welcome. i'm eric shawn for "sunday housecall." >> and i'm arthel neville. joining us is dr. david samadi chairman and professor of urolling at lennox hill hospital and chief of robotics surgery. >> and also dr. marc siegel, author of "the inner pulse, unlocking the secret code of sickness and health." >> good to see you. >> good to see you both, doctors. >> a troubling new study out on sleeping pills. researchers say that when people begin taking certain sedatives their risk of having a car crash can nearly double.

dr. samadi, is this true? >> well, you don't need a doctor to tell you this because there are a lot of side effects about the sleeping pills. the university of washington looked at about 400,000 records of patients who take these medications. we're talking about sleeping pills such as ambien, restoril, trazadone, all sedatives. i like them in a case where there's a crisis. let's say there's a real crisis in your family. you absolutely can't sleep. for a week or two i think it's good to use them to get through and get rid of them, but when you take a lot of these medications, they have a long effect. it's addictive, and it's not good for you, and i certainly, if you can stay away from it you should. a lot of times we talked about other sleeping pills. we've talked about ginger, valerian, chamomile, magnesium. did you know taking a little magnesium before you go to bed, your banana is better than this. >> my banana and milk. >> exactly. >> not the milk, banana only. >> grapes, cherries and more importantly i want to bring a concept of cognitive behavioral

therapy. cbt. cognitive behavioral therapy is looking at you and changing your lifestyle, your sleep hygiene and what you do before you go to sleep, what exactly you take or drink, no coffee. that's the feedback that we give you in order to improve your quality of life, so in an emergency basis, arthel, as we've talked about it i think it's okay but long term stay away from them because it's as bad as being drunk. >> dr. siegel, we like to kid eric about his banana and milk, banana, yes, but milk, always say no. is there something to drinking warm milk? >> you know i'm against that. i've told eric. eric is sticking to it and not listening to my doctor's advice or my prescription here which is warm milk can actually cause acid in your stomach, which could give more reflux which he's reported to and you stay up at night. the thing i want to start on, the national traffic safety administration reports 100,000 traffic accidents a year related to fatigue.

so we have tired drivers out there. they are overtired, and that's one of the reasons they are getting into car accident but david set this up beautifully is the solution to that isn't what america likes to do, arthel. throw a sleeping pill at it. dr. siegel says you're getting in a car accident because you're driving asleep. one-third of people say they nod off while they are driving. that's terrible but don't throw a restoril or ambien or trazadone at it. you may be adding to the problem. you may not be fully awake when driving. i like his point about cogniti. what's your discipline? are you use the cell phone? is it on brightly next to you? is it going off during the night waking you up? are you having a glass of wine before you go to sleep? that can cause you to wake up in the middle of the night? >> because the alcohol turns to sugar at some point in the night. >> exactly. when it wears off, exactly, when you wake up. we love coffee, coffee too close to bedtime is going to keep you awake. what foods are you eating? when are you exercising and what's your pattern? one last thing that i pointed out when preparing for this if

you have one sleepless night, okay, don't turn immediately to a pill. try to figure out what caused it and break the cycle. >> there's no short term -- no real therapy because out of all the medications between ambien, restoril and trazadone. restoril happens to be safer than the other two that they found in this and cognitive behavioral therapy is the best way to knock out a lot of best habits that you have and it is the safest and easier way. chamomile calls you down. absolutely beautiful. you don't need to work out before you go to bed which is arthel does all the time. 3:00 a.m. -- >> i'm awake because you guys know i can't sleep. i did sleep last night but i'm with you and you that i don't like the whole sleeping pill thing. >> try magnesium i promise you'll do well. >> i have the powdered magnesium and put it in warm water. nothing keeps me down. >> you know i have those machines, white noise machine to give you a nice quiet ambience. >> does it work? >> that's all part of the

behavioral therapy. >> having a good mattress, comfortable mattress, all of these are extremely important. the bottom line -- these are all knee-jerk reactions. go to the doctor and they give you the medications and you stay on them for a long time and there's a rebound effect. >> absolutely. >> two more natural things to add, tryptophan, an a amino acid in your bananas that you eat. >> and in your turkey too. >> it's in the milk but i don't like acid in the milk. it's in turkey, have a turkey dinner you are might likely to sleep better. the other thing to add to chamomile is valerian tea, valerian which makes melatonin the hormone your body is making itself to help you sleep. you want to mimic what the body actually does. >> if i use the melatonin, i have these lucid dreams. i'm not -- i'm not really down. >> so it's not for you. >> no, no, no, no, no. >> last resort. >> it's not for you. doesn't mean it's not for somebody else. every patient has to be treated individually. >> for you it's lifestyle.

being here early in the morning. just like surgeons. >> the schedule. >> i get up at 5:00 a.m. so you have to adjust your schedule to go early to bed and it's an adjustment thing. >> thought you got up at 4:00 a.m. >> 5:00 a.m. you adjust your time. but you're right. this valerian route is very good. chamomile we spoke about and we'll post it online. >> i've tried that. i think natural is better, and not just surgeons and doctors. everybody out there, we all have different -- >> you work at night. >> for people who worry at night. i've coined a term the cycle of worry in one of my books. you start to worry and the next night you worry you get lack of sleep and that increases your anxiety. figure out what is worrying you, get to the bottom of it and get rid of it. may not require a medication. >> and sometimes you're worrying you're not going to sleep tonight. >> when you get texts from him at 1:00 a.m., ignore it. that's another one thing sleeping well. >> dr. siegel, you're not texting? >> that's the o.r. texting telling him about the case. >> if you can't sleep at 3:00 in

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what is chronic pain? i mean, you have it all the time. can you get rid of it? >> there's 100 million sufferers of chronic pain in the united states. it -- it's a system that's supposed to help us, eric, going awry because pain is supposed to warn us about something danger. disease is coming when you get an illness. you feel pain from it, the body's warning system. if you banged against a wall, it hurts you because you don't want to keep banging against the wall, body's warning system but when you can't shut it off it's chronic pain and 100 million pain sufferers leads to addictions to medications, opiates, narcotics that's an enormous problem in the united states so the idea that we can come up with a novel approach to this is terrific, but i'll answer your next question before you ask it, this is not ready for primetime, not going into the doctor's office with this. what they did was they found a group of people who genetically didn't have any pain. 1 in a million people didn't have any pain and this is the way they sometimes get to a cure. why didn't they have any pain? they found out that they had a variant to a specific gene, and

when they had that variant, their nerves in their body didn't make any pain receptors so they didn't feel pain. we don't want that either, so by figuring out this gene, if we figure out drugs to block this gene we'll have a whole new group of medications we can use instead of the terrible opiates. >> if you have chronic pain it seems to me something is wrong, and wouldn't that be the basis of trying to address that it is. >> i think this study has a long way to go before it shows up on clinical trials but your point is well taken. as the american elder population is getting bigger and older, we'll be dealing with this chronic pain at every level, whether it's arthritis, spine, pro. we're sitting behind the computers and using our ipads more and not moving as a nation like we used to and that's why you have all the obesity. by the way, obesity alone can cause all. pain we have in our back because of the weight.

>> good point. >> the study needs to go forward and they may find a gene that may or may not pan out. if you sit on a warm area, that's your defense mechanism that says get up because you'll have a first-degree burn. when you hit your hand somewhere, that's your defense so while there's a lot of spinal treatments and epidurals and all the physical therapy, i'm sorry to say going back to alternative route, using capsaicin which is a derivative of the chili pepper is one way to go, the inhibit substance p. >> where do you get that? >> capsaicin, it's out there, you can buy them and adding tumeric to your food which is also an anti-inflammatory and ginger, one of our favorite in the program. all of these alternative things that we can use for such a thing is the first therapy before you go to your vicodin and, again, other addictive medications so i would go with this route before anything else. >> and to add to that there's a new medication on market over

the last few years which i love which is called voltaren gel. you can rub it into the area. >> oh i have that. >> great stuff for certain things that you can't reach before. i want to underline one more point why we're even talking about this. get this. chronic pain, 100 million americans. diabetes which we love to talk to about on this show, 25 million americans. heart disease, 16 million americans. this is four times as many sufferers, and granted with david's earlier point is great which they are related. have diabetes, end up being obese and have back pain. everything we do in medicine ties together but pain is a huge problem. >> i agree, but i don't want to undermine the importance of blood pressure and diabetes because that killings. chronic pain, you don't die from it. you may suffer from it but it's -- >> what's your point about that? >> my point is besides weight loss, besides a lot of things that we are talking about here, stick to yoga, stick to medications and acupuncture sometimes and as a surgeon, too,

push the alternative treatment. >> acupuncture. they talk about that a lot. >> but the problem with acupuncture is everybody is opening up a shop and they claim they know what they are doing and they don't. have you to look for an experienced person who is really well trained and knows the nerve endings and is able to put the right pressure there. >> one to add to them is physical therapy because if you have back pain, orthopedic injuries, before you go rushing to the pain meds which then you become addicted to, get into some physical therapy programs, those can work really, really well and weight loss, especially for back. >> orthopedic surgeons. physical therapists? >> or neurophysiologist. >> or what about massages? because most cities now they have all of these massage places, deep tissue massages, does help? >> i love that. i love, that arthel. >> i'm being serious because you have to be careful. >> to the earlier point. have to be careful that the person is qualified. >> yes. >> and don't go rushing to someone who does that without an expert like we talked about clearing you first and making sure there isn't some serious underlying problem. get -- understand what you're dealing with before you go rushing to solutions. >> you know where i was going

with that, first of all, the cream that you said. >> volterin gel. >> using it because i had a muscle that was really chronically hurting me, but it's okay now, just to clarify. why is she having that and using that? >> nobody is going to judge the lady. >> it's an anti-inflammatory. >> like the advil or aleve that you take. >> that can be an issue if you take too much of that. easy to pop those. >> advil. >> or any of those. >> huge problem. >> i know they are telling us to tease, but can i ask this one question. what i'm saying is we're here in new york and do acupuncture and yoga. what about people in middle america? what should they do? >> swimming. >> everybody can swim. >> right. >> because these are non-weight bearing exercises. >> or elliptical or a bike. >> exactly. >> and you do those exercises. you can basically like take a rope and start your exercise. the idea is don't start taking vicodin and percocets and those kinds of things. >> called low-impact exercise, like swimming, david's point, elliptical, bike. >> and he wants me to go to go for a massage and i refuse.

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welcome back to "sunday house call." you now for a segment should i worry. i'm a 72-year-old female with a family history of coronary disease. my total coronary calcium score is 480.9 total calcium volume is 330.6.

should i worry? dr. samadi, i know you know what that means, number one what is a coronary calcium score? how do i get it? what will it tell me? >> i thought you were going to ask me what my calcium score is. i got it two months ago and it was zero. what does all of this mean? we're looking for a plaque in your heart. all the coronary arteries that bring the blood flow to your heart. it can give blockage, calcium, atherosclerosis. which leads to angina and heart attack. if you can get a c.a.t. scan noncontrast c.a.t. scan that can look at those arteries and see how much calcium you have there, then you have the score. this is available. a lot of insurances may or may not cover it. it's $350 or so. you would go there, it's about half an hour. they look at your score and say, your score is zero.

under 100 is fine. between 100 to 400 is moderate and over 400 which is this patient, you would be in trouble. why is it important to know? we can tell you, listen, it's time to change your lifestyle. fix your blood pressure. you're heading the wrong direction. so, as a prevention, i love this topic. the issue with calcium score tests, he's going to be impressed by my research, sometimes you're not going to be able to see very soft plaque which is not calcium in it. then you have to go for angio. and other things. >> is it there, soft plaque? >> well, it can lead to heart attack which won't show up. that's a false negative. i like it. i went in. i was under stress. the staff wanted me to check myself. i came out. zero calcium. you should be proud of me. >> i'm relieved. you have low risk. >> thank you. >> would you recommend this, dr. siegel, to your patients? thinking out of curiosity, go in an mri and get this done? >> to start with, i like this

test. start with patients by asking what are your risk factors? in this case the patient has a family history of heart disease. that's a biggie. i'm already putting that patient in a category. should i worry? well, i'm a little concerned. are you a smoker, do you have high blood pressure, are you overweight? do you have diabetes? these are big biggies that would make me want to think about getting a calcium scoring test. here's why. the coronary arteries are tiny, eric. we abstract almost all the oxygen we can out of them. and you mow what, they're so easy to block. and once they block, and yet they have to be 70% blocked before you're going to have symptoms. well, i want to know -- i want to know when you're on the road to having symptoms. >> absolutely. >> this calcium scoring test, when you have injuries to your arteries, they get more calcium in them. over 400, as david mentioned, that's already a red flag. you have over 400, i'm going to get you on a treadmill, do a stress test. i might be more aggressive and do a c.t. angiogram. which i look to see exact will you how blocked u ed you are.

>> right. >> difference between a calcium scoring test and a stress test is that a stress test looks to simulate angina to see if you have symptoms. this gives you an anatomical view of exactly how blocked that artery is. someone at risk, i want to have this test. >> quickly, dr. samadi, bringing you back into this. i mean, what about this lady has a family history of coronary artery disease. cholesterol, high blood pressure, race. do any of those come into play here? >> absolutely, even gender. we see that sometimes in post-menopausal women, they are at higher risk. as a detective you want to look at this patient and say these are the risk factors and i want to find out exactly what's going on in your coronary arteries. once you do that, and you get that score, now you're on way way to to whether you want the strs test. whether you go to angio. maybe the patient needs the stent. i like the prevention.

i don't think everybody needs this test. be careful. for people who are at moderate to high risk, i like it. >> one final point on this, you brought up the one risk factor which i forgot to mention which is cholesterol. cholesterol correlates directly with the plagues in the arteries. if you have a high cholesterol, i would like to do this. with lifestyle change which we've talked about a lot, you can reverse it. it's not always taking a drug. lose weight. get on that mediterranean diet and lose weight. >> and listen to what he just said. if you know about this, you can reverse this whole mechanism and there's a lot of inflammatory process that's going on in this plaque that you can slow it down. coronary artery disease is the leading cause of death among men and women. that's why it's important to know this. >> we follow a trend on this test to see how much calcium you build up over the year. the same we do with the psa. >> we like olive oil. >> coronary calcium test. >> very good. >> so, a new study showing the health benefits of nuts, not these three, why researchers now say that they could help crack

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no peanut butter. peanut butter has all kinds of bad guys in it. stick with the tree nuts. a maybe some peanuts. >> avocados, olive oil. nuts are great for alzheimer's and any degenerative. have a nice day, thank you. the 2016 race heating up on both sides of the aisle, this weekend, bernie sanders and hillary clinton campaigning this hour in iowa. and former florida governor jeb bush set to officially enter the race for the white house tomorrow. welcome to "america's news headquarters." >> hello, everyone, i'm eric shawn. >> it's the eve of making things official. jeb bush gearing up for the big event with a frenzy on social media, releasing this new logo on twitter. as well as a campaign