<<Announcer>> Basin PBS is proud to partner with Midland Health to bring you the live Midland Wellness Tour Town Hall here from local physicians sharing expert advice, practical wellness tips, and answers to.

Questions from our community.

<<John>> According to the National Institute of Health.

Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high income countries.

Why is that?

And what can we do about it?

Back in 2014, Midland Health created the Wellness Tour that promotes health and wellness in Midland and encourages healthy behaviors, health awareness and wellness activities at locations across the city where the wellness journey is a custom approach for every individual.

The Wellness Tour is here to help provide a glimpse of wellness opportunities that Midland offers for our community.

I'm John Moesch, Basin PBS board member, and tonight we're coming to you live from the Basin PBS Anwar Family Studio, where we'll hear from the experts on warning signs, small changes that can have a big impact, and what you can do today to start your wellness journey.

Basin PBS is proud to partner with Midland Health to help educate our community not only on being active but staying healthy.

So please help me welcome our panel tonight.

Dr Patrick Naeger, Orthopedic Surgeon.

Dr Stephanie Caples, Vice President of Behavioral Health for Midland Health and Medical Center Health Systems.

Dr Madhavi Gadiraju Obesity, Lifestyle Medicine and Internal Medicine.

Physician Dr Rathnavali Katragadda Pulmonary and Critical Care Physician and Dr.

Saluy Patel, interventional cardiologist.

Thank you very much, everyone, for coming tonight.

We got a lot of ground to cover.

It's going to be a great conversation.

And but first of all, thank you for what you do for our community.

And we can't say that enough.

And thank you for spending time with us tonight.

Uh before we get into our first question, um Dr.

G, I noticed, uh lifestyle medicine is something that uh, is behind your name, and that's a term that we hear a lot.

But I don't know that a lot of people have a really firm grasp about what that exactly means.

Could you explain that?

<<Dr.

Gadiraju>> Well, thanks for having us, John.

Um, lifestyle medicine is in simple language.

It's just a, a kind of a type of healthcare, medicine where we encourage our patients to, oh have healthy lifestyle choices on an everyday basis to just prevent, treat, and also maybe reverse, uh chronic diseases like diabetes, high blood pressure, obesity, heart disease, fatty liver, and many more.

So we basically focus on six pillars, you know, eating healthy, uh regular physical activity, you know, managing stress and having adequate sleep and, you know, being socially connected, uh in general.

- So it's just treating the whole lifestyle is.

- Yes, on a daily basis.

- Well, that leads us in our first topic, um prevention versus treatment, preventative versus reactive treatments and patient outcomes.

So what are some of the biggest health problems you see that could have been prevented if caught earlier doctor G.

- Well, every day well I'm sure all the doctors agree with me is or every patient, almost every patient on a daily basis that we see, uh with chronic medical conditions, be it like diabetes again, high blood pressure, heart disease, stroke, fatty liver cancers, lung diseases can all be prevented if only they were screened appropriately because all of these conditions can be, uh identified with routine screening.

And, you know, just addressed with, simple, uh interventions.

So at the end of the day, as providers, we want to help patients understand the risk, uh not only in today's life, but going further.

You know what all these conditions can, uh complicate into and just help them, uh uh you know, participate or, you know, start doing preventative uh measures and maybe prevent and treat if they already have the disease.

So if you're asking it, which is better prevention versus treatment.

Both mostly go hand in hand.

Well if you want to say, hey I'm only going to do prevention.

Well, the patients who already have the medical conditions, it's like we are not caring for them.

So but again, if you're only going to wait until the patient develops diabetes or heart disease and then, treat them, that is too late too.

So they go hand in hand.

You want to do prevention.

You ask me, from day one in your life for all, all age groups, you want to do prevention and, uh uh again, you know, sometimes prevention alone is not good enough.

So you detect the conditions early.

So you treat treat them efficiently.

So at least you you're preventing complications from those diseases.

For example, treat diabetes uh efficiently.

You know, maybe healthy lifestyle changes and so that you're not, uh uh you're preventing, like, diabetic retinopathy or kidney failure or heart disease from diabetes.

- Dr.

Caples.

<<Dr Caples>> Yes.

I, I agree with with everything you said, mental health tends to play along the same lines.

A lot of people think mental health is different than physical health, but a majority of mental health symptoms that go along with diagnosable mental health conditions are physical in nature.

So there's a very big overlap between mental and physical symptoms.

But one of the things about prevention, if you if you look at the prevalence rates, which is how many people you know are having depression and anxiety in our country versus the genetic predisposition, which means you might just develop it based on your genes.

Right?

So you look at those, our prevalence rates in our country are a lot higher than what we know to be genetic predispositions, which says a majority of this can be preventable.

If it's not, we can absolutely manage it to keep the severity within a reasonable condition.

Another thing about mental health conditions, that's a majority of the time, most people with a diagnosable condition like depression, it's an episodic condition, an episodic, just like a TV episode.

It comes and goes.

So what that means is we can get your symptoms into remission, where you're asymptomatic, you're not feeling a lot of the symptoms of depression.

- Those episodes don't happen.

- So they don't happen as often, as frequently, or they don't get as severe.

It's just like, you know, when you get the flu and they say, you got to take Tamiflu within 48 hours for it to be effective.

Well, the earlier you come for your treatment, the better we can treat you and the faster that you we can get you into symptom management or remission.

And so when you look at the realm of prevention, prevention can mean a lot of different things.

A lot of times with lifestyle choices, uh we can make it to where you might experience an up and down or some stress, but it won't turn into the diagnosis like, noticeable, diagnostic episode.

Right.

Um, but so we can prevent the severity or we can prevent the onset.

But in the, in the case that it is a genetic predisposition that you develop it, we can manage it.

And so you can still go on to lead a very healthy life.

- Wonderful.

- Yeah.

- Doctor Patel.

<<Dr Patel>> I agree completely with what's been said so far.

I think heart disease especially is a little bit, in some ways, the end result of the lack of prevention of some of these other conditions that a lot of patients have, like high blood pressure, diabetes, high cholesterol.

And I kind of think of it as having a problem with your car.

If you catch something like a small leak somewhere, sometimes it can be patched up and you don't have to have any further work done on it.

But if you wait till the car doesn't start up, you end up paying a lot more in the long run.

- Thank you Dr Katragadda?

<<Dr Katragadda>> So, I know all of them have talked about uh preventing heart diseases, general health conditions with lifestyle management and physical activity, eating healthy and stuff.

The other important aspect, which we can focus on is, with uh prevention is are social factors like, you know, um what are your choices in life?

How what are you choosing to do as a social activity?

So in the pulmonology world, the biggest burden we have um , right now is COPD, which is also interchangeably called like emphysema, chronic bronchitis and uh, lung cancer.

uh earlier colon cancer, breast cancer were the leading causes of deaths in the United States in the current year, all cancer deaths combined from breast cancer, colon cancer and prostate cancer is equal to the deaths [cough] that lung cancer costs.

So it's a highest burden.

And how can we prevent it by, you know, you know, um, working on our social uh habits.

Smoking is a biggest thing.

Uh, someone who smoked in life has, um seven times higher rate of getting COPD.

And uh, someone who smoked also has higher prevalence of uh, lung cancer.

80% of lung cancers are associated with smoking.

So, you know, I would like to put forward this one and stress on the smoking uh In this particular question that, you know, uh that's the biggest thing in pulmonology world, which can prevent, uh cancers and COPD and, help, uh with preventing a lot of morbidity and mortality associated with these conditions.

- And, and wouldn't you say, though, when someone uh for example, decides to quit smoking, - mmhmm - which we hope they do right.

Um it's it's if it's been a few years, that doesn't mean just because you quit smoking a few years that you're, you know, that you don't need to be screened anymore.

You don't need to be, you know, followed up - Right Absolutely not.

That's the biggest myth a lot of people have uh.

Now nobody picks up a cigarette thinking they're going to be smoking for 30 years of your life.

Right.

And when you make that decision, that's the best thing, um to prevent COPD or cancer.

When you quit smoking, it takes about ten years for your risk of cancer to reduce to 50%, and it takes about 20 years to be equal to someone who's not smoked.

And, um I think Dr.

Patel would agree it takes 15 years for your cardiovascular risk risks to be equal to someone who's not smoked.

- Wow.

- So quitting smoking five years, ten years does not take away, um it decreases your risk for those conditions, but it doesn't take away the risk completely.

So you still have to be screened until your risk completely goes away.

- The sooner the better.

- Yeah.

Never late to quit smoking.

- Right.

- Uh, Dr.

Naeger from an orthopedic standpoint.

Prevention versus treatment.

Talk about that.

<<Dr.

Naeger>> Yeah.

So a lot of lifestyle plays a part in orthopedics.

Of course, a lot of, um muscular injuries in orthopedics, rotator cuffs a really good example.

So good warm up.

Make sure you're maintaining your flexibility and your mobility.

Proper lifting techniques, taking care of the smaller muscles around your shoulder so the rotator cuff doesn't have to work as hard.

You can avoid a rotator cuff injury before it's even a problem.

So that's a really good example of how lifestyle choices play effect in orthopedics.

- Yeah, and I know it's, uh spent some time in in physical therapy recently and I noticed, well, there's a lot of knee injuries.

- There's a lot of knee injuries - a lot of knee injuries - a lot of shoulders with the pickleball now a lot of hips.

[laughter] And the physical therapists are very mad.

- Well, yeah, they really are uh [laughter] but when it comes to, y y y you know, watching over your knees, can you give us some tips about, you know, preventing knee injuries?

I mean, sometimes they just happen sports injuries, things like that.

But, uh, what can we do?

- Yeah.

Great question.

John.

So, uh there's a lot we can do, actually.

So, a lot of little things to make a big difference.

One of them is you gotta stay condition.

Okay?

So keep the muscles strong around the joint.

Okay?

That means less force going through the joint.

Less pain from the arthritis.

Stay mobile.

Stay flexible.

Once that joint gets stiff, you can have a real problem.

Because the joint get stiff, you become less active.

You get more stiff, you're less active.

That's a tough cycle to break out of.

Okay?

Weight is a huge part in knee health.

Every pound you have, every pound you lose, I should say, makes the knees feel a lot better.

Okay, so the weight loss is good for the knees taking care of the muscles around the knee, the flexibility.

All of that really plays an important part in knee health.

- I think.

I don't think people realize how much when they lose ten, 15, 20 pounds, how much pressure they've now taken off of their knees and their joints.

- Exactly.

It makes a huge difference.

- Yeah.

Well, warning signs that, uh people ignore, uh and you all see that, what symptoms do people commonly brush off that they should actually prompt a conversation with a health care provider, and that happens quite a bit.

You know, they they kind of know something's going on.

But maybe I hesitate to find out what it might be because it might be something I don't want.

But, Dr Patel, what are some of the warning signs that you typically see people ignore?

- I think the biggest one in cardiology is shortness of breath.

A lot of folks, as they get older, they just attributed the shortness of breath to getting older and slowing down.

Can't do as much as I used to, but that really is a change.

And especially in someone who's been active all their life, if they're noticing that they can't do the things that they used to be able to do, that's a reason to get checked out and think about the heart for sure.

- Right.

Right.

- Dr.

Caples?

- All of them.

[Laughter] Mental health can can be challenging.

And there's a lot of symptoms that we feel that we may not attribute to a mental health condition that we ignore.

Right?

Um, stress, mood swings.

You know, I'm just in a bad mood today, or my kids are frustrating me.

And so that's why my mood is up and down.

Or maybe that's just my story.

[Laughter] I don't know, but, you know, we have a lot of it.

Or a fatigue.

Fatigue is a really big one.

A lot of people don't realize that fatigue is rampant in depression, and it's one of the major key risk factors, um of developing a more severe depressive episode is fatigue.

So there are a lot of symptoms, a good majority of them, that for different reasons, people ignore or keep silent or internalize, um.

When it comes to mental health, a lot of people think, well, I'm not sad or I'm not, you know, I'm not in this psychotic episode, so I must be okay, and I must be be fine.

They don't realize a restricted appetite or maybe even overeating is a sign of mental health condition.

So.

So many of our conditions and mental health, um really mimic lifestyle choices.

And it's hard to change what you eat and how you eat or to get up and move or to sleep.

You know better if you can't sleep.

I think we all just say, well, I'm too busy.

My mind is just going like, that's just how I've lived the last 20 years.

And those things in a range over prolonged period of time are just not normal.

So we often tell people, or at least I do, is if your daily functioning is impacted for about 10 to 14 days, then come to me, come to a doctor, go to your church, your pastor, or your primary care doctor and get a proper assessment.

And let us tell you what's going on and how and help you through that.

- I think it's interesting that at least my observation is that younger people, when it comes to warning signs about their mental health because they have been challenged so much in the last several years, it's interesting that they almost have arrived in a space where they can more comfortably talk about warning signs of mental health, and then than their parents and their grandparents.

- Right.

That is absolutely true.

In a way.

That's a great, great thing because there is an expression that happens with the younger kids where they are able to own where they are and almost advocate for themselves.

There is a double edged sword, though, because then they go to ChatGPT and TikTok and get the answers to [Laughter] - Right.

- What is fixing this?

And their peers and and sometimes that leads to great resources or it leads to help in aid.

And how do I talk about this with my parent?

Or how do I talk about this with my teacher?

But sometimes it's the opposite, because then you can't control the influences that they're getting to say, what should really this feel like?

What should this be like?

So it's kind of this balance that we we have to we have to play.

And but I think the biggest thing, the most positive thing about the awareness now is that they will speak on it.

Other kids will speak on it too, for them.

You know, I've had some of my kids friends come to me and say, hey, I'm worried about my friend because they know what I do, right?

And they can't necessarily articulate what exactly is going on, but they can tell me what they said and they know enough to be concerned.

And so I think that that is an absolute great thing.

- And even at the workplace, too, I think if you're just paying attention, you know, just just paying attention to your coworkers and you observe something, say something or, - Yeah - have a conversation or encourage them to have a conversation.

- It's so easy to say, doctor, she is in a bad mood.

[Laughter] I'm avoiding her.

She must be having problems with those two kids she told me about, [Laughter] you know, it's very easy for us to ignore each other.

But you're absolutely right, John.

We're.

We're now getting the message out that if your coworker, if your friend is something is going on, you don't have to say, I think you need to go to a shrink.

You can just say, are you okay?

But when you ask that question, are you okay?

Make sure you have time and space to listen just in case they start - because I'll tell you, [Laughter] Right.

- Sometimes they'll tell you and we call it emoting and that's a good thing.

Um but don't just give them the space.

Listen to what they say.

You don't have to have the right perfect thing to say back.

You know, you don't have to say, I know what that feels like.

If you don't just.

Open space, just.

Hold the space for them and say, I get it, I understand.

I hear what you're saying.

Sorry.

- Yeah.

- And we see that a lot in primary care.

Like, as providers, primary care providers, we have the advantage of knowing our patients through years.

So once a patient comes to us, which I see a lot actually they're not themself.

They're not them.

So uh I ask them what's going on.

They're really reluctant to share.

So I just give them based on how bad or good their mood is, you know, give them a few minutes and I just go and put my hand on their knee.

They break down.

- Thats right.

- They don't even realize they have depression.

They break down.

And a lot of times if there's something different, I ask, how is your relationship with your kids and your husband?

And they say something is going on.

So sometimes the patients don't realize, but the family realizes something is going on.

So yeah, we see that a lot in primary care.

- Oh wow a how how about you?

- So when we're talking about um, you know, sorry, uh - Warning signs.

- Yeah.

The warning signs, right [Laughter] So um, I would, um stress on weight loss.

Okay.

Um, most of the people are happy.

Okay.

I lost 10 pounds.

I lost 20 pounds.

Yeah, I am, I'm I feel better, I feel good about myself.

But if that's intentional, if you're trying to lose weight, you're making changes to lose that weight, that's a good thing.

But, um if that's unintentional, you're losing weight without doing anything.

That means there's something else going on with your body.

So I would reach out to your primary care or whichever your family doctor, whoever you're seeing to get checked.

It could be as simple as like, you know, you could have anemia, you could have like, endocrine issues, you could have diabetes, you could have malignancy cancers.

So we don't know.

It's a wide range of things that can cause weight loss.

So that's something if you're not intending to lose weight and you lose weight.

You have yo reach out - Pay attention.

- to your doctor.

- Right.

- Dr.

Naeger warning signs.

- Yeah.

So orthopedics is very different.

But I think one thing that's very similar to what you guys were talking about is the symptoms that are persistent.

So a red flag in orthopedics is symptoms that really don't go away, pain that gets worse or just lingers for weeks and weeks.

Um, orthopedic specifically, if you have joints that are unstable, your knee feels like it's giving out, your shoulder feels like it's slipping.

That probably warrants a doctor's visit.

If you can't bear weight, you know that probably is a red flag.

You need to go see a doctor.

So symptoms that are persistent or getting worse, that's probably a sign you need to go see somebody.

- Well, and you know, in this area of the country we live, we have a lot of, ex athletes - Oh yeah.

- who, don't want that.

They want to push through injury sometimes and not admit, no, I'm just fine.

Right.

And that's that's not a good thing.

- That's not a good thing.

And that's almost the art of medicine.

What is, you know, normal post-workout soreness.

What is, you know, just getting older.

What is ache versus what's injured.

What when am I hurt?

And I think if, you know, that's a good gray area that a doctor can really help you out and navigate.

- Yeah.

- And I would like to add something.

You know, we don't want to just restrict the symptoms.

I would say, hey, there are signs that warning signs also because a lot of this, uh health condition being cardiopulmonary diabetes, fatty liver, they are like the I would like to say they whisper before they scream.

So, you know, when you do routine, uh follow ups with your doctor and you say, hey, your A1C is a little high, but it's just in the pre-diabetic.

Don't worry about it.

Or your blood pressure is a little high, but you're fine, so don't do that.

You know, either the providers or the patient, because sometimes five years later, the patient comes to me with A1C in the 15th, already having kidney issues from that.

So it's those are all warning signs like borderline, uh uh abnormal blood work.

So make sure, uh I would always tell my patient, hey, if you don't do so and so, you know, it's just going to be diabetes and you have to be on medication or, uh if you don't watch your kidneys, you know, um you're going to go into kidney failure or diabetes, fatty liver and everyone, most of them in Midland have fatty liver.

And they think it's okay.

It's not actually fatty liver.

It's a precursor for heart disease a heart attack.

So those are small, uh uh warning signs that have to be addressed, uh and taken seriously not only by the provider, but also patients and not wait until they get worse.

- Well, and I think I, unfortunately, does not do any of you a favor, because when someone experiences warning signs, there's now a something in between you that's going to potentially say, well, or minimize those warning signs depending on what they put in there, which will again, give them this, this idea that, well, I'm I'm okay.

I'll just push it down a little bit further.

- Yeah.

It does warn you though, - Whats that?

- it says this is not a medical opinion - Thats right.

[Laughter] - AI is not a doctor.

Okay.

- But one one point - Right.

- I think that is really important is it's really about their perspective.

Right.

So when you were speaking about, some of the orthopedic in our athletes, some of our athletes have we all.

Well, if you're kind of in my age group, you know that no pain, no gain.

Right.

- Exactly.

- Which is there's which tells me that there's still stigma associated with going from any kind of medical care.

There's obviously still stigma associated with mental health, but other medical care, um just even because I remember when I was doing clinical practice and, and a young lady, she was very young.

She was in her late 20s, had been diagnosed with hypertension and did not want to take her medications and told me this very freely.

I don't think I need to.

And I said, well, I, I think it's really important for you to do that.

And she said, nope, that means something's wrong with me right now.

She didn't mind coming to therapy, but she did not want to be diagnosed with hypertension.

Right.

And she did not want to take the medicine because this is a chronic condition and that means something is wrong with me for a long time.

Fast forward a couple of months.

She comes into my office and she look, she just not did not look like herself.

And I say, you don't look like you feel good physically.

Something's off.

She was in hypertensive crisis when that moment in the office because of this stigma that if I go in and I do have diabetes, something's wrong with me, right?

So we're all in every aspect of medicine.

I think we're also working to change that stigma and advocate and let people advocate for themselves that something is just not.

Right - And something's off.

- Yeah, and that's okay.

- Dr.

Naeger, what really happens to our bodies?

Let's talk about inactivity because that's uh that's a big topic.

Um, the impact of inactivity, just simply not moving has its risks and its effects.

Correct?

- It does.

Yes, sir.

So it does have its risk and it's bad.

Inactivity is bad.

And there's three main reasons why inactivity is really bad.

Okay.

Number one is it it leads to less muscles okay.

You lose your muscle, you lose your mobility.

You lose your range of motion.

And you feel that.

You'll feel that in your daily activities, you start slowing down, um.

You become weaker.

Nobody wants that.

Okay.

Uh number two, we talked about that cycle.

The inactivity cycle, the joint stiffness.

This can exacerbate arthritis.

Um.

So your joints can really get stiff and make it harder to do stuff, and then, uh like, Dr.

G was saying, I am going to steal this, I love that, okay?

If you are inactive, you actually lose your bone density.

Your bones themselves become weaker.

Okay?

And this is one that whispers before it screams, okay.

It's usually silent until something bad happens.

And if your bones get weak enough, you can actually have fragility fractures.

Okay, we see this a lot in wrist fractures.

Spine fractures, hip fractures.

The best way to prevent that actually is be active.

Okay.

Staying mobile low impact activities.

Just a little bit of low impact can solve all three of those problems for you.

The older we get, the more important.

Being active is because as you age, you're already going to lose a little bit of muscle and lose a little bit of bone regardless.

- Yeah, I you know, you take it right off the page.

I was going to talk about elderly patients and, and how important it is to stay active, because you've probably seen the difference dramatically between someone who has continued to stay active throughout their life and someone who may have been active and then has slowed down and, uh they're more prone to injury.

- That's exactly right.

I could see two different 50 year olds in the office, and you can immediately tell who's active and who's inactive.

They look totally different.

They feel different, and they have totally different pathologies.

- Dr.

Caples, does inactivity have a correlation with mental health?

- Yeah, it really does.

For a variety of different reasons.

Um one of the ones that we talk about all the time is the dopamine release, right?

That's the the chemical in your brain that makes you feel better when you've done something.

You've heard of the term runner's high.

People that run kind of get addicted to that dorformine and, um dopamine.

And then they work out.

And so that chemical part is really, really important.

But then there's some other components that are a little bit more silent, but just as important, when you're more active, you're going to feel more productive.

And that's going to increase your motivation to continue to be active.

Typically when you're more active, you're interacting with other people socially.

And so social interactions are a huge preventative factor in depression and anxiety because you're feeling connected to other people.

So activity is is huge.

But the thing about it is when you don't feel good mentally, you don't feel like doing anything.

We've all been in a bad mood - Right - or had a major stressor or a life event happen, and you just you don't.

Some days you don't even want to take a shower.

But even those things of getting up and taking a shower, you feel more productive, you feel clean.

So whatever the activity is, and some people really can't, it's not that they don't want to, it's a can't.

- Right - And so taking those baby steps to get up and even go into a different room can be a very big win.

And then we got to get you out of the house, and then we got to get you in the exercising and whatever.

I don't even use that term anymore.

I just say, go take a walk or, - Right - you know, ten, 15 minutes.

I call them little bite sized things.

And that's what I do to motivate myself, because I don't want to work out for an hour either.

But if I can do it for 15, 20, 30 minutes, it helps me.

But then the way that you feel afterwards, you feel accomplished.

So that's the motivation for the next time of you doing it.

- Awesome.

Dr.

Patel, there's a lot of, um you see a lot of, times as far as how much activity you need.

Is it 15 minutes?

Is it 30 minutes?

Is it three times a week?

Is it five times a week?

What say you?

- So the American Heart Association actually has guidelines on this.

And the recommended amount of time is at least 150 minutes per week.

And there's actually data to show that if you double that to 300 minutes per week there's actually added benefit.

So it's quite a bit of time that's required.

But if you're not exercising at all then it's most important just to start somewhere.

- Right.

Dr.

K You follow that?

You agree?

- Absolutely.

That was one of my keynotes.

Um coming into this, um the key is to start slow.

If you have not been doing anything, baby steps and graded increase in your activity.

I just love this term.

Deconditioning right?

I use it with my patients all the time.

It's a medical term, but you can understand it.

Basically, when you're inactive, you're deconditioning your body to do less.

And then when that happens, like, uh Dr.

Naeger was saying, it's not just the peripheral muscles in your body, your heart muscles, your lung muscles, your respiratory muscles, everything kind of weakens.

And when you start to move in that condition, your heart and lungs are kind of working more for the same thing that they were easily able to do a few days back or a few months back when you were active.

So you have to recondition your body to that spot.

But yes, it's difficult.

It's very difficult to keep telling just to start with five minutes, ten minutes, move around in your house, walk around your neighborhood and then baby steps and get to where we have to.

- Dr.

G., I'm glad there's been a spotlight on walking.

You know, walking used to get a bad rap.

It's like, oh, it doesn't do anything for you, but walking's kind of become the star here lately huh, - Uh huh - Yeah.

- Yes you know, walking.

Yes.

It's good for cardio.

I always tell my patients, you know, because there's a lot of talk out there about.

Hey, my metabolism is low.

I don't lose weight.

But I try to explain to, to my patients.

Hey, you know, your muscles are like powerhouses.

You need to fill them with healthy food and fire them.

So if your fuel fueling, not firing or the vice versa, it doesn't help.

So both cardio and strength training, they're really important.

- Excellent.

Well, we're just getting started.

We still got half a show left, so I'm excited about that.

But we do need to take a short break.

Uh sort sites and break.

So when we come back, we'll have more from Midland Health.

Well welcome back.

We're coming back to you live from the Basin PBS studio the Anwar family studio, and we're going to continue our conversation on health and wellness.

We've just started scratching the surface.

So thank you all.

It's been wonderful so far.

Well, let's move on to small change that we were just talking about.

Just getting started.

But small changes and big impact.

If someone wanted to improve their health just over the next 30 days, say for example, what is one realistic change that you would all recommend?

Dr Patel, we'll start with you.

- So I think we were talking about walking and I think that's a great start.

But I think the most important thing is to also make sure that you're slowly increasing the amount of time that you're walking, and also the intensity of how you're doing it.

When we think about the American Heart Association's guideline on exercise, they don't define not only the time but also the intensity.

And we think about moderate intensity exercise for a prolonged period of time when you're initially trying to get to optimal health.

So you really should be exercising enough that you have a little bit of trouble completing a full sentence.

You really have to get your heart rate up and get those muscles firing to have a good long impact.

- Just encourage people to challenge themselves - Absolutely - and leisurely walk all the time right?

- Exactly.

- Uh Dr.

K., what's one small change you'd recommend?

- Um, more than it being like a health change, I would want to stress on being more socially active, too.

Okay.

If we're being in a world we're living in a world where we're more to ourselves, nuclear families, like, you know, just your spouse, your kids, your family, you're busy in your life's work.

But I think just stepping out of that comfort zone, actually consciously making time to for your extended family or friends, it just it just helps um, in a lot of ways, maybe it's an activity you're doing together with your family that helps with health.

It's, stress buster.

You venting out or, you know, just sharing your day.

You're sharing your life with the family that helps your mental your mental health.

It helps your mood.

So I think I think just just socializing more, uh giving time, spending time for, uh someone more than your just your nuclear family.

I think that's that's very important.

- Uh I one of the remnants of Covid, right.

Because we all kind of fall - Right - into our own little our pockets.

And we've now had to slowly kind of come out of that.

- Exactly as pulmonary critical care.

I don't like Covid for many reasons, but I was glad during Covid we were some of the, um very few professions which still had that human connect.

Um, I saw in real time, a lot of the professional people who were working from home, absolutely not, has not seen anybody else other than themselves, their own home.

And that has affected them in a lot of ways, physical and mentally.

But we were lucky in a way that we, we got out of the home every single day.

We went to the hospital, saw patients, talk to people.

Uh, I think I think that that's that's a good point.

You brought up now.

- Yeah.

Whats one change Dr G.?

- Well, I can't agree with more, with being socially connected and walking.

Actually, there's been a lot of research lately.

Also how walking even, like 20 minutes a day makes a huge difference with the chronic medical conditions.

But I would also say maybe, uh you know, just look into yourself and see what is that one small goal that you want to achieve.

So be it losing weight or is it your stressed, you know, your anxiety or depression are not controlled.

So try to make that one step closer to that one goal you want to do, be it like diet, physical activity or, you know, meditation or, you know, connecting with a friend or a family who you haven't talked to in many years.

All of those small changes make a meaningful difference.

- Because some folks, after a long time of, say, inactivity or maybe inactivity socially, you know, they sometimes think maybe it's, uh too much, you know, it's it's too daunting.

So, so small, small bite, small steps could actually help ease them into that.

Yes.

Yeah, I know you've got something to say about this.

[Laughter] - So I have a lot to say about a lot of things.

- Okay.

- Uh, sleep hygiene is a really big one.

uh, and some people think, well, I sleep well.

Sure, but if you sleep 12 hours a day, that's not okay either.

Right?

And so, most of us don't get enough sleep, or at least we feel like we don't get enough sleep.

We're not rested.

Even if you sleep eight hours, how much quality sleep are you getting?

Are you getting into the REM?

Are you getting into the stages?

I know I'm guilty of it.

We we stay up as long as we possibly can with all kind of stimulation going on, and then it's hard to fall asleep or stay asleep.

And if other people are like me, as soon as your eyes pop open, you're thinking about everything that you have to do, right?

So the quality of our sleep in general, I think, has been significantly diminished with advances in technology and lifestyle and all the things.

And so really focusing on a really good sleep hygiene routine every night for yourself and your family and your kids.

Because if your kids don't have a good routine, you won't - Right.

- have it, right?

Surprise, surprise.

So I think that that's a big one that I would suggest.

- What are a couple of of things, 2 or 3 things that make up that you would recommend that people do to try to achieve better sleep at night?

- Sure.

Well, routine is one of them, right?

Any time we get into a routine, that's helpful because you know what to expect.

Your kids know what to expect.

And routine simply means try to go to bed around the same time every night, right?

And, um if you need, if you're one of those that likes to shower because it kind of calms you down, make sure you do that.

One of the biggest indicators, though, is turn off anything that is stimulating.

I do not do that.

[Laughter] - I think all of you know.

- But I know, I know, I really am, uh, but I think there's been a couple of times where I have just to say, let me see what this does for my brain.

It's not going to work.

And then it works.

My sleep is better that that night.

Uh, and so that's a really big one.

But I think consistency is the key.

Uh there's a lot of recommendation about a very dark room.

A cool room, right?

- Right.

- Lower temperature, um comfy beds, make sure it has the firmness and the pillows and all of the things that support your actual body.

But I think the lack of stimulation and a cool, dark space that's quiet and that routine is the most essential.

- Awesome Dr Naeger.

What small change would you recommend for somebody that would make a big impact over the next 30 days?

- Yeah, John, for orthopedics, I would say get active.

Okay.

Uh, especially low impact activities.

Motion is a lotion, okay.

Whether it's walking like we talked about swimming, biking, light strength training, whatever your thing is the best, the best exercise is the exercise you do.

Okay, a little bit of consistency, um, with the exercise.

And the activity goes a long way.

So just be active.

Doesn't even really matter what you do.

- I'd like to connect what Dr Naeger said and what Dr Caples said.

Uh another important thing that would help in a better sleep hygiene is also exercise.

- Yes, that's true.

- Uh which is kind of contradictory.

Okay.

I'm like, all pumped up.

I went to the gym, but it's not that way.

You have an active lifestyle.

You do that, uh activity, you can have a better sleep quality so.

- Absolutely.

That's awesome.

Stress and physical health.

Anyone?

Uh Dr.

Caples?

[Laughter] - Why you make an eye contact, - I know.

Right?

You know, we often think of stress as just a mental health issue, but how to stress affect the rest of the body, Dr.

Patel, how to stress affect the body?

- I think stress, aside from mental health, also has physical effects on the body.

As well.

Even if you look at, for example, myself, I wore one of those glucose monitors and I would notice that when I was doing a stressful procedure, my sugar would actually go up.

So it was really interesting to see that.

I think just having a little bit of stress in your life probably does affect your hormones and your blood pressure, your glucose regulation, your insulin sensitivity, and so controlling that stress and finding a good way to cope with it and to relax is really, really important.

- Dr.

G., you mentioned, that you've seen some patients that are coming in to see you on that.

You've seen over time and you can tell when they're experiencing stress.

- Yes, yes, yes, for sure.

I mean, and I also see a lot of patients who come for me, come to me, for weight loss.

And again, they are in stress.

They have anxiety, depression, they don't realize.

So when I ask them the question, it I a lot of times diagnose them of anxiety, depression or stress and try to handle or treat that before we go into stress.

But um one thing is, you know, I always, uh uh uh liked reading about this.

So the difference between acute stress and chronic stress, I think Dr.

Caples will able to explain that acute stress is good.

Like a dog chasing us.

You know, our heart rate, our blood pressure goes up, our blood sugars go up.

You know, our muscles need all of that to run.

But as long as the threat, uh is gone, everything goes back to normal.

But now, in now, day and age, we are in a chronic stress eat, work, family, health.

We are in a chronic stress, and that keeps our blood pressure high.

Uh inflammatory markers, high sugars high that eventually cause heart disease, strokes, cancers and if you would like to add - Or have nothing to add, you stole my thunder.

[Laughter] No, no, no that was beautiful.

That's exactly right.

And that's why I was going to go.

Is a bit of stress is normal.

Right.

And we want to normalizing normalize the acute stress.

Right.

There's a situation in your life it's okay to acknowledge and own that this is a stressful event, uh once it becomes chronic is when it's problematic.

And that's when you're symptom severity is going to be prolonged, which means it's going to feel worse.

And you may respond very differently to maybe events that aren't maybe typically a stressful right to you.

You'll notice that you'll have a larger response to that.

And so that's what we need to do.

We need to develop effective management skills.

I tell people all the time, if you have a goal to never be stressed, first of all, give me the answer to this right now.

- Right - Don't know how to do that if you figure it out.

But that's not the goal.

The goal is is effective and efficient management of the stress.

So your stress cycle should go like this, right?

It shouldn't go like this or stay here.

The majority of us kind of go up here and stay here, and we don't kind of have that natural reprieve of stress.

- I would like to know that too, because a lot of our patients are in that state and they don't know what to do.

And as a primary care provider, I don't know what to tell them to, you know, I mean, because not all patients are willing to see a psychologist or a psychiatrist.

So I would like to know what to do on a daily basis, to help them recognize and to help them.

- We could be here a whole month if I could tell you what to [Laughter] what to do.

But I I think this is where it becomes into individual differences, right?

For your patient.

And you sound like you very much know your patients really well.

So I think identifying the source of the stress, but then narrowing it down to the primary stress or the thing that's the most stressful and develop management techniques for that, because the management technique for that is might feel a little different than the management technique for something else.

If you lost a spouse, you're going to manage that very differently.

Then if your boss just gets on your nerves, do you see what I mean?

And so it's about particular stressful events and effectively managing those.

But then we can have consistency and an overall lifestyle plan and things that we do to consistently manage, like what are we eating?

Are we active.

You know, are we enjoying family time and time with our friends or do we need to limit that?

Do we need to have boundaries about how much family time we have?

You know, so that is going to be on an individual basis.

But I tell everybody, bite size, don't go making significant lifestyle changes if it's not bite size that you can continue to do consistently for three weeks.

That's not the right activity for you.

So some people will tell me I love cooking.

That helps me manage my stress.

Well, I'm not going to go cook because that stresses me out.

[Laughter] So I don't want to do that.

Are you learning a lot about me?

I have a horrible sleep pattern.

I don't cook, but but there's different things depending on your patient and what gives them joy.

We all find joy and peace and things.

Add that into your daily routine.

You know, just a few minutes a day.

We need to start small.

Like we've been talking about adding elements of joy a few minutes a day consistently into our routine, and that sleep is huge.

In hydration.

We didn't mention hydration.

- Do we have any online resources or AI tools?

- Right?

Well, here we go down that path.

There's there's a lot of great online resources and self-help.

We would have to talk and I could guide you and some good ones.

Mayo clinic has phenomenal resources on mental health.

- You know, Covid has come up, of course, because it had I think it's still has.

So many effects that we're still, you know, learning about.

But when it comes to stress, I think that, um one thing we found out is that a lot of us, a lot of people didn't know how to manage stress because they were thrown into situations where, uh families members, maybe didn't know how to handle stress very well.

And then they came out of that.

And, and I think it really impacted young people the most.

So you probably have seen the effects of that kind of stress over the last several years.

- Absolutely.

As we're talking about Covid, the biggest stressor was isolation that people felt, which tells you that naturally, we're social beings.

We need to be out there and connect.

Sometimes for your patients that you may not know how to manage, have them just talk to a trusted person that will allow them the space.

People often say, why would I go to therapy?

Talking's not going to help me.

But what do a lot of us do when we're stressed out?

We start venting.

- Yep.

- So you're telling me [Laughter] it doesn't work?

Oh yes it does.

Right.

- Yup, yup.

- And so that can be a very easy.

But you can't talk to everyone.

You have to know who you can talk to, who's not going to start telling you what to do or giving you bad advice or whatever that is.

So that can just hold that space for you.

So connection can be a significant key for the majority of people, depending on life and lifestyle, and make sure they don't have any social conditions that prohibit that.

But connection could be a really good key.

They need a partner, an accountability partner, to lose weight or to take their insulin or whatever it is.

- Yeah.

Dr.

Naegr, stress have a orthopedic component potentially.

- It does actually.

And this is very well said.

And I was going to backtrack to something you guys mentioned about inflammatory markers and inflammation.

So a lot of times when stress manifests itself in orthopedics, it's actually after an injury.

And we see a lot of delayed healing and prolonged recovery that we don't see without stress.

So it absolutely can have an effect.

- Well, I know you're exactly right.

So I noticed that, you know, and I had some about with some tendonitis and it actually affected the way some labs showed up.

- Absolutely.

I had no idea.

- Yeah.

It can have physical manifestations.

- Wow.

Let's talk about screenings because, that's a uh well, we're lucky and we're fortunate in this day and age that there are so many screenings, and the quality of them have dramatically improved.

Has the ability of people to go actually and go have them improved at all, as it are they using screening more than I used to.

- I think so I think we definitely have access to a lot better screening and a lot more parameters that we can monitor.

- Um touching to what Dr.

G had said earlier about warning signs, there's all of these little parameters blood pressure, cholesterol, blood glucose.

Um, all these things start to get a little bit abnormal and they can go on for years and years and years before they really cause a major problem.

So screening for these things is really important because that can promote early intervention.

And a lot of times it's it's lifestyle changes.

It's not even requiring medications.

If you catch something early enough, it can be treated and it can prevent a lot of the downstream effects of those issues.

- What are some screenings that adults should just not skip?

- I think the biggest thing Dr.

G., would add on to that is, uh, lab work, simple lab work.

Every year after a certain age, you're expected to get bloodwork.

Okay.

So, um the very definition of screening is you're not going to go get that blood work or that test or investigation when you start having symptoms.

It's like even if you have no symptoms, okay, I feel fine.

Like, no, I don't need screening, I don't need to get a blood work.

But screening itself means that you do something before you have a symptom, before you start showing those signs so we can catch it early.

Um, so bloodwork is a major thing, but in a pulmonology field, obviously we're talking about, uh cancer and stuff.

The question that you asked, do we have access to the screening tools?

Um, I would say yes.

Compared to ten, 15 years ago, 20 years ago, a lot of areas the screening has been when more people are aware of what kind of screenings have to do, um, and even in and among the providers, uh, there are certain areas of medical, uh, conditions where screening has really, uh, you know, gone up the scale where the percentage of screening is really good.

Um, lung cancer screening, though, only 10% of the patients who actually qualify for screening get the screening.

So it's more education, more awareness, both among the patients, both, among the providers that we have to do.

Why is important?

Uh, are you going to find lung cancer?

Yes.

And that might be a stigma.

Okay.

I don't want to do it because I might find something bad.

But what does it do if you find something is you're not going to be a stage four, but you're going to be a stage one where your survival rate is 80 to 90% compared to 20%.

- And there are some cancers that don't have any noticeable symptoms for a while.

Correct?

- Yeah.

If you have a one centimeter spot on your lung, you're not going to have any symptoms.

Yes.

If you have a four centimeter, you're going to cough for blood.

You're going to have breathing issues and stuff so that the screening can catch that one centimeter versus when you have symptoms.

It's no more screening.

It's because you are symptomatic.

Makes a huge difference.

- Dr.

G., what screenings would you recommend nobody skip uh.

- Well just see your primary care provider once a year.

You know, I would say even I'm not a pediatric physician, but even pediatric population or I see 18 and about just see your primary care provider every year.

You're not only screening for, you know, age appropriate cancers.

We also do screening for high blood pressure.

Do those basic blood work screening for, uh diabetes or prediabetes or, liver enzymes in know suggesting fatty liver.

And also during the screening process, we also uh, encourage getting vaccines, which are also important in our day and age.

One thing I want to add, uh uh to Dr.

Katragadda is I don't know if, uh uh how many people know here 2025 has seen a record number of cases, cancer, a new cancer diagnosis throughout the world.

U.S alone had more than 2 million.

So that number can can be a little confusing or hard to interpret.

I'll just say, hey, in my primary care, practice, on an average every year, I may be having new diagnosis of cancer 3 to 5.

Last year I had 19.

- Wow.

- 19, and most of them are breast cancer, but a few lung, prostrate, pancreatitis.

Uh, actually, brain tumors.

So the good thing is most of them, they were diagnosed quite early, and, uh they got the treatment and they're doing good this year.

I already have 15.

- Wow Today, today's July 30th um, sorry, August 13th.

I already have 15 new cases.

So the good thing is, yes, there is increased risk, increased incidence of cancer for various reasons, but we are catching them early and treating them effectively.

So the, long term outcomes are better.

- And just taking those few minutes could just affect them profoundly in a positive way, potentially right Dr.

Caples, screenings for mental health.

- Absolutely.

Depression and anxiety.

So the American Academy of Pediatrics has already implemented a routine screening.

When you take your child for a world check exam, I think they start at age eight.

Um, we're seeing the early signs and symptoms of depression as early as eight now.

So the American Academy of Obstetrics and Gynecology has recommended that at anti partum stages as well, perinatal and anti partum stages and the American Academy of Family Physicians, which is primary care.

So a lot of these academies that that dictate and regulate medicine and medical practices are starting to say we gotta screen for depression and anxiety.

Thank goodness it's now been recognized that when you have any kind of physical ailment, your prognosis is a lot lower.

If you kind of have a comorbid untreated mental health condition like depression or anxiety, because when people are depressed, they don't take their medicines, right?

They don't go to the doctor, they don't tell anybody about what's going on.

So Dr.

Naeger screenings in your field.

- Yeah, orthopedics is a little bit different because we don't have a screening that everybody should get an ortho.

- Right.

- But I think one that is important is bone density, especially in that aging female population, people who have already had a fracture because this is a silent disease, you don't really know the health of your bones without the screening.

And like we talked all night, this is a really good way to prevent something worse.

- Fantastic.

What's the biggest misconception that you hear in your specialty.

Dr.

Naeger what is it?

- Yeah I love this question.

So there's a couple in orthopedics.

But the big one I would say is that I'm, I'm going to an orthopedic surgeon I need surgery.

That's not true.

Most of what we do actually has orthopedic surgeons is non operative.

Okay.

We have a ton of modalities.

We have physical therapy.

We have anti-inflammatories.

We have activity modification.

We have bracing.

We have all kinds of great things that are not surgery to get you back in the game okay.

So I think a lot of people are scared to go to an orthopedic surgeon because they don't want surgery.

They're not good surgical candidates.

We can still help you out.

There's plenty more we can do other than surgery.

Yeah.

- Dr.

Caples what's the biggest misconception that you run across?

- Well, I think there's there's two, that I would like to mention.

It's kind of.

One of them is if I tell somebody how badly I'm feeling, they're going to think I'm crazy.

[Laughter] - Right.

- Right.

And the other one is they're going to put me in an inpatient facility and lock me up, you know?

And the goal of mental health providers, any kind of family physician, any kind of intern as a primary care doctor is to keep you out of the hospital, which is why all of this early and preventative is so necessary.

Dr.

G.?

- Well, I feel fine.

I don't need a primary care doctor.

[Laughter] That's very common.

Or I'm.

I'm fine.

I don't need to manage my pre-diabetes or high blood pressure.

Yeah.

Most common.

- Yeah, that's a really good point because in orthopedics, a lot of people say, doc, I don't want to exercise.

I'm not overweight.

You know, I'm in a good spot.

Well, exercise is good for losing weight, but it has so many other benefits, you know, for your joints, for your muscles, for your strength, for your mobility.

So, um you should still exercise even if you are at a good way.

- Two things I would like to mention.

Okay, I've smoked all my life.

I've smoked for 30 years.

It's not going to make a difference if I quit now.

It's never late to quit.

Okay?

And we already talked about, what, a dozen, ten years, 15 years.

Second thing, okay.

I've had my screening.

I've had screening every single year for four years.

Everything's good.

I don't need a fifth year screening.

So that's not true.

You can be.

Your screening test can be all normal for five consecutive years.

You could still have something come back as positive on your sixth year.

So screening is meant to be done periodically and not to skip because you feel fine.

- Dr.

Patel, some misconceptions you've run across.

- I would echo what Dr.

G., said.

You know, I feel fine.

My heart's fine.

The ultimate fact is that people don't start feeling fine until damage has already been done, and so many things can be prevented if people get their screenings and tackle the issues that drive the root cause of these diseases early on.

- All right, so imagine a 50 year old working adult, busy, stressed, sits most of the day and has not seen the doctor in years.

What concerns with each of you have, and what advice would you give that person?

- I think probably the biggest thing is maybe what Dr.

Caples brought up is why hasn't this person seen a doctor?

What's keeping them from getting the care that they need?

And a lot of times it is some of that stigma of being afraid of what they might find.

But I think it's important to realize that what you might find is an easily treatable condition that's going to prevent a much bigger problem down the line.

- So what would you tell someone to, to, you know, assuage some of those fears that they that they have is there is there there's probably not a magic, piece of advice you could give, but what would you tell them?

Because that is a, um, that's a real you know, it's a real issue in our country is that people are just sometimes hesitant to you late.

- Yeah.

I mean, I think across all of our specialties, it's important for patients to understand we're here to help.

We're not here to judge what problems they have or what decisions they've made before.

We're here to help them move forward and live their healthiest lives.

- Yeah.

Dr.

G.

- Well, I see all the opportunities that were probably missed where we could diagnose him of cancer or thyroid issues or diabetes, heart disease and all the opportunities missed where we could tell him, hey, exercise, eat healthy to prevent those conditions or like vaccinations.

Everything - Dr.

Naeger or what would you say to that person?

- So in this situation, I'd be concerned about effectively wasting away the muscles, wasting the bone, wasting, the lack of activities concerning, I'd say, get after it, you know, small, consistent changes like we talked about.

And if you take care of your body, your body's going to take care of you.

- All right, well, what's one thing you hope everyone leaves here and does differently tomorrow?

If you could just isolate one thing that they leave here and do differently tomorrow, what would that be?

- I'd say, um, take time, every day to think about your health, to see, um to notice the small, subtle changes that your body is giving you clues about and to actually act on those changes and and your health take, take time, uh for yourself.

Yes.

We're in a busy world, but take time for your health.

- Dr.

K., what would you say?

I like that, I love that, I would definitely add to that, if not just taking time for yourself, but also take a little bit of time to focus on someone else, too.

Altruism is a really big risk factor in developing depression, which means you're giving to someone else.

- Yeah, that's a it.

Just serving in your community has has major benefits.

Yeah, I've discovered that with a lot of folks too.

But you - So I would like to elaborate that a little bit if you don't mind.

So I want everyone to understand, two terms life span and health span.

So life span is total number of years a person lives.

Health span is the total number of, uh years a person lives in good health like, free of, uh like severe medical illnesses or chronic comorbidities or, like, functional or cognitive decline or disability.

So just, to understand, just imagine there are two 85 year old people, you know, one person has been active throughout the life, uh, sleeping good, eating good, exercising.

And until he was 83 or 84.

And then he got sick and he passed away at 85.

But there's another 85 year old person who, um, starting at age 60 or 65, started having diabetes or complications from it, heart disease, maybe osteoporosis, a hip fracture.

Now the patient or renal failure on hemodialysis, they are, suffering.

They are suffering.

They are debilitated.

You know, they are dependent on dialysis.

So they don't have, uh the freedom or, the independence.

So if I'm not going to live forever, you know, or none of us, you know, but my goal for myself and for my patients is to make sure you do something today, you know, which will help with your current, uh health, uh uh goals, but also to support your future health uh and well-being.

- Awesome.

Dr.

Naeger.

- One takeaway for me, I would say, is to be active and try to get a little bit healthier every day.

- That's a good advice.

All right.

Well, that's all the time we have and I really appreciate each one of you.

I'd like to thank Dr.

Naeger, Dr.

Katragadda, Dr Caples, Dr.

Gadiraju and Dr Patel for joining us.

Also, a huge thank you to Midland Health for entrusting Basin PBS with these very important discussions that we've had tonight.

We'd also like to thank the Elizabeth Yeager family and the Anwar family for their continued support of Basin PBS.

I'd also like to thank the Basin PBS board staff and our amazing crew for tonight's program.

You know, programs like this are made possible by viewers just like you.

If you're not a member and you'd like to become one, we would love that.

Please visit basinpbs.org.

For more information on memberships or to donate.

I'm John Moesch and on behalf of the Basin PBS family, thank you so very much for watching tonight.

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