect it for purity or that it's effective for what they're saying it's effective for. That's true. That's true.

- That's what I'm gonna ask. So is it a scam? Are they just trying to sell me something, or do I need to get on board with this? And, I mean, I just don't know. I'm just skeptical. 'Cause even when I take a vitamin, I don't necessarily feel like I'm feeling a lot better because I take a multivitamin.

- Is it gonna hurt you, or is it just not necessarily gonna help you, like?

- Or do you not know? It depends.

- Yes. Just yes.

- Well, I don't wanna waste my money, okay?

- Well, so what I'll say to that is, in a normal individual, the vast majority of people that have a regular diet do not need vitamins and supplements. They don't make a difference. Maybe they make your urine smell really strong, and if you like that and it makes you feel good, then go for it.

- No thanks.

- However, what I will say though is that there are certain conditions that supplements would be advisable. For example, you know, patients on metformin for long periods of time, there's a strong association with B12 deficiency. Metformin is a wonderful medicine, lots of great benefits to that, but it can affect the absorption a little bit of B12, and so sometimes patients might need treatment for that or screening for that. Probably a third of patients in Valdosta-Lowndes County are deficient in vitamin D. And vitamin D is not just a vitamin. It's also utilized as a hormone. It's not just for bone health, it regulates our immune system. We found, for example, that in COVID patients, if you're vitamin D deficient, you're more likely to die than others. Unfortunately, we gave a bunch of vitamin D to patients when they had COVID and didn't seem to make a difference. But the point is vitamin D is also a hormone, and it's also utilized to regulate your immune system.

- So supplements, then, could be good, could be beneficial if they're recommended by a physician or supported by a physician and data from lab work that kind of represents that you need it. You shouldn't just go buy every supplement because it says it's gonna give you, you know, all these different-

- The best hair.

- Right, yeah. Hair and nails.

- The best skin.

- You got the collagen, all that stuff. Okay.

- Well, yeah. And just to expand on that just a little bit more, a lot of these supplements aren't just supplements. They do things, but there's also things over the counter. You know, St. John's wort is good for mood, and saw palmetto can help with, you know, prostate enlargement symptoms, and maybe help your hair a little bit. But all of these things, they do a little bit, but they do. You know, when we make medicines, we kind of extract the good stuff out of it so we have less of the side effects, but these medicines, they can do things, but they can also tie up your liver. They can tie up your kidney, you know, the metabolism of things, and that can affect the levels of other drugs in your body too, and potentially increasing the effects of those or decreasing and making 'em less effective. So you gotta be really careful with these things, and that's why we always ask, please tell us what supplements that you take. They're not necessarily bad. Most people probably don't need them, but sometimes you do. And I think Google it, bring it to us. We love to talk about it.

- Sounds good. Okay. So the next one is, and this is not me asking this, just want to be clear, "What is with my profuse sweating and what can I do about it?" And then part two, "Is it true that aluminum-based antiperspirants are dangerous?"

- These are some loaded questions. So this for the sweating, is this a friend that's sweating?

- It's not me. It was a listener.

- User-submitted. Listener submission.

- Well, you know-

- But we do live in South Georgia, so.

- It can get hot here.

- But aside from the heat, if someone is sweating and they're not even hot.

- Okay, well, the list is about this long of things, and if you Google it, cancer is one of them, although it's not usually cancer. But the list is very, very long. And so there would be an approach to this. The first question is going to be, you know, maybe how old you are, you know, if you're a woman, and sometimes sweating can be related to menopausal symptoms, vasomotor symptoms. Sweating at night when you're sleeping is a different concern than just sweating during the day. But let's just say for the sake of argument here, we're talking about hyperhydrosis, which is the fancy word. We like to use Latin words. My advice, by the way, if anybody's looking to be a physician, do Latin in school, because we've got all these fancy words that make us sound smart. All they are is just-

- A different language.

- Latin words. Hyper means a lot, and hydrosis means kind of like sweating. So, but hyperhydrosis, and that can affect a lot of people. This is a condition that the palms can sweat pretty profusely, the soles of the feet, sometimes the face, and it can be really disconcerting for a lot of people. It's not just about, you know, under their arms, but, you know, that it's hard to function, you know, when you try to meet somebody and maybe you shake their hand and you're sweating, or you're sweating and slipping, you know, while you're trying to take a test and smearing things, and that can be very troublesome for folks. And so let's just say for a moment that we ruled everything else out, and maybe that's what we're talking about here. You know, you shouldn't be sweating at night, if you have that, for example. The treatments are a variety of things, including aluminum-based antiperspirants, right? And I think that goes into your next question. So I'm just gonna guess that I'm kind of putting these together. Maybe that's what we're talking about.

- Or also the aluminum thing, people have said that the studies have linked it to breast cancer. So now you have all these deodorants that are aluminum-free for women, which I bought it, so I use aluminum-free deodorant, because I don't wanna get breast cancer. So I think that's kind of maybe where that question was leading.

- I don't want you to get breast cancer either.

- Thank you.

- I don't want anybody to get breast cancer. Well, I'll walk this back, and I'll say a couple things about this. Number one, there's a lot of information on Google, and there's always a little bit of truth to things, but that's where we can get overwhelmed with information. And so there is a little bit of truth that perhaps higher aluminum levels under the armpits is associated with higher instances of breast cancer. That does not mean that aluminum under the armpits is causing breast cancer. However, humans are really good at like, associating things.

- Piecing things together.

- Yeah. We're smart. I mean, even if we don't realize it, our brains are wired in a way to protect us. For example, if you was out manually drinking from like a lake or river in Africa, and you started throwing up and she's sitting next to you, she's probably gonna start throwing up, right? Our bodies are wired that way to protect us, right? And that's why if somebody feels nauseous or throws up next to us, it makes us want to gag, right?

- I thought it was because the smell of the vomit makes you want to gag.

- What about hearing it? Some people are really sensitive to hearing it, right? And again, it's because our bodies are like, "Well, you know, through evolution if..."

- So strange. Our bodies are so smart.

- They are very smart. So you do this in everything else in life too though, right? So you associate things together. And so if you say, well, you know, we put the deodorant under our arm, and usually in the upper outer quadrant of our arm is usually where breast cancer for most women are found, and that's also where we put deodorant, therefore the deodorant must be linked in some way. The aluminum deodorant works very well as an antiperspirant, because the tiny little aluminum products, they clog the pores and that's why it works. And also the aluminum is kind of antibacterial, and then that can help give you the deodorant ability as well. We have no better antiperspirant than aluminum chloride or some form of aluminum salt that we mix up and that we put in there. And there is a lot of research that looks into this. And suffice to say that we have seen some correlation with folks that maybe are using the deodorant earlier in life and earlier and maybe more breast cancer, but there's absolutely no link that one causes the other. You know, I think some of the thought is that if we're shaving under the arms, for example, and we're getting microabrasions or cuts, we may can deposit higher concentrations of that aluminum there. But I will tell you the official stance on this right now is that maybe there's something to it, but through literally thousands and thousands of studies, we've seen no causative effect of aluminum antiperspirants and truly increased risks of breast cancer.

- So it's kinda like correlation not causation kind of thing.

- There's a very, very, very, I would say weak correlation, but there is no causation. In fact, aluminum is in about 80% of antiperspirants, and that's actually what we recommend for hyperhydrosis first line. You put it on your palms, you put it under your arms. And if you ask me is it safe for you to use an aluminum-based antiperspirant, my answer to you will be yes if you're having concerning symptoms and this is really bothersome and other things don't work, then I think it's safe, however, as evidence evolves, if we learn otherwise, I'll let you know.

- All right, well, moving on to a very important topic that the listeners really wanna know about, everyone wants to know about, and we even kind of alluded to it in our last episode, was stress management. We talked about it, the impact that stress can have on your heart, and stress can have on your body and your health in general. One good reason to have a primary care provider is so that you can discuss what your stress symptoms are and how to effectively manage those. So how does that discussion look in a primary care setting? And then how should people feel about, I mean, 'cause I'm sure a lot of people have undiagnosed anxiety and different things. What are you seeing in that realm?

- Well, I'm seeing probably a third of my patients have some form of anxiety or depression or mood disorder. And it's somewhat, you know, pervasive, and it's, you know, maybe some of it's genetic, some of it's the way you've been raised, some of it's your life experiences and your traumas and so forth can affect your ability to process things around you and then manage them. But that's not a fault on the person. You know, in fact, you know, I tell every patient that we're gonna treat for anxiety or depression that first of all, first things first we listen, okay? But when I do speak, the first thing that I tell them is I know you're a good person, because only good people get anxiety and depression.

- Aww.

- Because, well, truthfully, well-

- That's sweet. Yeah, that's sweet, but yeah, that's true. I mean, that means you care. I mean, that means you are invested in something and it's bigger than you, and you're taking it on yourself.

- That's right. If you didn't care, this stuff wouldn't bother you, right? You would just move on about the day. So you do care, and perhaps maybe you care so much that it overwhelms you and it makes it difficult for you to make decisions without it being clouded by emotions or other stress. And, you know, I encourage anybody that feels like they may be getting overwhelmed, or they're worried that they may feel down. And by the way, depression isn't always, you wanna hurt yourself or you don't wanna live. I mean, there's a lot of subtle symptoms of depression, for example, not being able to sleep at night or sleeping too much, or eating too much, or not eating enough. You know, feeling down or depressed is certainly one of them, but there are others. And we have screening tools that we use for both anxiety and depression. Anxiety screening tools, it's seven simple questions that you kind of say, "Well, you know, in the last couple weeks, how often do I feel down, I mean, you know, overwhelmed or anxious?" And you might say, "Well, that's not me, and it never happens." Or maybe that's every day. And we can use this questionnaire, seven for anxiety, nine for depression, and we can kind of put a score on how you feel, you know, 'cause sometimes it's hard to really say, you know, like how much this stuff bothers you. And we can use that to kind of help us with the clinical diagnosis that we have. And we have lots of things that we can do. You know, I can tell you that whether it's for medical problems or stressors in life or whatever, this affects a lot of people. You can imagine if you're anxious or depressed, it's gonna be hard to work or function. But we can handle it. We're good at it. Therapy, medications, exercise, all have been found to be equally effective in helping manage stress, PTSD, depression, et cetera. But this doesn't just affect our mind. We've got studies that show that the hippocampus, where memories are kind of processed and we use and incorporate feelings and emotions, you know, as part of the process actually shrinks in people with trauma, PTSD, depression, and so forth. And therapist increases that size. We've proved that with MRI. Exercise increases it, medicine increases it. And you can do any of the three or all three or none of the three. It's based on what you want to do, and it's generally a conversation that we all have together.

- Yeah, I think it's important that people just don't ignore that, and that is one of the benefits of having a primary care provider is that you have a partner through that should that ever arise. And maybe it doesn't, but if it does, that you have someone that can help you work through that and not just ignoring it, and feeling like you kind of have to just trudge on, you know, by yourself.

- Don't be afraid to ask for help. We all need help at different times in our lives. So I think that's bringing us to the end of our questions.

- Yes, well, except for you always have the famous question that you have to ask.

- Oh yes. Okay, so-

- Real quick. We gotta...

- I would love to know what your favorite meal is in our cafeteria or in The Spice.

- Okay. Wow, the food here is really good. It is really good. It's so good in fact that when we invite other folks in with like applicants for our residency program or others, that we actually usually have the hospital cafeteria cater this. And when folks sit down and they're eating this food, I always like to say, "You know that comes from our cafeteria." And they're like, "What?"

- Yeah, 'cause-

- I would say my favorite meal is at The Spice, actually. And if you go up there, it may not be listed directly on the menu, but you can ask for a loaded chicken Philly on flatbread, so they'll put, you got flatbread, you got the diced up chicken, you got green peppers and onions, and I always get double pepper jack cheese. And then depending on how I feel, I might splurge on like the cheese sticks or something like that.

- Okay. Good answer, good answer.

- The best menu items are always not on the menu. You know, you gotta know the like secrets.

- Yeah, okay, well.

- Try it.

- Well, I'm getting hungry, so-

- Yeah, I think we're both-

- We'll definitely take a look at that. But I think that that brings us to an end of our-

- Yeah, we definitely appreciate you for sitting down. I know we could go on and on about so many different things, so we'll probably have to have you back on another time, 'cause this, I'm sure we'll generate some more questions, but we appreciate everything you're doing, you know, here within the health system, especially to teach our next round of physicians and help serve our community in expanded capacity. So we're thankful for you, and thankful for all of our listeners. So if you haven't already, please like and subscribe to the podcast so you can stay up to date to all of our new episodes. And as always, feel free to submit questions or topics that you'd like to hear about. So again, thank you all for tuning in, and we hope everyone has a wonderful day.