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. Raje Sudhath and award winning veteran broadcaster Ron Aaron, will share information to improve your health and wellbeing. And now here are Ron Aaron and Dr. Rajay Seudath.

RON AARON
Hello and welcome to the award winning Docs in a Pod. I'm Ron Aaron. Delighted to have you with us. Our co-host, Dr. Rajay Seudath, is with us. He is board certified in family medicine, a Tampa native and a current lead physician for Optum. He's at the university's location in Tampa, Florida. Dr. Seudath earned his medical degree from the University of South Florida, Morsani College of Medicine. He has a passion for primary care and guiding his patients to meet their health care goals while maintaining their values. Before his career in medicine, Dr. Seudath worked a whole lot of jobs, but working as an English teacher abroad was the inspiration that led him to a field in family medicine. He is also our guest expert today, so we get a two for one with Dr. Seudath. Rajay, good to see you.

DR. RAJAY SEUDATH
Good to be here again.

RON AARON
Well, you've picked a really interesting topic. We're clearly approaching the holidays of Thanksgiving, either is around the corner or has happened when you listen to this program. Then, of course, Christmas and Hanukkah and Boxer's Day and a whole lot more is coming your way. We're going to deal with the whole question of holiday blues, depression, dementia and a whole lot more. That's Triple DÕs Dr. Sudha.

DR. RAJAY SEUDATH
That is correct. The holiday blues is something everybody has probably maybe even heard of or even experienced. As we get towards the holidays, a lot of people can be affected just by the weather itself. As we're going from the end of summer into fall into winter, that just by itself can cause some of those depressive symptoms. Then as we're getting into the holidays, some people can be with their families, some people may not be with their families. If they were, particularly in families that were close and we've recently suffered losses, people passing, it brings all of that back. A lot of people can have those lower depressive type symptoms when we get to the holiday seasons. And that can be particularly difficult to deal with, especially for people who are in a situation where they're not able to be with their families, whether they're in a facility, whether they're by themselves. Then that leads into one, we have a low mood, and how much low mood becomes depression? Then, does depression lead into dementia? Then dementia leads into things like delirium. So, it's a whole spectrum of Triple D, as we said, that we can talk about. It's a very large, large, nebulous situation, but I think there are some key points that we can definitely touch on.

RON AARON
Well, you mentioned change in the weather and certainly as winter approaches, there's less sunlight. I have a daughter-in-law who is suffering from Seasonal Affective Disorder, aptly named SAD, and in the winter not getting enough sunlight really depresses her so she has invested in a daylight lamp that sits above her desk.

DR. RAJAY SEUDATH
Yes, I remember learning about this, and I was so impressed that such a simple fix of using a daylight lamp while you're doing your work or even reading with that lamp, kind of, stimulating your retina can actively change your mood.

RON AARON
Do you see patients with SAD?

DR. RAJAY SEUDATH
In Florida, not so much, but we do feel the changes, and I think people who may have underlying depression, they certainly feel it even more. Again, there's many different ways that we can try to combat that. Sunlight lamps can work. If there is sunlight, opening the windows, looking at the clouds, looking at the atmosphere, the blue atmosphere. Those kinds of things stimulate your retina, and that kind of keeps your natural sleep-wake cycle, which can reinforce your natural antidepressant chemicals that are already in your brain.

RON AARON
Now, you said something that triggered an alarm bell in my little brain, talking about how depression can lead to dementia. Is that what really happens or is it a symptom of dementia?

DR. RAJAY SEUDATH
It can actually be two very separate things. A person can have dementia. Now, dementia has many different causes. If we can get a little technical, just for a second. When we talk about dementia, it's an umbrella. It's an umbrella term. It just means that a person is not having good function for their memory. But when we talk about memory, there's many different types of memory. There's your muscle memory, can you ride a bike? There's your language memory. I remember that guy from 20 years ago, his name was Bob, and he worked at the fish market. There are many different types of memory. So, dementia is classified as a deficiency or not being able to use some of those parts of memory. Now, is it minor or is it major?

RON AARON
And the answer is?

DR. RAJAY SEUDATH
The minor or the major has to do with it, is it causing distress? So, if you are having distress, then that's considered major. If you're not having distress, it's just taking you a little bit longer to do your activities of daily living, then it's considered minor. So, you have two separate things that are very intimately connected. If you have dementia, and you have depression, it can worsen the dementia. If you have depression, and you're suddenly developing dementia, it becomes much harder to treat the depression. So, they're intimately linked, but they are two separate things.

RON AARON
Now we're going to come right back to that, but 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 podcast. We're on the radio as well in a number of cities in Texas and Florida. But on a podcast, you can listen to us around the world or in any other universe that may be tuning in to Earth. I'm Ron Aaron. Our co-host is with us, Dr. Rajay Seudath, also our special guest today talking about holiday blues. There's an interesting dichotomy, Dr. Seudath, and that is everywhere you look this time of year, and it seems earlier and earlier and earlier, holiday ads have begun the past several weeks, and we're not even at Thanksgiving. What do they feature? Happy, smiling people, wonderfully behaved kids, incredible, gorgeous settings, and whether you live in the North or not, snow often a feature of the holidays, and so you see people playing in the snow. You see that, Dr. Seudath, so then you say, why am I so depressed?

DR. RAJAY SEUDATH
Absolutely. You can tell it is so much of a created atmosphere because so many people when they go into the holidays, they may not be feeling that. They may have stress in their life. In fact, going into the holidays now here in Florida, so many people coming off the hurricane, they're having the stress of trying to rebuild or being displaced and now they're going into the holidays already in a depressed state. On top of that, I can't be with my family, or I have chronic pain. I have this, I have that. Those things kind of come to a head. It's also the end of the year. What have I done with my life at the end of the year? All those kinds of self-reflections can lead a person to have a decreased mood. So, let's kind of differentiate between decreased mood versus depression. There's baby blues, there's holiday blues, and then there's full blown depression. I think that's something that we can touch on briefly, in that if you have a stressful event, you lose your spouse, you get into a major car accident. A person can have a depressed mood so we say that's a stress reaction that can be up to three months. When that three months is over and a person is still having those depressive symptoms, now are they having distress in their life? Are they not able to function for two weeks? Now this is clinical depression.

RON AARON
Is that something you know or something someone else should tell you?

DR. RAJAY SEUDATH
A person can sometimes have a major insight into it. There's a saying, if you listen to the patient, they'll tell you the answer. When a patient says, I'm not myself, I'm a happy guy, I like to go out, I like to be with my family, and I'm not doing that. I'm sleeping all the time, I have no energy, I just feel so down. Sometimes I look at my pill bottles and I think about what would happen if I took them all right now.

RON AARON
That's a little suicidal.

DR. RAJAY SEUDATH
Right. If somebody says that, for a health care provider, that's a switch. We need to pay attention to this person. That's not idle talk. ThatÕs kind of a person who's truly depressed, clinically depressed. If you have cancer and you live under an underpass and you're homeless, you got a lot to be depressed about. There are some people who in that situation and they still look on the bright side of life but a person who's truly clinically depressed, they can win the lottery and they'll look at the winning lottery ticket and they'll be like I don't care. That's the difference between true depression, and I'm not feeling right. I'm not feeling good. I'm sad because of the season. The thing is, the seasonal low mood can lead in to a depression if that spiral continues downward.

RON AARON
So, in this hyper-pharmaceutical world, is there simply a pill you can give them? Pop this, you'll be good.

DR. RAJAY SEUDATH
People always wish for a magic bullet. If there was one magic bullet, we wish it would just work and then fix all the troubles. But when you look at the studies, when you look at everything, a multifactorial approach is the thing that works the best. When you look at studies, when you look at people who have clinical depression, with people who've had many bouts of depression, it's always a mixture of non-pharmaceutical things. So, therapy, changing your environment, getting into a regimented lifestyle, interacting with people, talk therapy, and then adding on the pharmaceutical as well. Something like an SSRI, which is a very common type of antidepressant. Sertraline, Prozac, those kinds of things. Of course, when we're thinking about medicines, we're always thinking about the person's individual diseases as well. You have to make sure that you're looking at their kidney function, their liver function. That's why when a person starts to have mental changes, I'm not feeling right, I don't feel normal, or their family is saying that, go to your physician. Go to your healthcare provider and talk about it.

RON AARON
And then work together to get an answer?

DR. RAJAY SEUDATH
Absolutely. Because when a person is in the grips of depression or falling into dementia, the natural knee-jerk response is to introvert. To say, I'm going to solve this on my own, and to really pull away from people, to get that social isolation. That can further the symptoms. So, kind of pulling things out of the dark into the light, getting them into the open. That's why so many people had a stigma with mental health for such a long time.

RON AARON
Well, as they say, denial is not a river in Egypt.

DR. RAJAY SEUDATH
You are correct. The first stage of grief is that denial. That's absolutely right. It is not just a river in Egypt.

RON AARON
Stay with us for a minute. We're going to get right back to you. I'm Ron Aaron. You're listening to the award winning Docs in a Pod. We come to you every week with a look at a variety of issues, both medical, physical, mental health as well, and a whole lot more. Dr. Rajay Seudath, our guest today, and our co-host. You're listening to the award winning Docs in a Pod.Ê

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RON AARON
We're so pleased you're sticking with us right here on the award winning Docs in a Pod. I'm Ron Aaron along with our co-host and guest today, Dr. Rajay Seudath. He lives in the state of Florida, where you have been hit, Dr. Seudeth, with hurricanes, one after another after another. What an impact that has on people's lives. As you were saying, add the holidays to that, and it gets pretty difficult.

DR. RAJAY SEUDATH
Absolutely. One of the things is that even if you're not depressed, if you're simply going through a difficult time, you're having a low mood. One of the things we talk about is coping strategies. What are the coping strategies? What are the strengths that a person has that they can lean on during those times of difficulty? For some people, it's their faith. For some people, it's their family. For some people, it's their work. What are those coping strategies that are positive coping strategies? Because there are negative coping strategies like self-medicating with alcohol, with drugs, or, arguing, being just an angry person, and lashing out, yelling. That's considered a coping strategy, but it's not a positive one. So, one of the things we can talk about to our patients, to our friends, is what are the positive coping strategies that are you doing when you're under stress?

RON AARON
Do you give patients a tip or two on what those strategies might be or do you try to get them to come up with them themselves?

DR. RAJAY SEUDATH
Absolutely. I typically start that talk and get them interested in positive coping strategies. For people who seem to be wanting to do more of that, I'll usually get them in contact with a mental health counselor because mental health counselors and therapies, that's what they're really doing. They're looking for solutions-based counseling. They're looking for things that I can do, ways that we can change your thinking or change your behaviors to a particular problem. So, one of the things that we can do is simply write down the problem. It's amazing when you have a hundred problems in your brain, and you feel like your head is just above the water and you're going to drown. Well, it's kind of like the old you name the demons around you, and they have no power. All of a sudden there's a light at the end of the tunnel because you can see those problems a little more clearly. It can be powerful just writing down, I got to do this, I got to do that. All of a sudden, it may be a page. It may be two pages. But at least they're quantified. That can be powerful when a person is trying to cope.

RON AARON
In addressing those issues, how often do you go to pharmaceuticals as an assist?

DR. RAJAY SEUDATH
Depending on a person's severity, if a person comes in, their regular checkup, their blood work is fine, I ask them just a quick two question screen. You having any low moods, any depression, feeling like things that usually make you happy aren't happy? They give me a yes or a no on that. If it's yes, having some depressive symptoms, we'll delve deeper. Depending on how severe those follow up questions are, I may say, okay, yeah, you're telling me you're thinking about hurting yourself. I may want to start some medication now. I want you to come back next week so we can talk more about this, see how you're doing with the medicine, and maybe continue some in clinic therapy while we wait for you to get to some mental health therapy.

RON AARON
I'm sure some of the patients that you see are retired military. We, of course, have seen a huge increase in suicides within the military. We've also seen an increase in suicide among men, 65 and over. I'm sure that's in the back of your mind.Ê

DR. RAJAY SEUDATH
Absolutely. To touch on the veteranÕs affairs, the, the veteran issue, I very much encourage my patients who are veterans to establish with the VA, whether they're service-connected or not. I always tell them that because now you have two systems behind you. Some people may say, oh, they take too long to do anything, or I can't trust them. It's two systems. One, your private insurance and two, The American government system. It's not a tug of war between me and the VA. It's a game of tennis. You come to me; I see a problem. I change something, I send you back to them for your follow-up with them. They see something they change a problem; they send you back. In that sense, a person is getting double the care, so that can be very, very helpful, especially for mental health services. The VA has a wide range of things. Support groups, psychiatry, mental health therapists. When we have them going through services at the VA, we also have them coming through services with us and that can be wonderful. Whether it's depression, whether it's dementia, whether it's other things, getting services for our veterans should be a team effort. Absolutely.

RON AARON
For some of the older men that you're seeing may not be veterans but are 65 and over who seem to show signs of depression. Is the risk of suicide in the back of your mind?

DR. RAJAY SEUDATH
Oh, yes, absolutely. As you said before, men have a higher rate of suicide. Men have a higher rate of fatal attempts. Some people say the term, they have a higher success rate on suicide and people laugh when they say that, but it's not a funny subject. So, I will say they have a more fatal outcome when it comes to a suicidal attempt.

RON AARON
Because very often they'll use a weapon.

DR. RAJAY SEUDATH
Yes, that's correct. If a male over 65 is telling me, I'm having depression symptoms or I'm noticing depressive symptoms, that makes me a little more focused on, I want to address this faster than I'll see you back in three months. I want to make sure we stay on top of that.

RON AARON
One of the things I hear you saying is you're proactive about the whole issue, especially around holiday time of holiday blues, that you pay attention to it.

DR. RAJAY SEUDATH
Oh, yes, absolutely. Your doctor's paying a lot more attention to you than you might think if they're a good doctor. They get to know you, you get to know them. As I see my patients and I see them regularly, I'm asking what's going on in your life It's not just your blood count. It's not just your metabolic panel. It's what's going on with your life. I have other patients who have had traumas in their life. Again, another VA patient. He lost his whole platoon in Vietnam in March. When February, March comes around, I'm always bringing him in for that visit, whether it's a three-month follow-up or one month follow up or one-day follow up. In that month, I want to see that guy, and I want to make sure he's doing well.

RON AARON
That's interesting. His entire platoon was killed in Vietnam. He survived.

DR. RAJAY SEUDATH
Yes.

RON AARON
So, you're talking survivor guilt?

DR. RAJAY SEUDATH
Absolutely. Survivor guilt as well as post-traumatic stress disorder. In that time period, he was also buried alive because he was in tunnels all of those things start to come about. Again, when those kinds of things start to get more pronounced and we're getting up in age, now we're worried about dementia. We talked earlier about depression and dementia. Again, a person who's having depression, it makes it more difficult to determine is this really dementia or is this depression? So, we treat depression we do all of those things, but now this person is still having memory issues. How can we help those memory issues? What can we do for that? There are medicines, but there's also things like changing his environment, having more structure in your environment, going over the calendar every single day, having his family call on him, having that patient interaction, family interaction. Having more interaction because humans are social. Those are some of the things that can not necessarily bring your memory back but make you have a better quality of life with the memory you have. Because that's one of the things is when we see a person with depression and dementia, their quality of life starts to spiral downwards, and that's when their diseases get worse.Ê

RON AARON
What kind of memory loss is memory loss to worry about? For example, I've got a good friend, Dr. Harry Croft, a retired psychiatrist who used to tell me, if you lose your keys, you find them and you know what to do with them, you're okay.

DR. RAJAY SEUDATH
Yes. We had touched on this earlier about the different types of memory. There's complex attention, which is I'm doing the math problem. I can do something that requires me to concentrate. There's the executive function, which is like multi-step tasks. I have to go, I get the groceries, I bring them in, I put them in the fridge. You don't just get the groceries and leave them on the floor and your milk goes bad over a week because you forget about it.

RON AARON
You sound like my wife. One of the jobs is, if you go to the grocery store, put the stuff away.

DR. RAJAY SEUDATH
I'm guilty myself. They're language memory. So, finding the words, and sometimes you say, oh, it's on the tip of my tongue. Sometimes you see that with people who've had strokes. A part of the brain that deals with language gets damaged, and they're not necessarily able to find that word. That can also happen with dementia from different ways. Learning and memory. Again, you're forgetting to buy the items. You go to the store, you bring them back, you put them away. It's just you forgot to buy so many things, right? You made a list. You forgot to bring the list. That's the one that we always laugh about, but it's true. It can actually happen. The other one is a kind of motor memory. Using the hair dryer, brushing your teeth, shaving, riding a bicycle. Then the last one is social memory. Are you doing a lot of inappropriate behaviors? Are you not having any empathy for someone who's crying? Are you having problems with judgment? You're doing things that are kind of out of character that are kind of misbehavior or aggressive behaviors. Typically, we start to see that in different types of dementia. We may see that earlier on, we may see that a little bit later depending on the type of dementia or the cause of dementia, I should say.

RON AARON
Yeah, well, frontal temporal dementia is the one where you see, as we saw in Bruce Willis, a total loss of that protective screen around you. The filter goes away, acting out behaviors increase.

DR. RAJAY SEUDATH
Yes, absolutely. So, frontal temporal dementia. There's dementia that causes low perfusion. It's called vascular dementia.

RON AARON
We've got to stop you right there. We'll come back to this another day. We're out of time.

DR. RAJAY SEUDATH
Oh, my goodness, is it really? Wow. That just went by so quickly!

RON AARON
Thank you so much. I'm Ron Aaron. Thanks for joining us on the award winning Docs in a Pod.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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