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The Legal Drug Dealer Podcast

Getting Pharmacy as a profession Closer to The Patient

May 26, 2020

#24 Is all Female's stress and anxiety related to hormones?

With Ricardo Correa, MD & Marilena Grittani, RPh

Today we are talking with the first male to be interviewed on my podcast, Dr. Ricardo Correa, endocrinologist. He has a very interesting point of view of what is the role of the patient on getting better or even cured of an ailment or disease

Some of the most relevant points she made are:

  • Not all it is solved with a pill.
  • Finding the underlying cause of the problem is slower and harder to fix, but it is actually what works.
  • Patients must take control of their health and help themselves not the doctor.
  • Some times what everybody says, like diet and exercise, it is the best medicine.
  • Among a ton more….
Ricardo Correa, MD

" Taking control of your health and doing things that everybody recommends, but nobody follows healthy lifestyle, good sleep hygiene, exercise, meditation, to understand your body, eating healthy, all of that will help you a lot more than a pill from a doctor. "

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Dr. Correa is a highly educated physician with lots of experience in the hormonal field. The fact that he took time from his busy schedule to teach us about females hormones and stress shows his interest in educating the community that needs this information

 

Let me know what you think about our conversation and if you have any questions!!!

comments@thelegaldrugdealer.com

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" Everything is linked, the lack of energy because of menopause makes you gain weight, the stress that you normally have gets worse and you don't feel well, plus everything that is changing on you, so more stressed and then add sugar cravings that increase your weight even more... "

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Episode Transcripts

Marilena Grittani, RPh  0:11 

Hola and welcome to The Legal Drug Dealer podcast Marilena Grittani. Here. I am a registered pharmacist and also your host. Thank you so much for listening to this episode where we are going to be talking about anxiety and the relationship with hormones with Dr. Ricardo Correa. Ricardo is a endocrinologist that works here in Phoenix. And we had a really interesting conversation about this where we approach all the issues that could make your anxiety worse, that doesn’t necessarily have to go directly with your hormones, but it might affect you in different ways and how to handle them. We discuss the different alternatives medications and not medication ones. I think you’re going to have enough information This podcast. So let’s listen to the conversation and I hope you like it.

Welcome Dr. Correa up to our podcast to The Legal Drug Dealer podcast is something that we’ve been planning for a while. And finally, I have you here. Welcome.

Dr. Ricardo Correa  1:13 

Thank you, thank you so much for for the invitation, and really excited to be here with you and all the people.

Marilena Grittani, RPh  1:22 

Thank you. We have today a very interesting topic that people my age are very, very interested on. And also, it is important that those that are younger or older that are not necessarily in this situation, understand what it is so they can support their loved ones. So that’s why I need to I need us to dedicate and pay attention to what’s happening to what we’re going to be talking about today. So you are a physician, right? You are a doctor, a medical doctor, and I am curious of why did you become a physician and how long ago was that?

Dr. Ricardo Correa  1:59 

Yes. So yeah, so I am an endocrinologist, originally from Panama. So I started my career. Well, I started I did my medical school back in Panama. Really, my passion for hormones start, probably when I was 13 years old or 14 years old, where I was delayed puberty. So I had a puberty and then what happened was that that was the first time that they got in contact with a endocrinologist, pediatric endocrinologist and I just found fascinating how everything control is controlled by the hormonal system. And even that the communication among cells is hormonal. We don’t understand yet a lot of them but this hormonal and then there’s so much for technical knowledge that it is a medical school. Just intention to become endocrinologist.

Marilena Grittani, RPh  2:52 

So that was your goal since the beginning

Dr. Ricardo Correa  2:54 

is the beginning. So I did medical school, and then I came to the US for my internal medicine residency. Because for doing endocrine you have to do medicine, internal medicine. So I did internal medicine just to become endocrinologist. Finally I did endocrinology. And then I did an extra year of research or neuroendocrine meaning, pituitary and adrenals. And was because my main passion was that central pituitary gland, control everything. And the big boss, yes, CIA suits director of the orchestra, so to control everything and then I wanted to see if this study more of that. So that’s basically my passion. It was hormonal controlling cells controlling cycles and an axis and I just really studied medicine to become an endocrinologist, but in the in the pathway, you start learning other things that become then your passion besides your main interest.

Marilena Grittani, RPh  3:56 

You and yeah, what you started with. So let’s just ask Some numbers here because I want people to understand what requires for anybody to become, in this case and endocrinologist, you have to go through five or six years of medical school. Right?

Dr. Ricardo Correa  4:11 

Correct. So in Panama is six years of medical school plus two years of internship. In the US, we’ll be in total, also eight years, four years of pre med and four years of medical school.

Marilena Grittani, RPh  4:26 

Okay, so eight years used to become a physician. Correct. Okay. Then you went to internal medicine school?

Dr. Ricardo Correa  4:32 

Correct. Internal Medicine is three years there, the residency.

Marilena Grittani, RPh  4:36 

So we’re having 11 so far.

Dr. Ricardo Correa  4:38 

Yeah. And then you go to endocrinology. So the majority of the problems is two years. I did my endocrinology at NIH, there was a three year program. So because the extra year of research that I did,

Marilena Grittani, RPh  4:51 

so that was 14 years of education, and escape case for you to become an expert in hormones. Wow, that’s a life.

Dr. Ricardo Correa  5:02 

Yeah, yeah, it’s another elementary and high.

Marilena Grittani, RPh  5:07 

Yeah, like, you will do it all over again. So whenever you have, this is a common for my for you, my listener that is understanding this for the first time, whenever you have a specialist, you just don’t have somebody that has decided that it’s going to work on that area, somebody that have gone through a lot of years of preparing to be an expert. And that’s why whenever you talk to me and you say, Well, my family medicine said that my hormones are fine. That person might not know because that person does not have the education that you in this case, Ricardo have because you went through enter internal medicine, which is a family medicine, it’s not the same. And then you went through endocrinology which is another basically another subdivision of medicine. So you are so Super specialized in hormone information and now you even like neuro hormone information. So even more specialized. So my goodness, thank you for doing that. Thank you for dedicating that much of your life to help others. That means a lot to me and I know your patients appreciate that too. And understand people out there, that that’s what we healthcare providers do for you, because we do all this just to take care of you. Okay, so now that we’ve established that you’re an expert, after a little bit of study, not that much. What type of jobs have you had, what types of medicine jobs have you had before?

Dr. Ricardo Correa  6:40 

Yes, so after I finished my fellowship at NIH, I went to my first job was in Rhode Island. I worked for Brown University as an endocrinologist so so usually in endocrine we see we our title release endocrine diabetes and metabolism. So that’s that’s the that’s the so majority of the patients that we see 80% of the patient are diabetic patient. So that’s normally the chronology of what they see. And after that, I decided to move to Phoenix to the University of Arizona, in Phoenix for doing more teaching, workup and more research. So I am the program director for the fellowship, meaning that the people that are in training for becoming an endocrinologist, so I’m the program director for that and I do some research on adrenal disease. So besides my clinical job that is seen patients usually try to focus more on pituitary and adrenals but at the end, I have to see everything

Marilena Grittani, RPh  7:14 

Because you are  endochrinologist

Dr. Ricardo Correa  7:49 

correct. You have to you have to see everything and diabetes of course is the most prevalent thing that the UFC clinic but I try to focus my clinic on adrenaline you too. problems.

Marilena Grittani, RPh  8:01 

So you are you are practicing as an endocrinologist, you see patients but you also coordinate students that are becoming an endocrinologist. So that is your position and also I know that you teach, like Ma Clinic you have done it.

Dr. Ricardo Correa  8:18 

So, yes, so I teach. So, the program director for the fellowship is they are already board certified internist, that want to become endocrinologist. So, they are already trained in tournament like I did first like entering general medicine then you go to endocrinology, so, I am the person that is in charge of them. But I also teach medical students basically at two places at the University of Arizona College of Medicine Phoenix, where I teach first, third and fourth year medical students and at the Mayo Clinic college of medicine that is a recent School of Medicine data open hearing. Phoenix, where I teach second years, I help with it in the Queen block.

Marilena Grittani, RPh  9:07 

So, hormonally speaking, why females get so stressed out in general, it doesn’t matter what age you are, since you’re a teenager because my daughter at 16, she would say, I’m so stressed out, and grandma died at 93. And she was still stressed out so it doesn’t stop. So what is it? Why are we so always under stress?

Dr. Ricardo Correa  9:30 

Yeah, so there is a multiple components on the anxiety and stress. So there is the psychological component of anxiety that it definitely is very important, I think, and it’s most important than any of the hormonal part. And it’s because we live in a stress world, different from what was in the past. So there is a lot of things that just stress causing us And then cause our anxiety to to increase by, just bike so the psychological component is very important There is also an hormonal component that every female has that is the cycles that happens every month where there is that on balance of certain hormones at one time one part of it that other hormones that comes so that make a little bit unstable the mood and, and you hear this a lot like mainly the the spouses male spouses complaining, oh my god this this is a time of the month that they you have your period and blah blah blah.

Marilena Grittani, RPh  10:45 

And it’s the MS in

Dr. Ricardo Correa  10:47 

Yes. And it’s because just it’s it’s the imbalance of this hormone. So progesterone BM more a androgenic hormones And estrogen be more and estrogenic hormone. So then for 14 days of your month you have a lot of estrogenic hormone that is estrogen, but then it comes a period of time where you have more than androgenic hormone that is progesterone that caused you that fluctuation in some cases of course if you are in oral contraceptive or you have a hysterectomy of your poor or your postmenopausal so it’s directly with hyterectomy remove on the ovaries to so you remove all the just the uterus, it’s it’s the same, but if you have removed the ovaries, that’s the problem and then it posts postmenopausal. Usually the base are different because you will not have to have that hormonal but then at the beginning of each day, your body has to start understanding that you back have some of them. So the beginning would be difficult to but then after that Then is is different, more balance? Yes, more balanced anything that the most important part here will be more psychological problem than a hormonal problem. Yeah, buddy. You’re premenopausal and you are having cycles every month, then there’s a big component of all of this anxiety being triggered by the hormones and the just the Pekin travel certainly.

Marilena Grittani, RPh  12:29 

Yeah. Tell me about that. Um, I had a total hysterectomy last year. And I saw I had too many pauses. I had my real menopause. That was about five years ago when I started. And then I had tumors and they had to remove everything, including my ovaries. So I had my second menopause. So I’m that lucky. It wasn’t great. Set. Nobody ever done to me. So let’s just say make a comment about this. I was talking to somebody yesterday, interviewing somebody. For the podcast that is going to air soon, too. And she was saying that the mental part on teenagers is is important, but hormonaly, it also affects them. We were talking about behavior and teenagers so what we agreed on is that when you are a child and you go through puberty when you are not the baby that needs to be protected, that wants to be with mommy that wants to be close by that is everything but you become start start to become independent. That is a huge transition. And it’s very hard for them to handle it. Because they’re not the baby anymore. They want to be adults, but they’re still scared. You know, all that stuff that is handling that’s happened in their in their minds, and then they have hair everywhere and then the boobs are growing and then the boys are attracted or the boys are getting hurt. You know all this changes that affect them and they don’t know how to handle it because it’s new for them. That happens when you are a child and become an adult. Then when you Go through menopause, or you go through pregnancy, or you go through menopause is the same thing. But in terms of everything is changing. If you are pregnant, then you belly becomes humongous. And they think that they’re, well, they feel like they’re unwell or a cow, humongous. And then their boobies are so huge that is just so painful and it’s hard. Then you’re developing a baby and you’re responsible of all this baby and you need to work because they need money. They need college, and all that trust gets in place. And then in the menopause phase, which is what I can attest to right now is okay, I’m old. I’m not good anymore. I don’t, it doesn’t. It doesn’t make any sense for me to make any effort because I’m going to die very soon. I’m not attractive anymore. I can’t have babies. So what’s the point? So all the concepts that your mind have been handling all your life as an adult as a female that is productive, that is beautiful. That is having all day. possibility changes totally. So besides the hormonal changes, the mental part is hard. It’s a huge change. And the beginning is the worst part because you don’t know what it is, and you want to fight to go back to what you used to be, but you’re not. And then it’s worse. So I totally agree with what you said that the psychological part is important. And that’s why therapy or going to through coaching is very important. And meditation, I would say, I would suggest that a lot because you need to understand that, that this is you because you look at the mirror and you’re like, that’s not me anymore. I gained a bunch of weight. My skin doesn’t look the same. I don’t have the desire that I used to have for my husband that I say, I still think that he’s very hot, but I don’t want to be with him. Or a lot of stuff that are happening and you’re like, this is not me. I wasn’t like this. But guess what, this is the new you and that’s what you need to accept and once the new you becomes part of you mentally and physically then it’s easier and faster for the process to move on. But hormonally speaking is a lot. What Why do they do what’s happening?

Dr. Ricardo Correa  16:13 

So I think that in every stage of the life besides physical and psychological part of the, the hormonal part, very important, many of the things that you don’t understand what is happening it’s just exacerbated by that. hormone rush that can happen so in the pain

Marilena Grittani, RPh  16:30 

by the way, I know you love hormones, I hate them. Go on.

Dr. Ricardo Correa  16:35 

Yeah. So in during puberty, you have the this person that is trying to become an adolescent and there is fighting with all the things but on top is not contributing that then you have in males, a rash of testosterone, that is a hormone that certain point definitely affect your mood. So that aggressiveness and that kind of things that may have is it comes from the testosterone. So, you have, all of that is happening in your life that you understand plus a hormone that is affecting your mood. And in females, you then on top of what is everything that is happening, you have an estrogen rise. So, this is also a hormone that affects many parts of your body. So, it’s triggering out and then you don’t understand and then in the cycle, you have the progesterone that there will be the androgenic part that that happened every month. So besides all of the psychological part, I think that the hormones that also work at the level of the hypothalamus and and the level of the frontal lobe for the mood and communication and all that is also triggering you that then when you pass you have an entire life then you get used To all this cycle or high testosterone angle males, and then you go to the older part where then there is a lack of the hormones and then you go to menopause in males is called underpass is rolling later in India in life for males, but to a deprivation of all those hormones, and then all the side effects of not having the hormones that you were having for at least 30 to 40 years of your life and then lacking of estrogen will cause your skin also to decrease the this mood of the screen. And also you will have more dryness in

Marilena Grittani, RPh  18:41 

everywhere.

Dr. Ricardo Correa  18:42 

So that’s this estrogen effect. So, besides all the psychological component of the hormone, there is also physiological components of hormones that depending on this stage of your life, you will have or not a menopause, all of that happened plus You have a decrease of the progesterone that is the androgenic hormone. And that causes you a decrease in the libido because you have less progesterone that is androgenic hormone. And you can see some things, for example that it’s not physiological and some people are doing is that they go to the doctor and then just started using testosterone, female studies and testosterone to increase libido. And there was recently a guideline published by the endocrine society that establish when it’s necessary and really, in normal menopausal people is not necessarily to replace testosterone. So, just to be aware, a little bit of why some people are doing this and it’s not adequate because you’re just starting another hormone that your body doesn’t need at that time of your life.

Marilena Grittani, RPh  20:00 

Then creates more imbalance,

Dr. Ricardo Correa  20:02 

correct an increase in violence I have seen people that use pallets of progesterone to increase the libido mainly because to increase the libido in postmenopausal AI, that the only thing that is missing is just more damage to your body. Because at that age supposedly you should not have that hormone and more testosterone that usually the females will not have an elevated numbers.

Marilena Grittani, RPh  20:29 

And then your your liver gets affected by it as well. higher level of testosterone. So then, as every medication and every commercial on TV will tell you whatever drug you take that affects other areas, and then use that and if it’s something that you’re not supposed to have, well, there you go, that’s a big mess. I am a firm believer that pellets are not the solution, much less if you haven’t tried anything before, because there’s a huge dose that goes into Russia and then they cannot fish out. So I believe that whoever is recommending you to start with pellets is just wanting to make money and it’s not it doesn’t have your best interest period. So I’m not opposed to pellets 100% I just want to say do not start with them. If you are going if you’re starting as you said the process of menopause, you still are not even you don’t know what it is. So you need to be replaced in a little bit of it if that is what the symptoms require, because you are having a really hard time just to make it easier for you. But you have to continuously monitored to make sure that what you have is enough is not too much. Or is an is 100% driven by symptoms or signs. What I mean is, if you are not having lack of libido, then we’re not going to use this or that but if you’re having hot flashes, then you need this or that. So it is basically how you feel and then whenever every three months at the beginning when they start testing your hormones they need to say okay, There’s increase a little bit or you got better, what are your symptoms and then you say, I still have struggled with this, okay, let’s just increase the one that triggers that. And not all of it. And that’s why I’m so opposed. And I’m this I have to put my foot down as a pharmacist. I don’t like the pills that are combination of drugs that are set. That’s why I advocate for compounding drugs. That is exactly what you need and the exact amount in the exact time that you need it and continuously monitored. Because I was victim of it. I they gave me Premarin is such a high dose and my life went ballistic. And this doctor never checked them. It was a gynecologist, and I’m like, I know better. I need help. But my brain was going Cuckoo. And I said to my gynecologist, another one that I went, I said, you need to fix me because this is not good. And I need to stop this drug. It’s messing me up. The imbalance was tremendous. So again, as a pharmacist, I can tediously say any drug that you take affects more than what you’re trying to fix. And sometimes if you don’t follow up if you don’t have a pharmacist that is helping you if you don’t have a good physician that is monitoring you, then you are going to suffer the problems, not the one that prescribe the order not the pharmacist that gave it to you you so you need to be responsible and continuously monitor yourself make sure that your team works for you, your doctor your pharmacist yourself and get it together to make the best decisions. I don’t know what you think about all this I went on a rant but I have so livid of people that get patches and stuff that isn’t in such a high dose and then they have all these consequences. That is ridiculous.

Dr. Ricardo Correa  23:43 

Totally agree there is so much mis communication about blaming hormones for everything and and and you can see it not just postmenopausal, but prematurity, premenopausal things and thinking sometimes They weight gain and that they fatigue is coming from an hormonal and not believing when they do the work of that come everything normal and say nice not. And the physician told you it’s not their hormones and then not believing that because you want to find a pill that solve everything is something that we face every day. Sometimes it’s not a pill, sometimes it’s just you. It’s that you don’t eat well, that you don’t sleep well, that you have all the comorbidities and then it’s not a hormonal part, all the physiology, you need to understand it sometimes feels will not solve the problem. And appeals are another solution. Then you have to put from yourself and then do exercises, start asleep by Gene and start eating better. All that meditation, it’s part of meditation. All of that is part of our well being and now we’re in on our body. So not everything is solved in medicine without Peale and that’s, that’s important. Sometimes you have the solution in your hands and just put in that. And it’s difficult because if you in your life has done exercise meditation and I tell you to do exercise meditation now to solve a problem, you will prefer that I give you a pill than to put yourself in that thing. And, and you, you see the patient when they start doing all of the kind of things good things like a healthy lifestyle, everything improve, even at mood change that happens, all the natural muscle improve.

Marilena Grittani, RPh  25:35 

Yeah, and also you get a little bit more relaxed and you know what is going on and it feels it feels more energy and everything is linked, like the lack of the lack of energy or the fatigue that you get through menopause that makes you gain weight and then the stress that you normally have also improves the feeling of not feeling well and then if you Decide to get super stressed with everything that is changing on you, that makes you more stressed and then you use crave sugars or crave junk food and then that increases the weight that it gets worse because you’re not working or exercise. So is everything is related. And as a pharmacist I can attest to there’s not one field that would solve this problem. There is not this is not the way that it needs to be approached. I have a lot of patients that are family members because you know, is the culture. Oh, but I eat junk and I feel fine. Yeah, so you’re getting yourself sick on purpose. It’s like those that smoke. Oh, but I’m okay. I don’t have cancer yet. yet. Is that the way so you’re just waiting for it. You’re gonna do it until it happens. What about if you stop and then you didn’t get yourself sick and then it happened. Whatever happens is not because you did it to yourself. So none of us will put our hand into fire intentionally. Those that don’t exercise eat well or do What is called self care with yoga or what is it meditation and stuff like that are setting themselves for something bad and then if you take care of that part that you can control and then whatever surprises you it does because you cannot control whatever medicine whatever the seas or even cancer that you can get that you cannot control. That’s another stuff but if you add with the ones that you cost yourself well guess what you’re gonna end up really sick very soon. So mentality taking care of yourself and at median dad, would you put in your mouth? What are the exercises that you do would determine your future? That’s the key. I think, what do you think your God,

Dr. Ricardo Correa  27:43 

I definitely think that taking control of your health and doing the good things that everybody recommend, but nobody follow. As I mentioned, healthy lifestyle, whatever it means from having a good sleep hygiene to do an exercise To do meditation to understand your body, to eating healthy, all of that will help you a lot more than a pill from a doctor.

Marilena Grittani, RPh  28:11 

Absolutely 100% agree. So let’s just talk about one thing and then the consequences of that. So most of the people that go to a doctor they’re looking for a solution My friend is is taking Xanax so I’m, I have anxiety Give it to me. And he’s a doctor says no, then the doctor is a crappy doctor. So demystify that explained to us. Why would you not give a benzodiazepine in this case? Xanax or Lorazepam or whatever other ones that we have in the market or press on them? That technically help with stress? But why don’t you do it and why do you say lifestyle is the first approach? Yeah,

Dr. Ricardo Correa  28:51 

so a little bit of why not give this kind of medication. So this medications of the public benzodiazepines are not. So I have consequences as any other medication. Oh, let’s compare this with what happened with pain and opioids, like 20 years ago in the US. So what happened was that pain was added as one of the fifth vital signs. So everybody came complain of pain, they needed to address the pain and how they address the pain given medication. So opioid start to raise. They at that time, we didn’t think about what was the consequences of opiates. And

Marilena Grittani, RPh  29:40 

we talked about it but nobody listened to the pharmacist. Sorry, I had to put that there.

Dr. Ricardo Correa  29:45 

So what happened was that everybody was having opioids, many people were dying from opiates, until finally somebody decided, hey, this is something happening and they find that OPI was the constant One says and then start now the opiate epidemic and now try to reconstruct what we did probably 20 or 30 years ago. So the solution probably for the pain was not taking a pill, probably in some cases is just doing correct exercise, there is a therapy, or B there is an electric tent that is an electric power. So there were many other things that can help you with the pain that now we’re starting to find because we cannot use the opiates anymore. So the same thing with a benzodiazepine so benzodiazepines are not really for use a simple anxiety is for people that have a mental problem or a mental condition that triggers other things. And in those cases, yes, you can use benzodiazepine for work for the common you want to avoid. One is basically create tolerance. So you start with one dose and Then after a certain amount, you have to increase the dose because the patient already or less adapt. They get used to it. They get used to it, yes, they get used to it. So you have to increase the dose and then higher doses are risk. Second is this other consequences are from hormonal pathways for example, benzodiazepine can affect the pituitary gland and can cause something that we call adrenal insufficiency, but also from respiratory problems. So yes, events can cause you to stop breathing and die and it so why to put you at risk or something like that. Many causes of anxiety are is our world, our own breast that triggers our own anxiety. So focusing on that, I think, in focusing for example, on your mental well being, you can be with a therapist, it can be with a psychologist, but focusing on that and trying to understand what triggers your anxiety and control that trigger will have more effect than taking a medication that yes, will calm you down, but will have a lot of side effects in the long term. So that’s the big issue with benzodiazepines and nowadays is a controlled substance. And most likely, there will be an epidemic of benzodiazepine in the upcoming years and we will have to go back again to everything that we cost. So it’s going back to the same process of appeal would not solve all my issues. Sometimes Yes, you need it. For example, if you have OCD disorder, obsessive, obsessive compulsive disorder, or if you have mental health or you have bipolar disorder, something like Yes, for those kinds of mental health problems definitely I’m not against using medication because this medication will help but if you are used Due to your stress of your daily living, it’s better to understand what is triggering to address that. And also, sometimes there’s other type of medications that are better than just the benzodiazepine, for example, antidepressant that have a component of anxiety, they decrease anxiety and a component of the period of depression that decreases depression. Those medication prolly are much better long term, if you want to use something for long term and one of them is paroxetine. That have shown that have that vary and decrease anxiety component and and that will help you more than just sticking a visit as it is just decreasing in that moment. And when the effects gone, you continue with the same anxiety and even you can have rebound when you stop that medication plus effect many of the things affect your sleep. Sleep pattern is affected by this So as a pians so you have more the rapid eye movement part of the of the sleep. So you have vivid, sleeps room.

Marilena Grittani, RPh  34:09 

Yes, yeah.

Dr. Ricardo Correa  34:11 

vivid dreams. And that’s worst.

Marilena Grittani, RPh  34:15 

Because you don’t rest when you sleep.

Dr. Ricardo Correa  34:17 

Correct. And then if you are, for example, taking this medication and you don’t take it one night you cannot sleep, so your sleep pattern. So there are many unintended consequences of a medication that really if you don’t need it, is not the best. And as I mentioned, if your doctor is telling you that you don’t need to use this medication for anxiety or for sleep, it’s much better to have all other things, meditation, all the things that can help you then the appeal. Sometimes your doctor will recommend, yes, the medication because they find that did you really have a problem for that? But the majority of the time you can find out that They eat, you can control by yourself. Of course, you need to learn how to do it. This is where the happiest and psychologists and all the mental health providers will help much better than taking a pill and you are not contaminating your body with something that 10 years from now will cost you more than even as association between benzodiazepine and Alzheimer. So, there is a lot of things that it’s a long term damage that you’re not seeing, and you’re just living that day by day, but you have to think in your life as 40 years later, 30 years later, or more.

Marilena Grittani, RPh  35:38 

Yeah. So from the pharmacist standpoint, when you start a benzodiazepine is a road that is not going to stop unless you decide to do so because as you said, you get used to the dose that you give initially. So then you want more and more and more and I have had patients in my pharmacy When I used to work retail years ago, on her knees begging me for one field, because that’s how bad they become addicted to them because that’s the word addict addicted, then if they have other issues that say that their their anxiety is caused, because of a pain problem, let’s say in my case, I’m going to put myself as an example because I want people to understand what it was. I had a labral tear and I have talked about it in my podcast several times, which is a problem in the socket where my leg gets into my hip. If something broke there, and it was causing horrendous pain, I couldn’t walk I couldn’t exercise and I was very athletic. So it was really bad for me. So I was in a pain between five and seven every day non stop. So that pain cause a lot of anxiety. I was so desperate some I was so irritable, anything that would happen to me that otherwise would have been normal. I exploded with because I had that pain. So because I’m a pharmacist, and I know better I didn’t take any narcotics I did not take any pain medication on top of that I have GERD or have irritated stomach so I cannot take any of the over the counter or non prescription medications like ibuprofen or naproxen or what have you. So I had to put up with that pain and because I think I’m strong I did it I just did it on my own. And then there was a point that I couldn’t anymore I was like, I am going to go kill somebody because I feel that stress and that anxiety and on top of that, I don’t know if you remember that I said that I got a hysterectomy that they also took my ovary so I had a labral tear. I had anxiety and pain and I was going through a second menopause. So it was a very, very stressful time. But I knew better that I did not need to take a pill to fix the problem. So I one day I was talking to my husband and I said how do we fix this we need to find out how to fix it because a pill whether is a anxiety drug or a paid medication or a antidepressant, because to take care of their anxiety, not because you have a diagnosis of depression, because you’re taking care of anxiety with them. They’re just a bandaid. They don’t solve the problem. So if you don’t find the root of the problem, you’re going to continue needing that band aid, and how many band aids are you going to put on you? Right, and then you get used to all of them, and then you need more doses. And then eventually you become like the people that are on that Netflix show that is called the pharmacist if anybody have seen it. People that will pay humongous amount of money for a prescription for a drug that they don’t really need, but they’re used to and the companies that are making them are getting rich. So don’t disregard when the doctor says you don’t need a pill, you just need to work on this. I know it’s harder. I know it will take a longer time. I know it’s not going to be as easy, but is the actual solution to the problem. Now in my case, I got my hormone balance. I have, I have my endocrinologist, I’m sorry, my gynecologist working with my pharmacist that is a expert on hormonal replacement that is fixed. I got my surgery, I couldn’t work for two and a half months. And that didn’t help with my weight. But that got fixed. Now I’m going to physical therapy to fix that problem, and then I’m able to work. So I’m losing weight now. And my anxiety is almost gone to pain is very minimal. I feel like me again, the new me though, because I’m not the same Marilena, that I used to be five years ago. But I understood that I need to, I need to get to that point. But I did what I recommend and is what you were saying, Ricardo, that we as a patient, we do, take ownership of what’s going on with you and fix the problem. Don’t go to the doctor to give you a pill because your friend had that drug and then they got better. You’re not the same and that’s not it’s a nice solution that doesn’t go anywhere.

Dr. Ricardo Correa  39:58 

Yeah, and don’t use pills of another person and

Marilena Grittani, RPh  40:03 

start with that’s illegal, you can go to jail for that.

Dr. Ricardo Correa  40:06 

So don’t, don’t do that, because at the end, you need to understand what is happening the doctor need to listen what is happening. And then sometimes you sink pills, whenever they check you in the blood, then sometimes it can come on normalities that it is not real. And it’s just because you didn’t disclose that you are taking this medication that nobody prescribed to you but you bring or in in cases now guys that will come from Latin America, we go you know, you can go to your country, it will not

Marilena Grittani, RPh  40:39 

be prescription there

Dr. Ricardo Correa  40:40 

on that. So they do you go to Mexico, you go to Mexico, and then you can get prescription drugs, and the border is just open, and then you get it and then you start taking it without knowing an endpoint and then whenever something happen, they You go to your doctor, then you don’t understand the doctor will not understand what is happening because you’re not disclosing that you’re using this mannequin. And sometimes it’s very complicated cases, for example, with benzodiazepine, there has been cases where patients started having higher doses of benzodiazepine, because they have a lot of anxiety and then they go to respiratory failure and have to be added to the hospital. So using using a drug that is not prescribed in the correct way is not always the solution. I think that there are many things in this anxiety world that is controlled by you and by a person that can guide you to solve the problem. So you can all the thing that you mentioned that is very important is to try to handle yourself because as healthcare workers, we tried always to think about it And then we can manage ourselves. But there was a point that you realized that you couldn’t. And so that’s, that’s important too. So we are not recommending that you don’t go to the doctor and you get handled by No. But it’s a it’s a balance between the physicians, and there’s a balance between you. And then when when it both is again, when when when both are on the same page, then you get the correct answer. So do not just tolerate it because it’s normal. It’s normal, but it’s normal, somebody reassurance that it’s not on this time and, and something, it’s fine, but probably you can have something abnormal. And that’s when the other things go so it’s about

Marilena Grittani, RPh  42:50 

it. And one thing that I need to mention here because most of my listeners are not like you and me that we’re in healthcare is that there is a Review dial rating that every physician has and every hospital has through the insurance or Medicare that pays their bills. And what I’m trying to say with that is like, if a doctor that is a surgeon, for example, has always complaints from their patients that were surveyed after they were discharged of pain, that doctor gets a bad review. And if the hospital gets a lot of doctors with bad reviews because they were in pain, then they get less reimbursed. So the first thing that the hospital is going to want to do to you is to push pain medication, so you never complain about pain and that bad reviews and go to them. It’s the same thing that you do on Yelp. I mean, if somebody gives you bad reviews, then nobody will go there. somebody gives you good reviews, then everybody will go there. Same thing, but you mess in here with the doctors and hospitals reimbursement or payment, which is very important for them because everybody likes their money. are they thinking about you needing that because you truly need it? Or are they They think in it because of their own interest. That’s what you need to think and that’s where you’re responsible. Going back to my surgery, my surgery, my surgeon because of this explanation that I just gave you gave me something called oxycodone with a busted a monofin, which is something that is very common is a very, very, very, very strong pain medication. I am a wimp and I have no problems admitting that if I take an ibuprofen 200 milligrams, I want to sleep eight hours because I don’t take pain medications. So if you give me another go down, that is five milligrams, which is a low dose between quotations. That’s not a low dose, but he’s the lower dose that you have of that drug. I will sleep for three days. And that is exactly what happened. They gave me 40 pills. They said you can take one to two every four hours as needed for pain. And I I know better It doesn’t mean that I need to. It says as needed. With me. I didn’t want to take any because I hate controlled drugs. I hate narcotics. I know what he can do to you. Then if it catches you in a bad situation, you can become a junkie, very, very easy. So I didn’t want to take any. But when I came home after my surgery, my husband made me take it because he said you need to sleep and this is going to put you to sleep. So you rest. So I don’t 40 that I got from that prescription that they gave me for my surgery, I took one, one, and I managed my pain with eyes with ibuprofen, and was not moving that much. And I knew I could control it. So then I was responsible, and I took the 39 remaining to my pharmacy and I said this post this for me, please, because I’m not going to use it and I don’t want it at home because anybody can take you know too many complications with control drugs. Oh no. So then whenever a prescriber, physician orders your pain medication, you better understand what it means and what it’s for and what is going to do to you. Now if we go back to the conversation that you were you You and me were having earlier regardless of the fact that you own Have 15 to 10 minutes to talk to your doctor. When you say I have pain, the first thing that comes to their mind is this you’re solving this just give you a pain medication. Do you really need that? In my case, I didn’t. I always refused pain medications. I said, No, I don’t need a pain medication. I need to know what’s wrong, order a test and find out what’s broken in my head because I have that pain. And I had to go to six positions. And I did until finally I found the expert that found it and fix it. It was a huge tear. And they finally fix me and I’m much better. But I cannot say is my doctors fault. It was my best interest. I needed to be better. I needed to fix a problem. I went to find the doctor and I got the solution because it’s my health is my responsibility. And with that, I want to leave you I want you to understand that your health is yours. It’s not regardless because he says your endocrinologist is not him because he goes home and he does whatever he does. It’s not about him. It’s about You so please take ownership understand what it is the doctor is the guide. The doctor is one of the members of the team that has a lot of knowledge about that particular situation but it’s not the one doing the things for you to fix it. It is not that you have a Midas touch that you touch them and they get fixed, right.

Dr. Ricardo Correa  47:19 

Yeah, that’s the hopeful of every every every healthcare worker that have a magic

Marilena Grittani, RPh  47:25 

wand or something. Yeah.

Dr. Ricardo Correa  47:27 

But really the we are living in a world that we need to understand there’s many things that we don’t understand yet and trying to fix some problems on creating others at the same time. So, so as you mentioned, I think that very, very important is pay attention to your health. You understand your body and you understand what can solve the problem that you have better than another person. But then the healthcare workers meaning working in a multidisciplinary team will make That guide the guidance to wherever you want to go. But is your health at the end and as you took advantage students will say okay I don’t want pain medication another person will take the 40 of them and leave ours without knowing that after four hours you will not feel any pain but you do vantage of knowing and say you know I will take one and with the others I will try to work then if you don’t want to big strong medications you can balance that with sometimes Tylenol. Even Tylenol is not a medication, really. Oh everything. Yes. What Tylenol can cause you live in debt. You can Yes, I hepatic damage and dying in few hours. So even 10 bullet in some cases, Tylenol in combination with end sets like ibuprofen or naproxen that also cause you another problems. Yes on time. combination of that make as strong as one of the narcotics that can cause you more problems. So the sibling of benzodiazepine sometimes can help you to sleep if you’re probably sleeping, they people taking melatonin and sometimes that can help you better than just taking a pill that will make you addicted to it. That is the last thing. So start always with the low things start listening to your providers and musicians and, and and i think that with that, then you you gain a lot.

Marilena Grittani, RPh  49:35 

So I’m gonna challenge anybody that is listening to this. There is an app that I personally love. I’m not affiliate or anything with it. It’s called calm, like c-a-l-m and that has sounds and has people that read your adult stories for you to fall asleep or maybe a guided meditation. I love it. I really, really do. I challenge anybody to listen To the free side of have calm and not fall asleep. Because if you put your earphones with that, it’s like they’re singing a lullaby to you and you sleep so deeply and so relaxing. And the next day, you’re like, Oh, I had a great night’s sleep. That is a good way to start sleeping well. So if meditation doesn’t help you during the day, if your heart is if it’s complicated for you to do meditation during the day, because of your style, because of family, or whatever, and these day Coronavirus days because this has been reported in April 2020. You can’t have that privacy, put your earphones and go to bed. And I’m telling you, you will thank me, Lady later and you’re going to say she was right. That worked. So do the best that you can for the least amount of medications that you can. And that comes from a pharmacist that is a drug dealer. So trust me when I say that, because they’ll just help me with it. Isn’t it true that the less medications you take the better

Dr. Ricardo Correa  50:59 

No, it’s totally true. You need medication for certain condition. And that’s not what we’re talking here about. Because there are certain conditions that you need medication. And that’s the only solution. Yes, we’re talking about here of problems that can be controlled by that. And you can deal with it without medication. And you can use the less amount of medication for controlling that. So anxiety in this world that we live is very high prevalence. And it’s not appeal that will cure you. But it’s mainly you understanding what triggers your anxiety that will help you and even if you have a hormonal imbalance, sometimes their hormones even you get a balance will not solve the problem because it really was not a hormonal problem or the psychological part. So having That meditation if you want an app or or if you have access to a mental health care provider that can guide you I have seen better results with even fatigue and anxiety because the mental health provider you know, do a lot of other techniques than just giving a pill when you go to the doctor will give you a pill to solve every problem fatigue they took days, or sleep to date take days, sick days. So you go on this this shopping pills. And one thing that at the end that will help you a lot.

Marilena Grittani, RPh  52:37 

I agree 100% with that, thank you so much for all the advice. Thank you for clarifying the details that for most people are really hard to to cope with. And thank you for letting us know that it’s not just a hormonal thing, that the part the psychological part, this stress, this stressors that we have in our regular life on top of hormones are the bad combination that we need to avoid. So thank you for clarifying that and for helping us with it. Thank you.

Dr. Ricardo Correa  53:05 

Thank you, thank you for for giving me the opportunity. I think that another component that is important is our food. Yeah, the food that we eat, and all the preservative and all the hormonal things that have the food that we eat, we have to take that into account. So as healthy as you can eat, I know that sometimes it’s difficult because it’s expensive, but as healthy you can eat will help a lot,

Marilena Grittani, RPh  53:33 

too. And that is going to be part of what we will be talking in the summit that we’re working on. And I wanted to plug it here because I think it’s important for everybody to understand that it’s not just one thing that solves the problem. You need to work in your body as a whole. You need to have a good diet you need to have not only good food, but also good quality food. And then you have to exercise you have to have Goodman mental health, you have to be checked by your provider by your your doctor, or your pa er, to make sure that you’re doing okay check the drugs that you’re taking to make sure that they don’t interact. Don’t take stuff that are given by your neighbor or a friend or buy in another country that you didn’t need prescription for that and you think you’re, you’re cheating the system, you’re cheating yourself if you do that. So the summit that we’re preparing them, the one that is about to be live very soon, and I invite you all over to participate because it’s free. We’re going to be talking about all this and we’re going to be talking about diabetes and we’re talking about menopause. We’re talking about geriatrics, getting older, and pediatrics and medications and patients with cancer. So we are going to give you a good view of what it is and then for you to make your decisions based on what you think is the best for you. Because nobody makes decisions for your health better than you and that’s the responsibility that I want everybody to take

Dr. Ricardo Correa  55:00 

Totally agree totally. So

Marilena Grittani, RPh  55:01 

we we, we expect it to be there regardless coming to the summit too. So there you go, we’re going to have fun. And we’re going to have a lot of stuff together. And even better, we are going to help each other get better. Because if we start with 10 people and those 10 people inform 10 other people and then continuous in their families, we’re going to have a better world at one point. And that’s the whole intention of this.

Dr. Ricardo Correa  55:25 

I totally agree. Yeah.

Marilena Grittani, RPh  55:26 

Thank you for that. Okay, because thank you so much for coming. That was Ricardo Correa, and endocrinologists from Panama, that was here with us helping us out. Thank you so much for your time. I appreciate you very much.

Dr. Ricardo Correa  55:39 

Thank you so much. Really? Anything that can help? I’m here. Thank you.

Marilena Grittani, RPh  55:44 

So what do you think? We have a regard for me, we agree in several subject areas about this specific topic. And as you know, I’m not a supporter of popping pills for anything and everything. I don’t think That appeal solves every problem. I do believe, of course, that there is medications that are useful and necessary for certain diseases or certain treatment. But I don’t think that the pill is the solution for anything a medication is a pill is that a medication is the solution for everything. I think that is harder for us to work on it. It’s harder for us to find the route. And if you have a situation that I described in the podcast with my hip, that it took me five years to understand and find out what the problem was, then I understand that it’s tough, but if it happened to me will happen to everybody. I was committed and I solve my problems and a much better right now. So please, take advantage of the information that we gave you think about what we discussed, understand the relationship between drugs and your system because it always gives you side effects and as the commercials on TV say there’s so many of them that you don’t even think that they could be related but they are and the only one that gets That the service is you to your body. Don’t make the physician or whoever the doctor or practitioner is make the decisions for you, you are entitled to make your own decisions, you are responsible for that. And you are the one that needs to decide how and when to do it. Okay? So be strong and do what you need to do. But if you feel like you’re not educated enough that you didn’t have enough information that you’re ignorant of a bunch of stuff related to medicine, and you don’t know where to start, but you do want to take ownership of your of your health and you want to be in charge of your own health, then you need to attend to our summit. The summit is going to happen the third week of June, starting June the 22nd. And the summit is called Getting in charge of my own health summit. So basically, I’m going to have over 20 speakers that are medical train speakers, whether they are physicians or nutritionists, Or pharmacists or clinicians that work in mental health that are going to help you understand what are the first steps that you need to take how what are the basis of certain diseases or conditions that you need to understand so you make better decisions for your own health or with the treatment that you might need. And also, and this is the part that I think is so valuable for each person that will attend to this summit is that this information is not just for you. This information will be for you to support your family, your friends, your loved ones, somebody that might come to you with with a mistaken diagnosis or even mindset that you can support and help based on the information that we’re going to give you. The best part of the summit is free. We’re going to have five days of a lot of information there is going to help you to get control of your own health and the health of your loved ones. As I said, we’re going to have a bunch of doctors, we’re going to have a lot of pharmacists. And we’re going to have nutritionists and therapists that are going to help you overcome that fear that you might have of getting information or not knowing where to start. And it’s going to empower you to feel like you can do it with a basic information that we’re going to give you. We’re not going to give you a diagnosis. We’re not going to give you treatments, but we’re going to explain to you enough information so you make your own decisions, and you can have educated treatments that is the best for you or your family members. I hope that you come over and join us in this summit. I worked really, really hard with all the time that I have is spent on this and all the speakers have put a lot of energy and love on this and we would do it because we want you to help us take care of your own health. And yes, we’re providers but the health and the treatment goes to you and you are the responsible one that has to do So please come over, feel empowered, feel educated, and take over your own health because it belongs to you. Nobody else should. If you’re interested in participating in the summit, if you want to listen to our suggestions and our recommendations in the summit, please go to takingcontrolofmyownhealth.com. And there, you’re going to find the link to register for the summit, again, is takingcontrolofmyownhealth.com. And then the summit is going to be in the first page there, you’re not going to have that much trouble finding it. And as I said, is free. Don’t forget that. Okay. So with that, I am done for this episode. Thank you so much for listening. Please subscribe to the podcast, give us a review. And if you have a question, you know that you can send it to me to comments@TheLegalDrugdealer.com and I will respond directly or I might just create a podcast episode about it like I’ve created several for that. recent poll so you can visit TheLegalDrugdealer.com site. And you can find a lot of information there that I posted for you about other episodes and other areas of health that you might be interested on. Don’t forget also to follow us on Instagram and our private Facebook group, and we’re even on Pinterest. All of them were as The Legal Drug Dealer podcasts. I wanted to let you know about next week’s episode is going to be about health literacy, which is medical information useful for you to make decisions. And this is one of the reasons why I decided to do the summit because most of us don’t have enough health information to make our own decisions. I had a conversation with Dr. Lynn Stiff she’s a family practitioner that is very knowledgeable and super mindful of health literacy important on the decisions that we make every day with our health and she is also going to be Our summit and she’s going to be talking specifically about health literacy and what to do to improve it and what is it that we need and how doctors perceive that. And I believe that you are going to really like this, this podcast episode that we will be talking about health literacy with Dr. Lynn Stiff MD. So with this, I’m done. But before I go, and just in case no one has told you today, I wanted to take a minute to remind you of how awesome you are. And how lucky are those that have you in their lives. Thank you for being the awesome you that you are. Have a wonderful rest of your day. This is Marilena Grittani, The Legal Drug Dealer Bye for now.

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