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
Well, thank you so much for joining us today on the award winning Docs in a Pod. We come to you every week with a look at a variety of educational issues involving your wellness, your health, your medical condition, and we have a good time doing it. Dr. Tamika Perry is our co-host, and today she is also our special guest. Dr. Perry is an associate medical director at WellMed. She oversees several large clinics in the Optum care North Texas region in the southern sector. As an associate medical director, Dr. Perry's goal is to support the providers at these clinics as they deliver quality care and a compassionate patient experience. She earned her undergraduate degree and is proud to say it, from Prairie View A&M University, then went on to graduate from the Philadelphia College of Osteopathic Medicine, where she was National Health Service Corps Scholar. She completed her family medicine residency at Methodist Charlton Medical Center, where she served as chief resident. Dr. Perry is board certified by the American Osteopathic Board of Family Physicians. She also is a diplomat of the American Board of Obesity Medicine. She's got a passion for primary care. When she's not playing doctor, she loves to travel. Dr. Perry, not only are you our co-host, but our special guest today.

DR. TAMIKA PERRY
I feel special. You're right, I do like to travel because what does travel do for me? It helps alleviate stress.

RON AARON
I would think so.

DR. TAMIKA PERRY
Yes.

RON AARON
And you're about to go on another trip?

DR. TAMIKA PERRY
Yes. If I could finagle one before June, I will. But in June, I will be going to Paris.

RON AARON
Ah, Per’.

DR. TAMIKA PERRY
Yes. What a bunch of girlfriends. We go yearly. But this year we're also going to see Beyonce.

RON AARON
In Paris?

DR. TAMIKA PERRY
Yes. Absolutely.

RON AARON
Oh, that's pretty cool.

DR. TAMIKA PERRY
I'm so excited.

RON AARON
Does she know youÕre coming?

DR. TAMIKA PERRY
IÕm going to send her an email after we get off and let her know. Make sure she has our seats ready.

RON AARON
You mentioned stress. We have you talking about five-minute stress relief techniques you can do anywhere. First of all, talk to me about stress. What is it? Do we all have it?

DR. TAMIKA PERRY
You bring up a really good point, because I think a lot of times, we'll intertwine stress and anxiety. They are intertwined, but there is a difference. Stress is a normal physiologic response to a perceived threat or challenge. That's what stress is. You may be a little stressed out because you are competing for a promotion against your coworker. You may be a little stressed out because the teacher called you from your kid's school and you're like, what's going on? I know I get stressed out every time my phone rings and I see my daughter's face is a freshman in college because I'm like, what's wrong? Or how much do you need? I always get nervous. SheÕs like, hey, mom, I just called to say hi. Really? What are you really getting to? So, stress is a normal physiologic response. Not to say that it doesn't affect your life because it definitely can. But anxiety is that persistent, excessive feeling of worry, fear or apprehension that interferes with daily life. Stress is typically short term. Anxiety is longer term, and anxiety may or may not have a trigger to it. People could just be anxious for nothing. There are people who have generalized anxiety disorder who have this heightened level of stressfulness at all times. Stress can also cause, as can anxiety, too, physical symptoms. Headaches, fatigue, muscle aches. In fact, when you get a tension headache, which is directly related to stress and anxiety, the tension headache is characterized by pain in the also point, which is in the back of your head, and it goes down and down your neck, down to your trapezius muscles. You may be all tensed up and have tight muscles. Tension is a hallmark of a physical sign of stress. So, there things that we can do for stress in the moment. Remember we talked about stress is short term, usually has a trigger to it. So, what can we do at that moment in time? I'm in my office now with the door closed. We're taping the show. But if somebody bangs on my door and says, hey, Dr. Perry, we need you right now because something has happened. What can I do to make myself a little bit more calm and in a short period of time? Visual imagery is very important, especially in counseling. It is a special type of therapy in which we use visual imaging. What is that? Ron, what is your favorite vacation? What is the favorite thing you've done or place you've been?

RON AARON
We like to go to Port Aransas, which is along the Gulf Coast in Texas. Take the kids. It's a port city. It's got all kinds of fun things to do or do nothing.

DR. TAMIKA PERRY
Perfect. When you're in a stressful situation, you're going to close your eyes, you're going to see the water. You're going to feel the sand in between your toes. You're going to hear the kids in the background going, daddy, daddy, daddy. Not stressful daddy, but daddy, I love you. So, you're going to visualize yourself in a place that is happy for you. There you go.

RON AARON
I put up as my background because we talk on zoom. That's a shot from the balcony where we stayed. And that's the water behind me.

DR. TAMIKA PERRY
That's exactly what you're going to do. Close your eyes and think about that place that you like to be, that you feel happy at, that you feel calm at, that you feel at peace at. So, visual imagery. Another technique is brief yet intentional relaxation. You clear your mind of everything. You either sit down or lay down at your desk, you take several deep breaths, and we'll talk about breathing in a second.

RON AARON
In fact, hold that thought. I want to let folks know who may have just joined us. You're listening to the award winning Docs in a Pod, Our podcast is available wherever you get your podcasts. We're on the radio in several cities in Texas and Florida as well. I'm Ron Aaron along with our co-host, Dr. Tamika Perry, who is also our guest today. WeÕre talking about a really important topic. With all the political pressures and news and anger that's spreading across this country, these tips she's giving us can be very helpful. You're talking about breathing as another way to relieve stress.

DR. TAMIKA PERRY
Absolutely. Let's go back to that brief relaxation, i.e. meditation. You're relaxing. You're focusing on your muscles. You're focusing on tension in your muscles. And then you're relaxing. Not to the point where you pass out, but you relax. Relax, meditation works. So does repeated prayer. It doesn't matter what religion you are, meditation, repeated prayer, it works to help reduce stress. All of this is less than five minutes it takes you to do. Your whole focus is to concentrate on your breaths. Your inhale, holding your breath and your exhalation. In fact, there was a whole campaign by WellMed during the beginning of the pandemic where I think I can globally say everyone was stressed out. Everyone was stressed out. So, we focused on techniques on how to breathe. These are tried and true techniques to relieve stress. You're going to inhale for four seconds. Hold it for seven. Exhale for all eight seconds. Several cycles through, your body kind of resets, and that stress level has decreased. Focus on your breathing.

RON AARON
And it works.

DR. TAMIKA PERRY
It works. I do it. I'm telling you after several conversations with my daughter, I have to go do it. And I have to focus on my breathing. But yes, it definitely, definitely works. I also wanted to talk about stretching. Stretching your body. Whether you do just simple stretching, like if you're sitting in a chair, you can take one arm behind the chair, the other arm behind the chair, grab it. Torso up, head up, breathe a few times in and out, stretching. You do the same thing with your legs, grabbing your knees, pulling it up towards your chest. One leg straight down. Just stretching. Focus on your breathing while you're stretching. It helps relax the body. It helps release endorphins. This also could be achieved through yoga. It can be achieved through Pilates. You can watch a YouTube video if you want to. Stretching.

RON AARON
Now, someone mentioned to me that while you're doing that, you mentioned breathing. Occasionally when I'm doing exercise, my wife will say to me, you need to breathe, because, as I do it often, I'm holding my breath.

DR. TAMIKA PERRY
Yeah. You're inducing this state of tension now when you're holding your breath. Your body is going to start to go, we're not relaxed. You're increasing your epinephrine levels, your adrenaline levels, blood pressure, heart rate starts to go up. Just breathe. Relax, relax.

RON AARON
I just have to remember that.

DR. TAMIKA PERRY
Think about what is the opposite physiologic response to relaxation? It's tachypnea. You're breathing fast like when you're having a panic attack. Heart palpitations. You may even have some gut pains. That's what breathing comes into play to help bring things back into its normal physiologic state. Focus on your breathing. Calm down. Let your body reset.

RON AARON
I interrupted you while we were doing stretching. What other stretches do you recommend?

DR. TAMIKA PERRY
If you have the ability to partake in a yoga class or even watch a video on YouTube, I really, really encourage yoga. It keeps your overall daily stress down. Period. People who engage in those types of activities, and this is as per surveys, are less stressful in life. If you ask about a specific stretch, you definitely can do the ones that we talked about earlier. But honestly, Ron, like in the middle of a conference at some point a good presenter will say, okay, I need everybody to stand up, stretch, shake it out, because you're trying to set everybody up physiologically and psychologically. You're trying to reset it. Sometimes you're in your office, you're feeling like you're having a stressful day, close that door, stretch those arms, stretch those legs. Take a few deep breaths, then open your door back up.

RON AARON
My Apple watch will tell me you need to stand.

DR. TAMIKA PERRY
Absolutely.

RON AARON
It'll say, get up. Get out of that chair. You need to stand.

DR. TAMIKA PERRY
Improve circulation. Absolutely. Remember, the body is a unit, y'all. So, it works together. The mind and the body work together. So, if your mind becomes boggled down, if your mind becomes congested, so will your body. These are techniques to help your mind and body come together and help you to relieve stress.

RON AARON
Hold that thought. We're going to get right back to you. She's Dr. Tamika Perry, our co-host and guest today. We're talking about ways to relieve stress and things you can do anywhere, anytime. I'm Ron Aaron, and we're so pleased to have you listening to us on the award winning Docs in a Pod.

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RON AARON
I'm Ron Aaron along with our co-host, Dr. Tamika Perry. We're talking about stress and stress relief on the award winning Docs in a Pod. We went through several ways, Dr. Perry, that you can take a little breather. Literally take a breath or two and relieve stress with a few techniques you said can be helpful. What about medication?

DR. TAMIKA PERRY
If your stress has ventured over into the realm of anxiety, and it's more than just a situation, like you were preparing for a presentation at work. Anxiety, remember, is when it hinders your everyday life. So, there are medications that you can take for anxiety to calm down that psychological response that makes us nervous, have that impending sense of doom that overtakes our lives. What this medicine does is that it helps your brain to dampen that response of fight or flight. So, think of anxiety like this. You can stretch over into anxiety from stress when you, let's just say, heaven forbid, a parent died. I'll give you my own anecdotal situation. When my dad died many, many years ago, he was a cigarette smoker. Every time I smelled cigarette smoke, I would have a panic attack. It would just make me nervous. I would be sad all the time. What could I have done for that besides the relaxation technique? My PCP could have prescribed something because that cigarette, in my mind was my threat. It was the threat of I'm going to feel sad because my dad just died from this. There are medications that we can give to help dampen that response that we have that causes anxiety. Those medications, good, bad or indifferent, like all medications work. But they do come with side effects. So, if we look at think of some of the medicines like the Benzodiazepines, those medicines are like Xanax, Clonazepam, Ativan, which, a generic name is Lorazepam and Xanax generic name is Alprazolam. But what they do is they call a sense of relaxation in your brain. That sense of relaxation feels good, and because of that, it has an addictive potential. And not all created equally. But some of them definitely have an addictive potential.

RON AARON
So, your little brain says, I want more of that.

DR. TAMIKA PERRY
I like that. I like that feeling. IÕm nice and calm and I feel good. We try our best to get them to use sparingly. Some cases not at all. The other flip side of that, too, is that yes, they do work. But not only can they have addictive potential, they have been linked to memory loss too. So, we don't want to, definitely in medicine first, do no harm. Now, that's not the only kid on the block. That's for like right then and there, it's going to take away my panic attack or my anxiety. But if you're having anxiety, now remember this is different than stress, if you're having anxiety on a regular, or panic attacks on a regular or disrupt your daily life, then we can also look towards a class of medicines called the SSRIÕs. The Selective Serotonin Reuptake Inhibitor. So, they allow the happy hormone in your brain, the common hormone in your brain to be there a little longer. And over time, your incidence of anxiety or panic attacks decrease dramatically with that class of medicine. Because it's a longer acting drug, you don't get that euphoric feeling with them, and the addictive potential is not there like with the other medications that we talked about.

RON AARON
What are some of those drugs?

DR. TAMIKA PERRY
Those are like Zoloft, Prozac, Celexa. You guys may have heard of these. These are all the trade names for them. They've been around for a while with a safe efficacy program profile. I mean, every medicine, including Tylenol, has its drawbacks. But the efficacy profile is safe and the potential for addiction is not there. Now, there are other medicines that we use that are older school medicines that are just really antihistamines, like hydrazine. It is an antihistamine that we use for a lot of things, including itching and allergies. But we use it for anxiety also, and it works well. Side effect profile is a little lower than the Benzodiazepines. However, it does have its drawbacks. If we give you medicines that rapidly sedate you or rapidly cause your anxiety attack to come down, it's a calming effect, and that calming effect can result in sedation or sleep. So, just be aware that if you are prescribed some of these medicines, talk to your PCP. Which one of these is going to make me sleepy? Am I safe to take it when I'm in public? Should I take it only when I'm at home?

RON AARON
That's good advice.

DR. TAMIKA PERRY
Yeah, definitely. If I do prescribe a patient a Benzodiazepine for whatever reason, I will always tell them the first time you take it, please make sure that you're at home so you know how your body reacts with it. I don't want you to have a panic attack if you're in the middle of Walmart, and then you take your pill and you say, I love everybody, and you fall asleep. It did its job, but it calms you down a little bit too.

RON AARON
Attention, sleeper on aisle four.

DR. TAMIKA PERRY
Right? I don't want that pill bottle to roll out of your purse with my name on it, so what I want you to do the first time you take it is to make sure you're at home, so you know exactly how you react to that medicine. Because remember, these are typically meant to be short acting acute medicines that we don't give chronically.

RON AARON
Do patients come to you and ask for medication? Say, doctor, I'm having all kinds of issues with stress and anxiety. I need a pill.

DR. TAMIKA PERRY
I think it's about a 50/50 split. Some people come because it has definitively disrupted their life. Not that they necessarily ask for a pill, they just ask for some help or physiologically, what is wrong with me? How come I have these heart palpitations, shortness of breath, what is going on with me? We do this million-dollar workup to realize that it was stress and or anxiety, and then you start to always ask people, too, is something going on in your life is different? Oh yeah. My teenage daughter said she was pregnant, my house just burned down, and I just lost that promotion. Well, that's probably what's going on. Let's talk about that. So, people come in seeking help, and then the other half, like we just talked about, they come with the symptoms. But they say what's wrong with me? And we do this million-dollar work up. But what I've learned over my career is to ask. I was like, I'm not trying to be rude, but is anything different in your life than the last time? So, they come in with certain symptoms. We ask about what could be causing your headaches, your heart palpitations, your shortness of breath.

RON AARON
Do people generally fess up? Do they tell you?

DR. TAMIKA PERRY
I found this to be another 50/50 split. People will be like, oh my God, I'm so glad you asked. I didn't think anybody would ask. And then they just go on to this, and then I tell them, I have a great counselor for you, and I even have some medication for you because I don't give good advice. I was not trained to do that. I was trying to recognize it. Then I usually refer them on to a counselor who they thoroughly enjoy. Other people say, well, this is normal. This is my everyday life. I don't think this is going on. And I ask and we come to find out they do have like three jobs and two kids, and one of the kids isn't doing bad. But to them that's everyday life with your body after a while saying you're tired. There's too much going on and we need to do something about that.

RON AARON
When it comes to the chemicals that we produce under stress, something called cortisol, are we aware of that happening?

DR. TAMIKA PERRY
It's not like we start to produce the cortisol and then we go, oh my cortisol levels are up. Cortisol is a physiological response. Your brain produces cortisol in response to what may be going on in your outside life. Like is that the repo man coming to get my car? Your cortisol levels are going to go up, right? So, when your cortisol levels go up, guess what? You're in that fight or flight mode. Here's an example. If you come in contact with a big bear, you're either going to fight him or you're going to fight. Either way, your pupils are going to dilate. Your heart is going to start to palpate. Your breathing is going to speed up. Blood is going to be directed from your gut to your muscles. Your blood sugar is going to go up. In fact, blood sugar is what we call an acute phase reactive. So, when you're under physiologic stress, even if you're not diabetic, your blood sugar may go up a tad because you're getting your body is getting ready for battle. Whether that battle is physical or psychological, it is getting ready for it.

RON AARON
That comes from when we were primitive human beings.

DR. TAMIKA PERRY
Correct. We were still, I guess, beating on our chests and dragging women into the cave with their hair. That's part of that survival mode. Wait, we still do that, right? Beat on our chests. Okay, so that was part of that survival mode that we had then. But now, we have to say how does that survival mode manifest in us physically? And how can I do something about it if it's disrupting my daily life?

RON AARON
Well, one of the things I'm hearing from you is we need to pay attention to what causes our stress, and if we can eliminate that from our lives or learn how to manage it, life will be better.

DR. TAMIKA PERRY
Yes, that's exactly what you're hearing for me. So, when I have patients who finally fess up that something is stressful that was going on and I just can't handle it. I'm like, well, is it going to is it going to resolve or go away? A lot of times those patients can, believe it or not, people including myself, I was like this at one point, they get burdened. We put this unnecessary strain on ourselves for other people. No, it's okay. That shouldn't cause you stress. No is a complete sentence. You can say no, it's all right. I know a lot of my seniors, they get a little perturbed because, well, my granddaughter asked me for this and I just didn't have it, now she stressed out. You can say no. It's fine. Self-preservation is not a sin. You can say no. It's absolutely fine.

RON AARON
I used to work with a guy who almost weekly to give a speech somewhere, and he could never say no. So, here's what would happen. He'd say yes, he'd accept, and then two days before, he'd say, oh, something's come up, I can't do it. So, he upsets that group. He's dealt with the stress. I said to him one day exactly what you're saying. Say no to begin with. It's okay. All they want to know is if you can do it or not.

DR. TAMIKA PERRY
Yeah. It's okay. Your opportunity will come again. And that wasn't the opportunity for you if you had to say no.

RON AARON
That's a hard lesson for some people to learn.

DR. TAMIKA PERRY
Listen, I know that she was talking about something else, but just like the late Nancy Reagan said, just say no.

RON AARON
She was talking about drugs.

DR. TAMIKA PERRY
Yeah, she was talking about drugs. Say no to that also, but it's okay in every aspect. A lot of times, we have to fill out all this paperwork for the patient that says, why can't they be at work and what can't they do? I know they probably hate to see my documentation come in because when they ask, what can't the patient do? What task can't they do? I say anything that is physically or mentally taxing, which could be anything. That patient needs to relax. So, for that period of time, we don't need anything stressful.

RON AARON
Well, before we let you go, where can folks learn more about this?

DR. TAMIKA PERRY
Definitely your PCP. I know I'm probably the broken record of PCP advocates, but definitely your PCP because they'll say is this stress? Is this anxiety? Is there something else going on? So, you can kind of tease through it. Now, if you just want some leisurely reading, you can go to familydoctor.org, you can go to the Centers for Disease Control, or you can go to the Mayo Clinic. These are all good resources to find out about stress and anxiety.

RON AARON
That's one website I'm not aware of, familydoctor.org.

DR. TAMIKA PERRY
It is it's like the patient friendly website for the American Academy of Family Physicians. It gives you a lot of good, sound advice.

RON AARON
Dr. Tamika Perry, thank you so much. I'm Ron Aaron, and we really appreciate you joining us today on the award winning Docs in a Pod.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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