Your world with Dr. Beatrice Hyppolite
Hello,
I am Dr. Marie Beatrice Hyppolite. I hold a doctorate in Health Science with emphasis on Global Health and master’s degree in social work. I have over 14 years of experience in the field of health and human services.
This podcast is primarily focused on mental health and the quality-of-life elements that affect it such as divorce, death, domestic violence, trauma, toxic relationships, and single parenthood to name a few. It is no secret that mental health challenges continue to profoundly impact modern society although not enough discussion is given due to stigma. Research has shown an increase of 25 % in mental health crises after COVID-19. It is important to have honest, uncomfortable conversations about mental health while being supportive. Although we are interdependent, change begins with the individual, hence “your world.”
I welcome you to join me on my journey and look forward to your responses.
Your world with Dr. Beatrice Hyppolite
Neurocognitive Disorders
What happens when neurotransmitters like dopamine and acetylcholine go haywire in our brains? Join us alongside the distinguished Dr. Mario Gustav, a neuropsychiatrist with 24 years of expertise, as we untangle the mysteries of neurocognitive disorders. Our conversation unveils the brain's fundamental mechanics, exploring how neurons and electrolytes interplay to affect behavior and cognition. Through real-life examples such as psychosis and Parkinson's disease, Dr. Gustav illustrates the dramatic consequences of neurotransmitter imbalances on mental health.
Navigating the landscape of neurocognitive disorders is no small feat, especially when differentiating between conditions like Parkinson's, Alzheimer's, and vascular cognitive disorders. Dr. Gustav sheds light on the critical elements of accurate diagnosis, emphasizing the role of patient history and symptom progression. You'll gain insights into the distinct characteristics of Alzheimer's versus vascular disorders and learn about the unique behavioral symptoms of frontotemporal dementia. This exploration also touches on the substantial economic impacts of these conditions, offering a profound look into the challenges faced by individuals and healthcare systems alike.
Treatment of neurological disorders demands a nuanced approach, requiring collaboration across various sectors. Dr. Gustav elaborates on the team effort needed, from pharmacological interventions to the indispensable support of family and social networks. We highlight the complexities of managing conditions like Parkinson's and Alzheimer's, including the pitfalls of self-medication and the hidden dangers of over-the-counter drugs and lifestyle choices. To support those navigating these challenges, we also provide essential hotline resources. Tune in for an enlightening session packed with valuable insights into the intricate realm of neurocognitive health.
Hello everyone, I am Dr Beatrice Ippolit and this is your World. Today we have the pleasure to have a great, great, great guest in the show. It's Dr Mario Gustav. Good morning, dr Gustav. How are you doing today?
Speaker 2:I'm doing fine. Good morning. First, I just want to take the time to thank you for that invitation, because that's a topic that's meant so much to me and I think we're going to have some good time discussing neurocognitive disorders.
Speaker 1:I'm looking forward to that. A brief description about Dr Gustav's background. He's a board-certified neuropsychiatrist.
Speaker 2:In general, psychiatry.
Speaker 1:In general psychiatry, thank you, and he's an assistant professor of help me out. Of psychiatry Of psychiatry, and he's also an academy psychiatrist.
Speaker 2:Dr Gustavino, how long have you been working in the field?
Speaker 1:Let's say 24 years 24 years. Yeah, Prior to that were you a GYN doctor.
Speaker 2:Yes, I come from the top down and then I go back to the top. Now, Okay.
Speaker 1:So if I may ask, is there any reason why you switched from being a GYN doctor to a psychiatrist?
Speaker 2:This is one word opportunity.
Speaker 1:Okay, so you know opportunity, so who's not really looking for better opportunity? So it's like that's how we go. It's like the more you can go, the more you can reach to the higher or to the top, so the better. So I understand that and I guess everybody will kind of like relate to that answer. Today we're gonna talk about neuropsychological issues.
Speaker 2:Yeah, neurocognitive disorders once again.
Speaker 2:Again. Thank you so much. So we're going to discuss neurocognitive disorders today, but I'm thinking about it. Before we got the disorder, thing was okay, something happened. So we need to see how thing is normal first before to go to the disorders.
Speaker 2:Let's try to understand the brain first. It's a very specialized organ. We have a small unit in the brain. They call it a neuron. Let's see what happens in the neuron. Let's see normally how that neuron functions before to understand the disorders that may occur. Usually we got that neuron doing nothing.
Speaker 2:So the way it works is under simulation. The electricity in the neuron is going to change. So when is that race? What is the level of electricity? We know is minus 70. Like I said, under simulation we're gonna change that electricity, sometimes make it positive, sometimes a little negative. So what happened when we make that neuron, or we stimulate that neuron, and it changes? We're going to see a cascade of reactions.
Speaker 2:I don't think one hour, two hours, will be enough to discuss the changes that will happen on the stimulation of that neuron. But first I have to tell you there's a couple of electrolytes like sodium that will play a big role in that change and we have chloride. But I have to say more. We're not gonna see those change just like that. You know how do we know there is change in the other one? Because we can see changing behaviors. We know what those small little molecules are doing. I'm gonna give you a couple of them and explain what their job, what they are supposed to do, and you understand, based on what I see, I can say oh, I know what's going on, I know what is not working here. So stay with me. Right there, we got one called dopamine, we got the acetylcholine. We got thousand of them. Let's stay on those two and I'll give you an example right now so you can understand.
Speaker 2:I say everything got to be normal. When is an excess or deficit? We're gonna have behaviors changes. Example if you have too much dopamine, you know what will happen. You may hear voices that can lead to psychosis. What about if you have not enough dopamine? You can have a common disease they call Parkinson's disease. You see, let me repeat myself, things got to be normal. Otherwise excess or deficit gonna produce different type of behavior, different type of changes. So, once again, we're not gonna see those change in the brain. But when we see your behavior. We know what is not working. All right, I'm talking about Parkinson's.
Speaker 2:First, let's understand something I said deficit of dopamine will lead to Parkinson's. Oh, if I know that, I can correct that. That will be easy. I just give you dopamine. We're not going to describe how we do. It is a little complicated. But if I can give you dopamine, put it at the normal level. Oh, look at that, the Parkinson's improve a little bit. So I know that was really a deficit in dopamine.
Speaker 2:But there's more than that. There's more disorders we can see and based on, like I said again, the way you behave, I will know. Let's see, we got major no cognitive disorder. We have mild no cognitive disorder. Understand with me mal neurocognitive disorder is not the same thing than major neurocognitive disorder. Now there's a distinction and I'm going to explain the way I'm going to make. That distinction will be the way you behave, the way you function.
Speaker 2:Let's say we got some activity of daily living right. We got basic activity of daily living. We got instrumental activity of daily living. Let's say, people with mild neurocognitive disorder can have problem with IADL instrumental activity of daily living but the basic ADL will be okay. What are the basic ADL? Something like eating. That's very simple, it doesn't require too much skills, just put a spoon in your mouth. What is IADL Cooking? Oh, now that one is more difficult. You need to remember the sequence when to put the water, when to turn on the stove, things like that. What again? Another basic activity of daily living Taking shower. Taking shower, walking, switching from a chair to a bed.
Speaker 1:Combining your hair.
Speaker 2:Yeah, what is instrumental activity of daily living? Paying your bills, making a phone call, manage your house those require more cognitive skills. So let me repeat what I said If your basic activities of daily living are intact but you have problems with your IADL, maybe it's just a mild neurocognitive disorder, right. But when you have problems in both IADL and basic IADL, that's a major neurocognitive disorder. That's a major neurocognitive disorder In major neurocognitive disorder. We got many of them. Some books describe 13. They include so many of them. You told me somebody's coming to discuss Alzheimer's so, as I may, will be one of them, so I'm not gonna discuss Alzheimer's because there's many other cognitive disorder that can be.
Speaker 1:We have a zomber, we have Parkinson, we have a tenton, we have a mutual figure lateral, what we are ALS. Yeah, so it's like you said, it's so many of them, but what are the most common ones?
Speaker 2:Alzheimer's is 60 to 70% of all of them. It's really high. Alzheimer's is 60 to 70% of all neurocognitive disorders. That's the most common one. And then after that you got vascular neurocognitive disorder, louis, body, no cognitive disorder, lbd or pdd, parkinson's disease, dementia. Those are two sisters. They have the same cause but there are some differences. Maybe we can discuss later. So I was saying so. When I see your behavior I may have an idea what was going on and what I'm gonna try to do is to correct, to put that door transmitter at baseline and that could change and at baseline, and that could change and improve your symptoms. Other thing we talk about is like what are the cognitive symptoms? I'm talking about? Because according to the dsm-5, the book psychiatrists use to make diagnosis of mental disorders. If you have one cognitive symptom, you diagnose with neurocognitive disorder. One symptom, that's neurocognitive disorder one symptom.
Speaker 1:Can you be more specific? One symptoms of what?
Speaker 2:I'm gonna tell you in a few seconds.
Speaker 1:Okay.
Speaker 2:So I said one symptom, that's no cognitive disorder, like you said. What are those symptoms? There's a few of them Amnesia, problem with your memory. Aphasia, problem with language communication. The proxy, a problem with five motor movement problem with neglect syndrome I don't know if people heard about that and we got agnosia. Problem with full cognition. We got people with neurocognitive disorder cannot recognize their own children. That's bad, that's really sad. That's a terrible disease right it is.
Speaker 1:It's most likely alzheimer and dementia, not dementia most likely Alzheimer's.
Speaker 2:Alzheimer's is the most common type. Like I said, 60 to 70% of them will be Alzheimer's. Like I said, that's a terrible disease. It takes time. The onset is so slow, compared to vascular neurocognitive disorder where the onset is abrupt you got a stroke and tomorrow morning you have disorder where the onset is abrupt you get a stroke and tomorrow morning you have problems. That will be abrupt. Alzheimer's is insidious. It takes time to show. So sometimes people miss the diagnosis at the beginning.
Speaker 2:So we are talking about aphasia. I think I need to discuss that a little bit because I've seen that's one of the popular symptoms we see in neurocognitive disorder. What is aphasia? I said it's a problem with language. We have a lot of specialized structures on the brain that is responsible, they are responsible for our language. You have one in the frontal lobe they call it bocas, one in the back, in the temporal, and they in power at all, they call it bionic. Let's see the workers is responsible for the motor component of speech, is responsible for the motor component of speech, motor component of speech. So if I rupture, if I block the auric supplying vocals, you're going to see me having problems to express myself. That will be a non-fluent aphasia, because my problem is like I cannot express myself, but I can understand Because I have no problem in the other area called vernicate.
Speaker 2:Who is responsible to understand what people are saying? If I have a problem in vernicate, I can speak, but I cannot understand. Think about it. I can speak but I don't understand what you're telling me. Guess what I'm gonna talk? Gibberish, because I don't understand. You ask me a question. I don't understand, but I can speak. I see you moving your mouth. I'm gonna speak, but I will not make any sense.
Speaker 2:So it's not pretty things to see people suffering from those diseases. Like I was saying A common thing people need to make a distinction that between those no cognitive disorder and a delirium. A delirium is something that people need to think to make the diagnosis. You have to think about it. That's a patient who is good, no problem talking to a doctor, and when the next doctor comes, the patient is so disorganized You're not going to believe it. There's a change in that patient consciousness.
Speaker 2:Now you're going to say this's a change in that patient consciousness. That's now you're gonna say um, this is not local, this is not dementia, this one is daily young. There's the patient is not stable, he's okay at one time and really completely disorganized the next minute or the next hour, the next minute or the next hour. We always that to make that distinction. No, you remember, I just told you one cognitive symptom is no cognitive disorder. Everybody should be able to do that, even my mother. So when we're gonna need help, if to make that distinction we stop, of neurocognitive disorder is that, you know, in order to do that we need a very good history and we need a physical exam. I'm going to give you a couple of examples so you can understand.
Speaker 1:But before you even go any further, so is there an age of onset for each of them.
Speaker 2:Usually. If I can say a word about Alzheimer's, alzheimer's usually starts around 60 and doubles. The prevalence is 2% at 60 years of age but double every five years, meaning the prevalence will be 4% at 70, 8% at 75 and then and then and then. So yes, alzheimer's, the onset is usually around 60. But there's other type of neurocognitive disorder start a little early, like Huntington. Usually is the fourth decade Around 40, 30 to 40. That's where we see the onset that early.
Speaker 2:Yeah, for Huntington. But that genetic thing you get it from family, from your dad, most of the time. So yeah, it's that that early we got phone to take. All dementia is earlier than that alzheimer's disease. So, yeah, different. That should be part also of my assessment. That should be very that should mean something for me. Of course the sclerodermature can be at any time. People have stroke almost at every time.
Speaker 2:So you remember I talked to you about agnosia, right, difficulty to acknowledge, recognize even your children. That one is terrible. That's really terrible, I think. So you remember I was saying also, we got those little molecules. They are very small on the brain they are the one that will respond. If I wanna raise my hand, trust me, the order will come from my prefrontal cortex. My prefrontal cortex, my prefrontal cortex is going to send the message to my premotor area and say he needs some of his hand and then from there he's going to send it to the muscle. But remember we have those small little molecules that will do the job after I change the electricity in the other one. That's the way it works that disease, usually many of them.
Speaker 2:The life expectancy will be around 10 years to diagnose after diagnosis for Alzheimer for many of them, with only one exception, and that thing, that exception, I need to talk about it. That's the one they call Cousville-Jacobs disease. Cjd neurocognitive disorder kill people between six months and one year. They call it also mad core disease. That happened in England at one time. We have a big issue that was sometimes so that the same prion, that is small little molecule that infect people and give you a lot of problems when I have the dementia. I told you the issue is important, the physical exam is important. Everything will be important for me to find out which type of the neurocognitive disorder, because the treatment will be different. I told you if I have Parkinson's disease and dementia.
Speaker 2:Based on the diagnosis Of course I need to give dopamine to that patient. If I have Alzheimer's disease, dopamine will not help me. I need to have the acetylcholine level a little higher for that patient. You see, that's how important is the diagnosis of neurocognitive disorder. So how we make that diagnosis, again, history when was the first time you noticed that change? Yesterday? Oh, no, no, no, that's maybe vascular or cognitive disorder. When was the first time you noticed that? You know, I've been saying not doing well, but how long? Maybe one year. You sure it could be two, because it's so insidious. People would take time to tell you I started maybe three to four years. So the history is very important, but the physical exam is important also. If you just and the duration.
Speaker 2:Definitely. If you have a stroke, maybe vascular disease, if you have a cardiac condition, or this is maybe vascular disease. If you are doing well, you decline very rapid. Or I'm thinking about CJ, cjd, fusel-jakob disease. But there's, I told you, parkinson's disease, dementia and rebodied dementia. They are two sisters because they almost got the same cause In the one they call rebodied neurocognitive disorder. What you're going to have is like vivid hallucination and there's some things also that will happen. Only your partner can tell the doctor oh man, he's been kicking me all night. They call it REM slam behavior disorder Because you see, when I sleep I need to be paralyzed. Even if I have a dream playing soccer, you're not gonna see me moving my foot. But in that disease I cannot control that. That's why I will kick my partner, that's why my partner will complain and sometimes sleep somewhere else.
Speaker 1:So in that situation, body movement will be involuntary.
Speaker 2:Involuntary sleep. I know some people want to use it and say no, no, I got leprosy because they want to kick people. No, no, don't use that as an excuse.
Speaker 1:Because you don't want to deal with any legal problems down the road.
Speaker 2:Don't go kick your partner and say that everybody has a neurocognitive disorder. So there's that genetic component also. They find out. You see there's a lot of risk factors. We can talk about a few of them. There's a big protein that the APP, amyloid precursor protein two enzymes is going to cut that protein. Sometimes they cut the protein more, give you an amyloid beta protein 42, which is not water soluble. You cannot eliminate that protein, aggregate and kill the new one. You remember the little molecule that make up the brain. So you can have also neurocognitive disorder because of that. There's also another factor. The APOE. Apolipoprotein is just a cleaning coup from the brain. We move the cholesterol a clean tank.
Speaker 2:It comes that one in different flavors. There's one apple e4, apple e3, apple e2. If you have apple e4, you get apple e4 from mom, apple e4 from dad. That will increase your risk to develop neurocognitive disorder. If you have APOE3 from both parents, it's neutral. If you have APOE2, that protects you against neurocognitive disorder. You're not going to believe that. Maybe you need to check it yourself to find out what I'm saying. Can I tell you one of those? Neurocognitive disorder is so expensive. America use maybe four times more money to address that neurocognitive disorder compared to cardiac condition.
Speaker 1:Is there any specific one?
Speaker 2:and the Alzheimer's, of course. Let me tell you we have four. You have to follow that one, you have to help me on that one who got four million cases of Alzheimer's right? How much money? $100 billion for 4 million of Alzheimer's. We got 56 million of cardiac conditions.
Speaker 1:How much money the amount that you just mentioned is being spent yearly.
Speaker 2:Yes, yearly $128 billion for 56. People need to help me with that. I made it Right. Think about it 56 million, only $128 billion, only $4 billion. Almost the same thing, $100 billion. That business is very expensive. Think about it. You need some of them need 24 hours special service because they wander on the street, they are dangerous because they will leave the stove open, they will go out at night. Like I said, it's a lot of support, a lot of services for that disease.
Speaker 1:For caretakers. So it's being considered, yeah, of course, everything is part of it.
Speaker 2:Of course, take a nursing home, forget it.
Speaker 1:That's a lot of money.
Speaker 2:That's a lot of money. The distinction in vascular and Alzheimer's was very easy. Usually there's a scale you can use. You need to get this. High blood pressure is something, cardiac condition something, diabetes is something. Do with the disease progress, let me tell you, in Alzheimer's you got a very nice curve going down. In vascular you got a stepwise progression. You got a stroke. The person decline, but plateau until the next stroke, decline, plateau again until the next show. So the distinction can be a little easy between vascular and Alzheimer's. But you know what, where we have problems sometimes is to make that distinction between frontotemporal dementia and Alzheimer's. If you follow your patient you're gonna have a little clue. Because in frontotemporal dementia they have no social races. Those people they curse, they disrobe in front of people, they are hyperse, they have no boundaries. These look like a little like a little mania the way they behave dangerously they don't care, unpredictable no boundaries at all.
Speaker 2:I'm telling you they will curse at you. Actually, let me tell you. I have to say something that happened to me. I was doing a group where I work and I have my cup of tea on the table. The only patient we suspect to have frontal temporal dementia came up to the table, get my coffee, get a sip and put the cup back. That's how much boundary. She doesn't care. She doesn't care. So, like I said, I don't want to talk about Alzheimer's like you're going to, yeah, but I have to say just a couple of words.
Speaker 2:There's many hypotheses about that disease. We got the cholinergic hypothesis. That's the one, the most popular one they use. They use a lot of cholinesterase inhibitors. Remember I told you what you need. You need to keep the acetylcholine level a little high. The way they're gonna do that they're not acetylcholine. After doing his job got to be neutralized, right. They block the enzyme that's supposed to do that. That's the cholinesterase. They use a cholinesterase inhibitor to block that. There's maybe two of them on the market right now Rivastigmine, galantamine, dunpazil. There's another one they don't use because it's too little toxic. But they use also another drug, that's mementin, that block the excitotoxicity of the cells.
Speaker 1:We haven't discussed that because that will make that and, and I'm pretty sure so each of those medications have really serious side effect. So it's like, let's say, for example so whatever the neural condition issue that somebody may be dealing with, so it's like you know. So if I'm taking this type of medication or that type of medication, is blood work for some of them are required yes, I'm so glad you, but I didn't want to discuss it.
Speaker 2:You don't want to come in.
Speaker 1:You have to be responsible because I know some of my patients or clients, so, if I may call them that way, so it's like those who are taking lithium. Lithium is a very you know the side effect of lithium, so it's like you know. So it can lead to kidney damage. So it's like those clients need to be monitored, you know, like on a you know very, very close, and blood work I think is required every two weeks or every month not for those.
Speaker 2:The thing is remember I said at the beginning you need to increase the level of acetylcholine. So all we need to know, if I'm gonna increase the acetyl the level, what acetylcholine can do to my body. That's what I need to know. That will be the side effect what acetyl can do on my body. Anything acetylcholine will put water everywhere on my body, increase salivation, increase urination in diarrhea. Everything that acety in the first will be the side effect of those medications. What else acetylcholine can do. Let me see On the heart what acetylcholine can do on the heart.
Speaker 2:It will slow down the heart. That will be the side effect. So if the heart rate is too low, you don't give those meds. What else acetylcholine can do, let me see. So if the altitude is too low, you don't give those meds. What else I said to look at him. You can increase water everywhere, I said also in the lungs and constrict the bronchioles. If I have asthma, maybe I need to be careful with that medication. Like I said, the side effect is any type of effect that acetylcholine will have on my body but any, any doctor who's treating you for whatever condition that you may be dealing with will know about your medical position and from there will decide what medication will be more appropriate to prescribe you in that situation.
Speaker 2:Of course, there's no question about it. So, like I said, we try to go over, like I said, very superficial on those different types of neurocognitive disorder. For our first meeting, I hope we're gonna have more. I'm gonna invite myself Meaning. Think about it, please. The earlier you address this issue, the better for your patient. A little memory problem you forgetting your key. I was going back to my house. You know I get lost. I couldn't get there. Huh, maybe that's the time you go to the doctor.
Speaker 1:But how many times that have to happen. If that only happened one time. So let me share an example, you know, so it's like one time. So I was on the phone talking to somebody. So it's like literally, I told the person oh, give me one second, I have to go back home to get my phone. And the person was like Beatrice, it's not the phone we are talking now, that's the phone you're using to talk to me now. And I'm like oh, but that's only something that happened once.
Speaker 2:I know people will be defensive about that, but one time doesn't mean anything at all. Maybe I was thinking about something else, maybe I got some distraction, maybe it's not important to me. I got something.
Speaker 2:But one time a few times doesn't mean anything okay and then, however, when you get in your 60s, in your 70s, you're gonna have some deficit. They are not diseases. That's age-related. You need to make adjustment for that. If somebody want to send me to a market right now, I'm gonna have a piece of paper. Would you tell me what you want? I'm gonna write them. Maybe 30 years ago I didn't need to do that. Maybe I could remember them. If I have to go to two places, I have to make some effort. It's not a disease, because I can make adjustments.
Speaker 2:This is what we call age-related cognitive things. You know what Maybe I'm going to?
Speaker 1:stop here if you have any questions. Yes, thank you. Thank you so much. That was really interesting. Of course, I do have questions you know, so I know today, so it's like it was not about medication, so we didn't really tap on uh, what medication for each of them. Though you mentioned some medications, you know, not too long you will be coming back to talk about pharmacology.
Speaker 2:Of course.
Speaker 1:So now let's start with the first question. So what experience do you have working with patients with neurological problems?
Speaker 2:I have the privilege and honor to do two years of research at Downsage Hospital with Dr Kalko and who passed not too long ago. So we do hear that that was a great day. So I did research for two years. I think I have two presentations that was at Port Orko, if I remember, or San Diego on the study we were doing, and I think I wrote a paper also on neurocognitive disorder. So I got some experience at Down's.
Speaker 1:I know oftentimes medication is not something that people feel comfortable and I don't want to say everybody, but most patients so, and it's like whenever, even if it is high blood pressure medication, diabetes medication, whatever type of medication or medication for people who suffer with mental health issues, people either, you know, for the reason either for the side effect related situation or whatever other personal reason people tend not to take medication. Have you ever worked with patients, you know, without neurological issues or for whatever reason, don't want to follow the treatment or don't want to take medication?
Speaker 2:as every other patient, they have problems. The people will stop medication when they have side effects. They will stop medication if we don't take time to explain, to make them aware of the possible side effects. So that our job to make that education, to prevent people, to make people acts, to make like that balance between the benefits and problems with the Okay.
Speaker 1:So education is vital because you know so. The more the people are being educated about the condition you know so it's like the more insight they're gonna develop into the situation and, down the road, have the willingness to embrace the idea of taking medication not only just taking medication, but taking medication as prescribed.
Speaker 2:Of course.
Speaker 1:Dr Gustave. So is there any treatment? What are the treatments that they have for people who suffer with neurological issues?
Speaker 2:As I said at the beginning, there's many of them, so that will be very difficult for me to go to each other. Okay, but we got success with parkinson's disease. The dopamine will give them slow down the process okay and then that's where we went. With alzheimer's. We can slow down the disease. For two years we got some okay.
Speaker 1:After that said, let's move on to the next question. How do you assess and diagnose neurological conditions?
Speaker 2:Like, think about it, when you see the person behavior, when you see the person physical condition, that tells you maybe what neurotransmitter is deficit or in excess. Transmitter is deficit or in excess. If you're psychotic, maybe you got too more dopamine. If you move, that movement disorder or Parkinson, maybe you lacking dopamine, the excess give you psychosis, deficits will give you Parkinson's. Okay.
Speaker 1:What treatment approaches do you find most effective for neurological issues?
Speaker 2:You have to be a team approach, because we need people. We need pharmacology, that's true. We need social interventions that's also true. We need psychological intervention that's also true. We need psychological intervention. That's also important. But we also need support in the community. Family plays a big role. Family is so important, Not only to give you what happened. Sometimes we have patients who cannot tell us about the issue, about what happened. So family will play a significant role.
Speaker 1:Okay, how do you stay current with advance in neurological research treatment?
Speaker 2:the thing is, I am helping people, especially the resident, the psychos that I interfere, passing the board exam. So therefore I have to be I have to be sure I'm talking about the current things with them okay, that's why you constantly busy working almost 24 7 you.
Speaker 1:You know, I know you are a busy man and that's why, you know, I really appreciate the fact that you were able to fit me in your schedule or, you know, to address that important issue with those who are listening or watching at this moment. My last question can you discuss any challenges or successes you have experienced working with patients with neurological disorders?
Speaker 2:That's always, I think, the last part. That's always a nice feeling when you see you can help people. That's so great when somebody coming with a deficit, you're able to improve or decrease the level of that deficit. The thing sometimes you got some beliefs that not helping People sometimes want to do things their way and will not talk to us about what they are doing, which is very dangerous. If one day I have the privilege to come back to talk about pharmacology, you will see how dangerous to see when people take those medication with no measures, with so many of them on the street over the counter, things like that and we mix them with the one we prescribe, bad things happen sometimes. That's also sad sometimes to find out what people can do by lack of education or communication with a caretaker lack of education or communication with the caretaker.
Speaker 1:Okay, so when you say, like you know people who mix them with scrub medication, with over-counter medication, so it's like it could be anything like most likely drugs, you know, like you know.
Speaker 2:Believe it or not, people feel it's okay. They have a pain, they go over the counter get some Tylenol. That's a benign medication. Listen, there's no such thing. Tylenol can be very dangerous. Actually, that's the number one cause of liver transplant due to medication usage. So I don't know where we got that idea that medication is so inoffensive. That's not true.
Speaker 1:Medication was not something for people to be careful about. I think you know those will not even be a concern. They will have just said, hey, go out there and just medicate yourself, you know. So that's very important. But have you ever you know, uh, dealt with any client who tend to mix the medication with alcohol or any type of?
Speaker 2:all the time, all the time, all the time. Actually, one thing when we get where I work, they cannot smoke. When you discharge that patient, when you say smoke like a cigarette or weed. Cigarette.
Speaker 1:Okay.
Speaker 2:When we discharge that patient the first thing they will do at the gate is to get a pack of cigarettes. The thing is the thing cigarettes will compete with some medication that we give that patient. Let's say the level. I just give number. Let's say the level of the medication is 10 in your body, you get that cigarettes. You think the doctor thinks you got a level 10. In fact you got maybe three, four so the person sometimes they compensate and come back because of that cigarettes, believe it or four. So the person sometimes they compensate and come back because of that cigarette, Believe it or not.
Speaker 1:Okay, I guess that's the end of our show. So thank you so much, Dr Gustav for taking time. You know, like I mentioned earlier, to be with us today, and so it was a pleasure having you.
Speaker 2:Anytime.
Speaker 1:And before we leave, we want to leave everybody with some hotlines numbers. Sometimes, you know, people may be dealing with people who suffer with any of those neurological issues dr gustav just mentioned and don't even know what to do. So I'll leave you with the National Institute of Neurological Disorders and stroke hotline. The number is 1-800-352-9424. Once again, the number is 1-800-352-9424. And the other one is the Brain Injury Association of America. The number is 1-800-444-6443. 1-800-444-6443. It was a pleasure to be with you today. I'll see you next time.