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Prevention is one of the most effective ways to maintain long-term health and well-being, especially as we age. Ryan Jones, MD, co-regional medical director at WellMed in North Texas, shares tips about the importance of preventive care in older adults for reducing complications, staying independent, and enjoying life to the fullest.
Dec. 4, 2024
Podcast transcript
INTROWelcome 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, everybody. Delighted to have you with us on Docs in a Pod. I'm Ron Aaron. Today we are going to be covering a really important topic, and along with our co-host who is with us today, Dr. Tamika Perry, we are so pleased to be able to talk with you. Docs in a Pod, by the way, is an award winning program, a podcast and a radio show that you can hear in a lot of cities in Texas and Florida. You can find our podcast wherever you get your podcast. 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 thereof. She has an associate medical director, her goal is to support the providers at these clinics as they deliver quality care and a compassionate, passionate experience. Dr. Perry is a graduate of just a wonderful, wonderful school. She'll tell you all about it if you ask. Prairie View A&M University. She then went on to graduate from Philadelphia College of Osteopathic Medicine, where she was a National Health Service Corps Scholar, and she's done a whole lot more, but we won't take all this time telling you. Tamika, great to be with you again.
DR. TAMIKA PERRY
Oh, you know, I love being here. This is my absolute favorite time and I'm excited about the topic for today because you know I'm always preaching you have to have that relationship with your PCP.
RON AARON
We're going to talk to a woman who knows a whole lot about that. The importance of preventative care. Dr. Ryan Jones is with us. She serves as a regional medical director of primary care at WellMed/USMD, part of Optum. Dr. Jones is responsible, as is Dr. Perry, for overseeing, in her case, more than 300 clinicians in 80 employed clinics in North Texas. She is a graduate of medical school at the University of Texas Health Science Center in Houston and completed her residency in internal medicine at Baylor University Medical Center in Dallas. She's board certified by the American Board of Internal Medicine, and she's a member of the Texas Medical Association and the American College of Physicians. She's got two little kiddos. Sawyer who is 16 and Dylan and Elizabeth, who are 11. When she's not at the office, you can find her in the stands at her kidsÕ basketball and softball games. She spends a lot of time dabbling in interior design and looking at the photo we're seeing of her sitting in her office, we talk to each other via Zoom, I can see the incredible touches you have like that dead plant in your corner. It's great to see you, Dr. Jones.
DR. RYAN JONES
Thank you for having me. I'm so excited to be here and this is one of my favorite topics.
RON AARON
Why? Why is preventative care an important topic for you?
DR. RYAN JONES
Because we know that patients who see their primary care doctors more frequently, and patients who take a proactive approach to their care, they live longer and they feel better. That is really what we're here to do. We're here to help you navigate this healthcare system, which is very complex. We're here to help you navigate that and live the healthiest life that you can.
RON AARON
Now, one of the things I said to you while we were chit-chatting before the show, and it brought a big smile to your face. How many patients say to you, hey, look, I only go in when I don't feel well. If I'm feeling great, why in the world should I come see you?Ê
DR. RYAN JONES
Yes, we hear that all the time. It's no different than getting your oil changed and maintaining your car. You're going to get more miles and you're going to have better performance if you take the time to be preventative. Let's be proactive, not reactive.
RON AARON
Walk us through that first or second visit where somebody comes in to see you. Perhaps they haven't been in like forever and they say, I feel great. I'm only here, in the case of a guy, because my wife made me come. What is it that you walk through in talking with them?
DR. RYAN JONES
The first thing that we're going to want to do is ask, what matters most to you? Is there anything on your checklist that we need to talk about today? Because that's the first thing and it's common that you might come in for your first visit or even your second visit and we're not ready to get to the preventative part of your care yet. You do have things that are on your mind and your primary care doctor wants to know first and foremost, what matters most to you.ÊBut as we start to address those conditions, then we need to take the time to have an appointment to go through that preventative lens and go through that checklist. And it's a pretty long checklist that we've got on our minds as your primary care doctor. WeÕve got about 20 things we're going to cover, and sometimes we're going to send you home with a pretty long to-do list.ÊSo, we don't want that to be overwhelming. We want to prioritize and decide together how we're going to get through it one step at a time.
RON AARON
All right. Hold that thought and let's talk through that to-do list. But for those of you who may have just joined us, you're listening to Docs in a Pod, the award winning podcast available wherever you get your podcast, or you can hear us on the radio in a number of cities in Texas and Florida. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry, and our special guest, Dr. Ryan Jones. We're talking about the importance of preventative care. Dr. Jones, what's on that checklist you go through with your patients?Ê
DR. RYAN JONES
First we're going to think about screenings. What are some conditions out there that if we detect early, we can make you live longer and or feel better? So, we want to know what your blood pressure looks like. We want to know what your cholesterol looks like. And as you probably know, cholesterol requires a blood test.Ê We're going to talk about cancer screenings. Looking for things like breast cancer and colon cancer, things that we know that we can detect early and when we intervene on appropriately can have a huge impact on your life. Last but not least, diabetes. That's a big thing that we screen for, and we know that we can impact you if we treat it appropriately.Ê
RON AARON
In screening for diabetes, Tamika, what is it that the A1C test shows you? I hear that all the time, but I'm not sure what it does.
DR. TAMIKA PERRY
An A1C is a two to three-month average of your blood sugar. So, when you have that A1C, if we're looking for a diagnosis of diabetes, that's 6.5 or more on two or more occasions. Prediabetes is anywhere from 5.7 to 6.4. In addition, if you came into the office and we did a random test and you were not fasting, if it's 200 or greater with that random like finger stick, then you have diabetes or 126 or greater if you're fasting for blood sugar. But I think the most profound thing that Dr. Jones has resonated with me so far is having that relationship with the primary care provider that says what's important to you. Dr. Jones and I know science, we went to school a long time for science, a little bit of math, all that jazz, but you do know your body. You've been with it your entire life. So, we take our thought processes, and we put them together and we say, this is the plan for you because you only get one body. You don't get a do-over. If we did, I'd pick Beyonce, but we don't get a do-over, right? So, it's important that you have this relationship with your PCP.
RON AARON
Dr. Jones, when, when people give you that checklist of things that are important to them, what are the kinds of things that you hear about? Like in my own case, we have three young kids, I happen to be 82. My goal is to live to 120 so I can see them all graduate college and get married or whatever and be there for them. That's my goal.
DR. RYAN JONES
That's a good one.
RON AARON
Thank you.
DR. RYAN JONES
Sometimes we are talking about big-picture goals like that. Other times we're talking about things like my knee really hurts today. My knee is slowing me down and it's keeping me from exercising, and I need to get help with addressing that problem. So, all ends of the spectrum need to be addressed. But really, we want to know when you walk in, what's the most important thing to you that we need to address before you leave this office?Ê
RON AARON
Dr. Perry, what do they say to you?
DR. TAMIKA PERRY
Anything from my toenail hurts to my chest hurts. ThatÕs two broadly different things. A lot of times when patients make the appointment, it will be my toenail that hurts. And then by the time we got in there, I meant toenail, I really meant chest. But you need to once again, have that candid relationship with your PCP to be able to tell them things. It's very important to tell them things that you don't think are that important. Like, I am using the bathroom more often. I'm a little bit hungrier, but my wife cooks really well so maybe I'm eating, more. But hungry a lot, thirsty a lot, peeing a lot. These may be signs that you really do have diabetes. Or if it's a young lady who is having more vaginal yeast infections than the average bear, it may be diabetes. That's why you need to have that candid relationship. I think Dr. Jones and I will both tell you that these screenings don't go on forever. There is an end point to certain screenings, right, Ryan? Like, what are some of the end points to the screenings that we have?
DR. RYAN JONES
Colon cancer is a great example. We want to check you for colon cancer between the ages of 45 and 75. If you have normal screenings throughout that time, and you're someone who we consider low risk, there will come a point when we don't need to continue checking that test. And the reason for that is these screenings are designed to catch tiny things that are going to slowly grow over 20 or 30 years. For most people, when we're thinking about an average lifespan, catching something at 75 that's not going to impact us until 105, isn't really where we want to focus our energy.
RON AARON
As long as they keep giving me propofol, I'll keep going for colonoscopies.
DR. TAMIKA PERRY
Oh no. Disclaimer, we did not recommend that. Ron is special.
DR. RYAN JONES
These conversations are complex conversations, and they're individualized and we want to partner with you and do what we call shared decision making to decide the best way forward for each patient. Weigh the risks and benefits.
RON AARON
Let me ask you, because you brought up colonoscopy, which I have done and do regularly. There are some people who are pretty squeamish about colonoscopies, and they see all those TV ads for that little box that comes to your door with a smiley face that says, hey, here's an easy way, and we don't need to invade your privacy to get a check on whether you have colon cancer.
DR. RYAN JONES
Yeah, so that is one of the multiple options available for screening for colon cancer. And again, it's a decision and a discussion that you need to have with your doctor, but we see a lot of patients where that is the best way to test.Ê
RON AARON
But what they need to understand is if they find an indication of a problem, you're still going to have a colonoscopy.
DR. RYAN JONES
That is true.
DR. TAMIKA PERRY
That is correct. But some people just get the idea of a colonoscopy, they just can't get over that thought process. We do prefer some type of screening. Now, Ron, you make a very valid point with those colorectal DNA detection tests. If you have a history of polyps in the past or if you have a personal history or first degree relative with a history of colon cancer, other tests would be more beneficial to you for the detection of cancer. However, I cannot get my own mother to get one. The colonoscopy is not for her, but those colorectal DNA kits is the way for her to go. So, we'd like some detection.
RON AARON
I had a good friend who died of colon cancer, a very well-educated, high professional who just wouldn't get a colonoscopy. When they finally got one, it was too late, and he died of colon cancer.
DR. TAMIKA PERRY
That's what we're trying to prevent.
RON AARON
Stay with me. We're going to get right back to you. Delighted to have Dr. Ryan Jones with us and our co-host Dr. Tamika Perry. We're talking about the importance of preventative care. I'm Ron Aaron. You're listening to the award winning Docs in a Pod.Ê
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RON AARON
We are so pleased you are staying with us right here on the award winning Docs in a Pod, our podcast is available wherever you get your podcasts. We're on the radio as well in several markets in Texas and Florida. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry, and our special guest is Dr. Ryan Jones, and we're talking about the importance of preventative care. We've talked quite a bit about colonoscopies. For the other screening tests that you mentioned Dr. Ryan, blood tests often are involved.
DR. RYAN JONES
That's right. Your doctor is going to want to check your blood probably once a year, maybe more frequently if we do detect some conditions, but we're looking at things like your kidney function, your liver function, your blood sugar, which detects diabetes. Electrolyte levels like potassium and other common basic blood tests that can detect early if you might have a problem that we need to look into more closely.
RON AARON
Now that we had started talking about the checklist that you have with patients and Tamika, you wanted to jump in.
DR. TAMIKA PERRY
Yeah. Dr. Jones said that once a year, it's important that we go every year. Patients will say a lot of times, oh, my cholesterol was good five years ago, or, my kidney function was excellent five years ago, but we often look at trends. So, there's a level of normal within two values and you may be within that level of normal, but are you trending down or are you trending up? So, we not only want to look at that point in time, we want to look at historically, how have you been doing and these indices that we look at.
DR. RYAN JONES
You're leading to something that I think is so important that we talk about today, and that is how frequently should I see my primary care doctor?ÊWe have data that shows that people who see their primary care doctor more frequently and are more closely knit with their PCP team, they have better outcomes. Better outcomes mean they live longer, and they don't go to the hospital as much. We consider that to be a big success.ÊSo, if you're over age 65, I think you should check in with your primary care doctor once a quarter.
DR. TAMIKA PERRY
Yes.
DR. RYAN JONES
It might not always be a face-to-face visit, maybe it's even a phone call, but having those quarterly touches is really important. Is that how you practice, Dr. Perry?
DR. TAMIKA PERRY
It's absolutely how I practice. I have several patients who are maybe a little bit higher acuity who I call at least once a month. I'm just calling to make sure that little things don't become big things. Tell me what's going on in your world, what's happened different than last time that I talked to you? Then I have other patients that I see, like Dr. Jones suggests, once a quarter, what's happening? With that said, my patients are very savvy, so they ask me about updates like updates on shots, what's going on? One of the updates is this kind of new respiratory syncytial virus vaccination, RSV. RSV typically little kids get, but we know RSV can be serious in babies and adults. So, is the vaccination recommended? Yes.
DR. RYAN JONES
Also, let's remember flu shots and COVID vaccine this time of year. Very important to protect yourself.
RON AARON
And it turns out you can get a flu shot and a COVID shot on the same day. You don't have to go back and forth.
DR. TAMIKA PERRY
Absolutely.
RON AARON
On the COVID there are, of course, mutations that occur in the COVID virus, much like flu. Every once in a while you see, oh, there's a new COVID vaccine. Should you wait a year to get it or are you really better off getting it when it becomes available?
DR. RYAN JONES
I'd say get it once a year around the same time as your flu shot. That's something that's really turning into a yearly routine that we should all be in.
DR. TAMIKA PERRY
I think people were a little disappointed. We were so happy when we, a vaccine came out for COVID, and then everyone was like, why do I have to get another one? I always equated it, just like you guys were saying, to the flu. It's a virus, it mutates, it changes, so we change with it. ThatÕs how it protects us.Ê
RON AARON
For a period of time, we were seeing a lot of deaths from COVID. In your experience, has that declined significantly in your patient population?
DR. TAMIKA PERRY
In my patient population, absolutely. I'm sure Dr. Jones would agree too. It's just not a vaccination. Vaccinations is the major cause of it, but it's also being aware of what the virus is, hand washing, using sanitizer, wearing your mask when appropriate. All this has contributed to the decrease in deaths of COVID.
RON AARON
You agree, Dr. Jones?
DR. RYAN JONES
100%.
RON AARON
We talked about a couple of vaccines. There are others in the term of preventative care that one ought to think about. Shingles would be one. Nobody wants shingles, but a whole lot of people get it.
DR. TAMIKA PERRY
Yes. What the vaccine is preventing is something called postherpetic neuralgia, which is decreasing the incidence of, and this is horrible. What postherpetic neuralgia is, is that the virus is very smart. It can get into our nerve cells. It can irritate those nerves where they just keep causing you the blues, meaning severe pain in that particular area. Pain, like if you blow on it, it's going to hurt really, really bad. This becomes problematic for all populations, but particularly our senior population. So, that's what shingles helps us reduce significantly.
RON AARON
Dr. Jones, give us a little background on shingles because especially in the older population, many of us had vaccines that prevented that virus, but I understand that virus can be living inside all of us.
DR. RYAN JONES
Yes, shingles is the reactivation of chickenpox. Interestingly, we have a vaccine for chicken pox now. So, many young people never had chicken pox like all of us on the phone probably did.
DR. TAMIKA PERRY
Yes.
DR. RYAN JONES
But the majority of adults have this virus living in their bodies. Even if you never had chicken pox or you don't remember having chicken pox, you should still get the shingles vaccine. I just can't reiterate how frequently we see shingles in our clinics.
RON AARON
I can remember as a kid when my mom said to me and my brother, Jimmy, you got to go over to Spencer Sharwell's house, he was a neighbor, he's got chicken pox, you want to get it. Boom. Pushed us out the door, went to see Spencer, and of course, Jimmy and I both got chicken pox, which I gather was a good thing.
DR. TAMIKA PERRY
Yeah, my mom did the same thing to me. My sister had chicken pox, and we were never allowed to drink soda and she bought us a Sprite and let us share it and I got chicken pox. I thought it was a treat; it was really a trick. You know what I mean? Yeah, absolutely. Your mom was inoculating you.
RON AARON
For the younger population, Dr. Jones, who've been vaccinated, are they still at risk for shingles?
DR. RYAN JONES
No. People who have been vaccinated for chicken pox should not get shingles and do not need the shingles vaccine. Do you agree, Dr. Perry?
DR. TAMIKA PERRY
I do agree. That's the lucky part of this generation now. Shingles vaccine is almost exclusive to our senior population.
RON AARON
Another illness that can be a killer is pneumonia. There are, I gather, a couple of vaccines that can help with some forms of pneumonia.
DR. RYAN JONES
That is exactly right. Especially in older adults, if you're over age 65, please get the pneumonia vaccine and your doctor can talk to you about which version is best for you. But we're getting into that season where it's more important than ever.
RON AARON
What's the difference between the seasons? Why does that make a difference?
DR. RYAN JONES
You see fluctuations in a lot of the different respiratory conditions and we're coming into that time of year where we know hospital rates start to go up from the pneumonia virus.
DR. TAMIKA PERRY
If we circle back around to something we were talking about earlier, we were talking about diabetes. If you're immunocompromised, like your blood sugar is high, you have a history of COPD, really bad asthma, cancers, I can go on and on, an immunocompromised disorder like lupus, it's really important that you get these vaccines because that illness, that COVID, that pneumonia, that influenza is even worse in you all and the rates of hospitalization are higher in this population than in the non-at-risk population.
RON AARON
Dr. Jones, we only got a couple of minutes left and before we go, take us back to the beginning for those who may have just joined us here on Docs in a Pod. Why is preventative care important to patients?
DR. RYAN JONES
Preventative care is important because we recognize that we can have a real impact on your life, your quality of life, how long you live, how good you feel, if we take more of a proactive approach rather than the way we used to practice, which was all oftentimes just being reactive and responding to signs and symptoms when they popped up. So, engaging with your primary care doctor, building that relationship, and really communicating with them about how you feel can have a huge impact on your life.
RON AARON
It's interesting, the founder of WellMed, Dr. George Rapier, had an interesting theory. It's easier to keep people well than to try to cure what it is they walk into the office with. And that's what I hear you saying, Dr. Jones.
DR. RYAN JONES
That's exactly right.
RON AARON
As you think about your patient population, we of course are a nation where a lot of us are getting older.ÊDoes that increase the burden you have in your office? More and more older people coming in.
DR. RYAN JONES
Did you know every day 10,000 patients in this country age into Medicare? So, we have the baby boomers coming along. We have a lot of seniors to take care of and that is what we specialize in at WellMed. So, we're here to help you meet those needs. We've got clinics throughout Texas and Florida, and we embrace the challenge to hold hands with our patients and help them navigate the health care system and live their healthiest lives.
RON AARON
Let me touch on one item we haven't covered, and that is skin screening for cancers.Ê
DR. RYAN JONES
Yes. Your doctor will talk to you about what to be on the lookout for, and we'll probably do a skin exam when you're in the office. Not everyone needs to see a dermatologist every year for a skin check. A lot of this will be handled with your primary care doctor, but we'll also spend time educating you on what to look for when it comes to keeping your skin healthy.
RON AARON
Tamika, the fun thing is when you come to the office, you bring your skin with you.
DR. TAMIKA PERRY
That's absolutely right. You never leave it at home.
RON AARON
To both of you, I appreciate you being here. For Dr. Ryan Jones, thank you so much. We're going to have to do this again. To our co-host, Dr. Tamika Perry. I'm Ron Aaron. Thanks for 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.Ê
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