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Geriatric Medicine with Dr. Pablo Veliz

George Grombacher September 29, 2022

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Geriatric Medicine with Dr. Pablo Veliz

LifeBlood: We talked about geriatric medicine, how to improve outcomes for the senior population, the key areas to focus on to promote healthy aging, and what you can do if you’re concerned about a loved one, with Dr. Pablo Veliz, Medical Director of Carmel Valley Manor.

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Our Guests

George Grombacher


Dr. Pablo Veliz

Episode Transcript

Unknown Speaker 0:15
what’s up? This is George G and the time is right welcome today’s guest struggle powerful Dr. Pablo Balise. Dr. Pablo, are you ready to do this? Let’s do this. Let’s do this. Dr. Pablo is the medical director at Carmel Valley Manor their senior facility in Northern California city new standards for geriatric health care, their certified Blue Zone project approved worksite Dr. Pablo are excited to have you on tell us a little about your personal life more about your work, why you do what you do. Sounds good. Yep. So originally from Los Angeles, early on, I thought I was going to be a lobbyist. So I had a poli sci degree graduated in 2008. Not the best time to graduate with a poli sci degree to do a pivot. My mother’s a dentist and healthcare was always kind of relevant in my household. So seeing what she did on the day to day was always important, especially with the geriatric patients, she did a lot of house calls. So for me that really resonated early on. I was attracted to medicine, fell in love with the number one student in the class, which was my wife, who’s now working in internist here in Carmel. We did residency together in Phoenix and have two beautiful kids, one that’s 12 weeks old. So a lot of caffeine going on here, but very excited to be part of the show today. Nice. Well, congratulations on the new arrival.

Unknown Speaker 1:40
Thank you. Thank you sleeping. It’s been a good sleeper. stretches, but it’s incredible what the body can do under stress. No doubt, no doubt. Well, it’s been a it’s been a busy. How many years? Has it been since 2008? It also runs together, it’s been a busy 12 1314 years for you, actually, right? Amazing. So the pandemic was really hard on on all of us feel like it’s probably harder on certain groups than others. What what is the state of Geriatric healthcare as we’re coming out of the pandemic? I think what we’re seeing is a lot of rapid aging, you know, when we’re told to isolate when we’re told to stay away, a pretty vulnerable population, like our geriatric population is really susceptible to a lot of these changes, they’re no longer interacting with their friends. And this is really affecting mentation. They’re not eating a well balanced diet, which is important for healthy aging. So we’re seeing a lot of preservatives in their food, which we didn’t see before as much. And we’re also seeing overall increases of alcohol use, which unfortunately, does, you know, decrease our vitamin intake and increases our chances for dementia. So unfortunately, we’re seeing a vulnerable population be significantly impacted by a pandemic that was supposed to protect us. But ultimately, we’re starting to see a lot of these long term complications from it. Yeah. Did you say mentation, mentation? What is specifically the mentation? It’s a word that we like to kind of categorize instead of cognitive decline, it’s just a nice way of kind of saying, Hey, we’re seeing decreases of certain day to day activities, such as calculating their checkbook from anywhere to kind of grocery shopping and things like that. So basic, every day kind of tasks that we take for granted. We’re seeing those kinds of things deteriorate. And, and unfortunately,

Unknown Speaker 3:40
at some record high numbers.

Unknown Speaker 3:43
I have read in the past that at a certain age, our cognitive abilities start to exponentially decrease. Is there is there a rule around that? I think it’s hard to say, you know, put exact numbers on it. Unfortunately, genes plays a big part of this. So we have to thank our mom and dad. But it’s all about putting yourself in the best position to succeed. And it’s important to remember that a basic diet, important hydration, and of course exercise. When you’re putting yourself with those basic foundations, you’re putting yourself in the best position to succeed. And unfortunately, a lot of people non geriatric don’t even do the basics, right? So when it comes to any form of cognitive decline, making sure we do those basics right is important. Yeah, yeah, there’s no doubt about that.

Unknown Speaker 4:31

Unknown Speaker 4:34
I imagine that you’re working on improving as many different variables as you can from the diet and the hydration, exercise and socialization and spending time with friends and loved ones and then environmental factors and sleep. How do you prioritize or how do you help people prioritize? Tell me a little bit about that. So it’s a multi pronged approach right?

Unknown Speaker 5:00
Everyone’s a little different. So we really have to focus in on giving the most resources available. I’m fortunate to be the medical director at a life retirement community. So we have a lot more control on the day to day in terms of diet, there’s a lot of social opportunities for group exercise classes, there’s a lot of opportunities for group socializing. And a lot of that, you know, we take for granted, especially, you know, during the pandemic, when you can get together with your, you know, we have our weekly bridge group, our weekly hiking group, and a lot of those had to shut down, unfortunately. So it’s important to always try to address everything, as much as we can, from different kind of ways of seeing that I think, ultimately to is, what we’re seeing is a lot of increases in anxiety and depression. Not to say that, overall, it’s improved, but we’re seeing people more comfortable addressing their inner anxieties and depression. And so it’s important to check in with your primary care doctor, your therapist, your family members, and just make sure that if you’re dealing with these stresses to look out for it, and a lot of early signs look like insomnia, decreased appetite, you know, it’s not necessarily suicidal ideation, there’s a lot of early factors that we’ll look into regarding depression and anxiety that we have to really focusing on our mental wellness. Yeah.

Unknown Speaker 6:17

Unknown Speaker 6:19
challenging situation, you’ve got people that have maybe never had a great diet, maybe they not really ever get it drinking water. And so you go into this kind of environment. And as we get older, things can become more difficult.

Unknown Speaker 6:35
And that we weren’t kept away from some of our loved ones is obviously exacerbating a lot of these problems. But there’s still a lot of people who have moved away. And so there folks are halfway across the country. And we’re worried about aging parents, but we don’t have the ability to touch or

Unknown Speaker 6:52
we have less control. How do you counsel, perhaps the would be caregivers or just loved ones that want to help position aging parents for success.

Unknown Speaker 7:05
I think it’s important to kind of tap into local resources and local community resources we take for granted a lot of things like Blue Zones, projects, Alzheimer’s Society, there’s a lot of local societies that have resources, wheels on me, Meals on Wheels, here locally, are great ways to help get nutritious food to local geriatric patients. And then of course, Rotary Clubs, YMCA, there’s all kinds of local groups that I would definitely recommend family members reach out. And then of course, you get that social aspect, which is really important to those patients. So ultimately, it’s about understanding the needs for our loved ones. Is this

Unknown Speaker 7:45
more of a dietary concern? Is this more of a mobilization or more of a socialization and kind of figure out what is needed and look for local resources. But

Unknown Speaker 7:56
you know, we, a lot of the pandemic funding also went into a lot of these resources. And it’s important to kind of tap into them, we, we kind of take them for granted sometimes.

Unknown Speaker 8:06
I think that that’s 1,000%. Correct, that there’s probably way more resources than people who are listening can possibly or can even imagine, that are just a call away and can make a world of difference. Definitely.

Unknown Speaker 8:23
In terms of you are a certified Blue Zone, project approved vendor, what does that mean? So the blue zones is a great project, they basically look at where there’s been healthy aging across the world. And they said, Why do certain pockets in Japan, Asia, really have significant life expectancies? And they really focused in on what were the main reasons that may have increased that life expectancy and how we could improve it in place that have decreased life expectancy. And what they found was that eating local was a big factor. Socialization was important. And so Blue Zones projects now here in the United States does a great job of embedding into the communities and getting geriatric patients, as well as other patients involved in saying, hey, let’s engage with our community. Let’s take care of each other, and really kind of in a tribe mentality, let’s really band together and take care of our vulnerable populations. Yeah, well, that’s, that’s incredible. Eating local, why what’s what’s, what’s the benefit there? So we’re looking at you know, I think it’s a little biased, where we’re out here in the central California, we’re pretty blessed in terms of that. But eating local really was interesting in terms of being able to produce your own foods, be able to work the fields in your own local foods. So when you’re putting in that effort of going outside, doing that physical exercise, having that relationship with food, it’s very important to appreciate food that goes bad or produce that goes bad. That gives us the better understanding that preservatives are really not great for us. And it’s important to understand that the nutrition you get from from

Unknown Speaker 10:00
food that you grow yourself that you see that process, you have a better understanding and appreciation for that food. Yeah, that makes a lot of sense.

Unknown Speaker 10:09
I think sometimes I fall victim to wanting to attack a big problem and fix everything, when in reality, I just need to take small bites at it. And I have to imagine that that’s the right approach as we’re trying to have influence over another human being who’s older that I that I look from the outside in and say, Oh, my goodness, this person is not eating well, they’re, they’re, they’re not exercising, they’re not spending enough time with other people. If I can get, say, my mom or my dad to just one day a week change your behavior is that worth doing? Definitely small little milestones really builds up for long term changes. Unfortunately, like weight loss, we want rapid results, but it takes time and consistent good habits over a long period of time to really make a difference. And especially, you know, I caution those who do crash diets, for example, it’s not sustainable. And we want to have sustainable short term changes. And especially post pandemic and say your parents situation, having a walking buddy can go a long way, even twice a week, it helps with conversation and how supplementation. Most people though, just need that initial push that initial motivation to keep going. And once that gets going, you know, the long term sustainable growth can really, we can really see those long term changes.

Unknown Speaker 11:33
So carrot or stick

Unknown Speaker 11:37
wherever it works, you know, and I hate to harp on this, but post pandemic, I’m just multipronged approach for everything these days. And wherever we can see change, I’m all about it. And, you know, as a physician, it’s hard. You know, when I have patients, I’m probably dealing more with mental stress and mental wellness more than anything else these days. And it’s tough to see that so much of our population, the United States here, we don’t even do the basics, right? We don’t eat well balanced diet. We don’t drink the appropriate amount of water we need to and the basic exercise and so many people who come in with any kind of chronic condition and anything that’s my first step, let’s work on these basics have a good foundation, and then we can really dig deep on all the chronic conditions. Yeah, master in the fundamentals.

Unknown Speaker 12:28
So I want to say that you’ve got like a laboratory environment, it’s probably really inappropriate thing for me to say, but you have you have you are the medical director of of this wonderful facility.

Unknown Speaker 12:43
Has anything surprised you that this has really worked well, and I didn’t think that maybe it would.

Unknown Speaker 12:50
So we’re fortunate at the Carmel Valley Manor, and we just awarded top 100. US best independent and assisted living, you know, there’s still so much room for growth. So that’s pretty exciting on that. And but you know, we have in house physical therapy in house trainers, a dietician, nurses, we’re really blessed with the amount of resources. And exactly right there is times where it does feel like a laboratory and that we’re there to manipulate life expectancy, right? Because we all want to see what’s the best way we can live a long, healthy life, even with controlled settings, you know, I think it’s important to remember that our genes and the choices we made in the past can still influence our future decisions. So I’m always cautious to say that even in this controlled environment, it’s important to know that our expectations are reasonable. But again, putting ourselves in a position to succeed when we can monitor the diet, the physical therapy and the exercise that’s really putting yourself in a good position. Yeah, for sure. Expectations. I mean, that’s if we have flawed expectations, or we’re not on the same page with the other person, it’s probably not going to go well.

Unknown Speaker 14:02
How would you counsel people to try and set expectations for a loved one that that they have access to? Or or is or is further away?

Unknown Speaker 14:14
So I think that’s where and I’m, you know, as a primary care physician as well, I think it’s important to have that relationship with and continuity with someone, right? You always want to understand what the expectations are of someone’s chronic conditions based on their age. It’s important to see if that is the case, if they need the resources that things are available to them, but it’s always hard, you know, to tell anyone that their loved one is having cognitive changes. That’s never easy. That’s never a fun conversation. But we have support groups for everything basically, under the sun. Because we’re as humans, we’re going through this as a shared experience. And it’s, it’s important to remember you’re not the only one going through this and if you can tap into that it’s nice to have that reassurance that you’re not the

Unknown Speaker 15:00
Only one. Yeah.

Unknown Speaker 15:03
And it does imagine going back to tapping it all the resources that that you can, particularly if you’re not in the same city as your loved ones.

Unknown Speaker 15:14
I was just I’m sort of thinking in my head, if you were because my mom, my mom lives by herself, and she lives in the same city that I do, but I have not been she comes over to our house a lot. But I have not been to hers in a while. And I thought to myself, well, you know, I’m sure everything’s fine there. But if I could get over there, and just make sure there’s anything that needs to be done. What do you think about that? So we’re fortunate at the manor where we have our physical therapist once a year go in and do in home evaluations. Those are important silly things from our the rugs.

Unknown Speaker 15:47
In an issue for fall risk, right. As we age, it’s important to understand our fall risk potential. And so we have our physical therapists analyzed the rug situation that are their handrails appropriately, where it’s supposed to be, is the Gaslight arm is the oven, there’s a lot of it’s a real danger zone, really, when you look at an individual’s home, if we start to see some early mentation, so a home visit is a great way to really check in on the mental health health as well, you know, are they taking out the trash as much as they should be? If there’s an animal around? What is their weight situation, we walked into situations and the dog starving or their stool over? And that gives us a lot of information very quickly, in terms of caring for others. So unfortunately, a home health visit would be my recommendation. Getting over there and seeing what’s going on gives you a lot. Yeah, yeah, that makes a ton of sense.

Unknown Speaker 16:37
small bites, expectations, all of these things. Any closing advice?

Unknown Speaker 16:45
No, I just have kind of my top five tips during the post pandemic. Again, I’m really harping in on getting everyone out there. But I think the first thing is focusing on on a really well balanced diet. I know that’s not easy. Focusing on foods on produce that goes bad stick to the outside aisles. Food that goes bad is going to be the best kind of food for you stay away from those preservatives in the middle. The second thing is hydration, drink water, drink water, drink water.

Unknown Speaker 17:12
Six to eight classes is recommended. And if you look at that all up together, that’s a lot of water. So make sure to have fun little ways of staying on top of that. Keep moving as we age, it’s important to keep your body moving and keep moving. Join an exercise class, join a friend’s class, mental wellness, be sure to check in on our loved ones. And then the last one alcohol in moderation. These are just a great way to live and enjoy life.

Unknown Speaker 17:39
And focusing in our post pandemic selves. Love it.

Unknown Speaker 17:44
Is the average American 35 year old getting six to eight glasses of water a day. Probably not.

Unknown Speaker 17:51
Right. Yeah.

Unknown Speaker 17:53
Excellent. Well, Dr. Pablo, thank you so much for coming on. Where can people learn more about you? How can they engage with you? Sure. Carmel Valley Manor, great place to look about what a life retirement community looks like a great place to see what we’re doing there. We’re excited about the future changes to come. And, you know, making sure that we’re aging in a healthy manner, and making sure we have reasonable expectations. So I appreciate it. Love it. What’s What’s the website? It’s just Carmel Valley Manor. Yeah, just take a quick Google there you’ll find us. Excellent. Well, if you enjoyed as much as I did sort of Republic your appreciation and share today’s show with a friend who also appreciates good ideas go to Carmel Valley Manor, Carmel. Valley Manor car me l Valley Manor, ma n o And check out all the great things that Dr. Pablo is working on. Make sure that you’re eating a well balanced diet. Get enough water moving your body. Be mindful of your mental health and alcohol in moderation. Thanks. Good Doctor problem. Appreciate it. Thank you. And until next time, remember, do your part by doing your best

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