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By Onn Rathy
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>> CANCER SCREENING AND TREATMENT - WHAT YOU SHOULD
KNOW AND WHEN YOU SHOULD GET IT, TONIGHT, "ON CALL WITH THE PRAIRIE DOC."
>> GOOD EVENING AND WELCOME TO "ON CALL WITH THE PRAIRIE DOC."
THE BATTLE AGAINST CANCER HAS BEEN GOING ON SINCE THE BEGINNING OF MEDICINE.
WE HAVE MADE REMARKABLE PROGRESS, BUT THERE IS STILL A
LONG WAY TO GO AND MANY QUESTIONS TO BE ANSWERED.
BUT, FIRST, SPEAKING OF QUESTIONS, LET'S TAKE A LOOK
AT THIS WEEK'S PRAIRIE DOC QUIZ QUESTION.
TRUE OR FALSE?
THE AMERICAN COLLEGE OF OB-GYN RECOMMENDS YEARLY MAMMOGRAMS BEGINNING AT 40.
HOWEVER, THE AMERICAN ACADEMY OF FAMILY PHYSICIANS RECOMMEND
THAT ANNUAL MAMMOGRAMS START AT 50.
TRUE OR FALSE?
VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED
INTO A DRAWING TO WIN A SIGNED COPY OF OUR BOOK, "THE PICTURE OF HEALTH."
EACH OF MY ESSAYS, ORIGINALLY WRITTEN FOR THIS SHOW, COMES
WITH A WONDERFUL ACCOMPANYING PHOTOGRAPH BY DR. JUDITH PETERSON.
WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW.
REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN!
WE ANSWER YOUR MEDICAL QUESTIONS ABOUT CANCER
DETECTION AND TREATMENT AS THEY ARE CALLED IN OR SENT TO
US VIA FACEBOOK OR EMAIL.
CALL IN QUESTIONS TO 1-888-376-6225.
OR SEND US AN EMAIL TO THE ADDRESS ON THE SCREEN.
JOINING US VIA SKYPE FROM SIOUX FALLS TONIGHT IS
DR. MARK HUBER WITH AVERA MEDICAL GROUP ONCOLOGY &
HEMATOLOGY, AND DR. LUIS A. ROJAS WITH AVERA MEDICAL GROUP
GYNECOLOGIC ONCOLOGY SIOUX FALLS.
AND WITH US IN THE STUDIO, DR. DEB JOHNSTON WITH
AVERA MEDICAL GROUP BROOKINGS.
THANK YOU, DEB, FOR JOINING US, AND DR. HUBER AND
DR. ROJAS FOR JOINING US.
IT WOULD HAVE BEEN NICE TO HAVE YOU HERE IN THE STUDIO.
>> THANK YOU FOR HAVING US.
>> IT WOULD HAVE BEEN NICE TO HAVE YOU IN THE STUDIO, BUT,
YOU KNOW, I KNOW WHAT HAPPENED WITH THE SNOW AND THE WEATHER
AND IT'S NICE TO BE ABLE TO HAVE YOU AT ALL WITH SKYPE.
THANK YOU.
THANKS, DEB, FOR FILLING IN ON AN EMERGENT BASIS.
>> FUN TO BE HERE.
>> GREAT.
WE'RE GOING TO HAVE A GOOD TIME TALKING ABOUT A NOT SO
GOOD TIME TOPIC AND THAT IS ABOUT CANCER AND HOW TO PREVENT IT.
YOU KNOW, WE'LL TALK ABOUT PREVENTION OF ANYTHING AND
WE'LL TALK ABOUT ANY ASPECT OF CANCER AND BETWEEN THE TWO OF
US, WE CAN ANSWER QUESTIONS ABOUT ANYTHING.
WE CAN TRY TO ANSWER.
>> WE CAN TRY.
[ Laughter ]
>> SO PLEASE CALL IN YOUR QUESTIONS THIS EVENING TO US.
1-888-376-6225.
SO LET'S START WITH OUR GENTLEMEN IN SIOUX FALLS.
DR. ROJAS, HOW LONG HAVE YOU BEEN HERE IN SOUTH DAKOTA?
>> YEAH, THANKS FOR HAVING US, RICK.
I'VE BEEN HERE TEN YEARS NOW.
TEN AND A HALF.
>> I REMEMBER WHEN YOU FIRST CAME AND WE HAD A CHANCE TO
MEET YOU AND YOU CAME UP TO BROOKINGS AND SPOKE TO US
ABOUT GYNECOLOGICAL CANCERS.
THANK YOU FOR BEING PART OF THIS.
DR. HUBER, THANK YOU ALSO FOR JOINING US.
YOU WERE MY CANCER DOCTOR AND I WANT TO TELL YOU PERSONALLY
HOW MUCH I APPRECIATE YOUR EXPERTISE, YOUR WISDOM, AND YOUR DIRECTION.
>> MY PLEASURE.
THANK YOU FOR HAVING US ON THE SHOW.
AND I'M GLAD YOU'RE DOING WELL.
AND ONCE AGAIN, NICE THAT WE COULD JOIN YOU TONIGHT VIA SKYPE.
IT WOULD BE NICE TO BE IN BROOKINGS NOW, BUT WE'RE GLAD TO BE HERE.
>> YEAH.
DR. ROJAS, LET'S START A LITTLE BIT.
YOU'RE DOING SOME RESEARCH RIGHT NOW WITH REGARD TO
SENTINEL NODES, CAN YOU EXPLAIN A LITTLE BIT ABOUT
THAT, WHAT'S GOING ON THERE?
>> AS YOU KNOW, WE ARE TRYING TO MINIMIZE THE POTENTIAL SIDE
EFFECTS THAT SURGERY FOR ENDOMETRIAL CANCER AND CERVIX
CANCER CAUSE, MAINLY SWELLING, SWELLING IN THE LEGS.
AND NOW THAT WE HAVE GOOD INFORMATION ABOUT, WE
IDENTIFIED THAT FIRST LYMPH NODE THAT DRAINS FROM THE
UTERUS, WHICH IS THE ONE THAT MIGHT HAVE THE MOST LIKELIHOOD
OF HAVING CANCER INSTEAD OF TAKING ALL THE LYMPH NODES,
THE STUDIES HAVE SHOWN THAT IF YOU DO THAT, YOU HAVE THE SAME
GYNECOLOGIC OUTCOMES.
AND YOU DON'T HAVE THE SIGNIFICANT RISK OF COMPLICATIONS AFTERWARDS.
SO WE'VE BEEN DOING THAT PROBABLY THE ONLY CENTER IN
THE REGION THAT IS DOING THAT, AND PATIENTS ARE GETTING A LOT
OF IMPROVEMENT OF POTENTIAL COMPLICATIONS AFTER THOSE SURGERIES.
>> THAT'S THAT ONE STEP FURTHER EVERY DAY THAT YOU CAN
PUSH FORWARD WITH SCIENTIFIC RESEARCH.
MARK, YOU WERE TALKING TO ME EARLIER ABOUT METASTATIC COLON
CANCER, APPROACH TO PEOPLE WHO HAVE SPREAD OF THE COLON
CANCER TO THE LIVER AND HOW WE'RE DOING THAT DIFFERENTLY NOW.
COULD YOU EXPLAIN THAT A LITTLE BIT?
>> SURE, ABSOLUTELY.
I WOULD SAY TEN YEARS AGO OR SO, WHEN PEOPLE HAD SPOTS IN
THE LIVER, YOU JUST GAVE THEM CHEMO AND THAT WAS IT.
YOU KNOW, SPECIFICALLY FOR COLON CANCER THAT SPREAD TO THE LIVER.
NOWADAYS, WE'RE MUCH MORE AGGRESSIVE TO TRY TO REMOVE
ALL THE SPOTS, FULLY TREAT THE SPOTS, THAT'S OFTEN A
COMBINATION OF CHEMO, BUT WE OFTEN WILL DO RADIOACTIVE
BEADS TO THE LIVER, ABLATION, SURGERIES, EVEN IF THERE'S
MULTIPLE SITES OF THE DISEASE, GAMMANITES, RADIATION, THESE
ARE ALL THINGS WE FAIRLY ROUTINELY DO, YOU KNOW, FOR
SPREAD COLON CANCER NOW THAT'S GONE TO THE LIVER.
AND FOR SURE THE FIVE-YEAR SURVIVALS HAVE DEFINITELY IMPROVED.
>> GREAT.
SO HERE WE HAVE IN SIOUX FALLS A SURGEON ON YOUR LEFT AND AN
INTERNIST, AN ONCOLOGIST ON YOUR RIGHT, AND IN THE STUDIO
WE HAVE FAMILY PHYSICIANS, DR. DEB JOHNSTON.
SO, IN YOUR PRACTICE, YOU'VE BEEN PRACTICING IN BROOKINGS FOR --
>> 20 YEARS OR SO.
>> 20 YEARS.
>> I KNOW.
[ Laughter ]
>> I REMEMBER WHEN YOU WERE MY RESIDENT.
>> I WAS A BABY.
JUST A BABY.
>> SO, WHAT IS IT THAT YOU FIND YOURSELF SPENDING THE
MOST TIME AS A FAMILY PHYSICIAN DOING AND IS THAT
ANYTHING RELATED TO CANCER?
>> YOU KNOW, CANCER IS CERTAINLY PART OF WHAT WE DO.
BUT MOST OF WHAT I DO IN REGARDS TO CANCER HAS TO DO
WITH TRYING TO PREVENT IN THE FIRST PLACE, GETTING PEOPLE TO
QUIT SMOKING, GETTING PEOPLE TO GET THEIR HPV SHOTS,
GETTING PEOPLE TO WEAR THEIR SUNSCREEN AND THEN SCREENING,
GETTING PEOPLE TO GET THEIR COLONOSCOPIES, THEIR
MAMMOGRAMS, THEIR PAP SMEARS.
THE LUNG CANCER, PEOPLE WHO ARE SMOKERS, TO GET THEIR
C.A.T. SCANS FOR THEIR LUNGS.
ONCE SOMEBODY'S BEEN DIAGNOSED WITH CANCER, THEN I'M LOOKING
AT MY SURGEON COLLEAGUES AND MY ONCOLOGY COLLEAGUES TO HELP TREAT THAT.
THAT'S OUTSIDE OF MY AREA OF EXPERTISE.
ALL THESE NEW DEVELOPMENTS ARE SO EXCITING, BUT IT CHANGES SO
FAST THAT YOU REALLY NEED SOMEBODY --
>> AND THEY GO DOWN THERE, AND THEY HAVE THESE TWO WONDERFUL EXPERTS.
>> WONDERFUL PEOPLE.
>> AND THEN THEY COME HOME, THEY HAVE A PROBLEM WITH
DIARRHEA, THEY HAVE A PROBLEM WITH PAIN, THEY HAVE A PROBLEM
WITH TERMINAL SITUATION, WHEN DO WE QUIT, WHEN DO WE GO
FORWARD, YOU'RE THE PERSON FOR THAT.
>> WE'RE STILL VERY MUCH INVOLVED AS PRIMARY CARE
PEOPLE BECAUSE THE PERSON IS MORE THAN THEIR DISEASE.
AND THEY HAVE OTHER HEALTH CONDITIONS THAT MAYBE ARE
TAKING THE BACK SEAT TO THAT CANCER TREATMENT RIGHT NOW,
BUT WE STILL HAVE TO KEEP THEIR DIABETES UNDER CONTROL
AND THEIR HEART DISEASE UNDER CONTROL AND THEIR HYPERTENSION UNDER CONTROL.
AND OFTEN THEIR DEPRESSION UNDER CONTROL.
>> YOU MEAN THEY DON'T HAVE JUST CANCER, THEY HAVE OTHER THINGS?
>> THEY DON'T HAVE JUST CANCER, THEY HAVE OTHER THINGS.
AND THE WHOLE FAMILY IS AFFECTED BY A CANCER DIAGNOSIS.
SO, WE'RE FREQUENTLY HAVING CONVERSATIONS WITH SPOUSES
WHOSE FAMILY MEMBER HAS BEEN DIAGNOSED WITH CANCER, GIVING
THEM A SAFE PLACE TO TALK ABOUT HOW THEY'RE DOING IN THAT PROCESS.
>> YOU KNOW, WE STARTED THIS CONVERSATION ABOUT SCREENING
CANCER, BUT WE'RE TALKING ABOUT THE COMPLICATIONS AND
THE PROBLEMS WITH CANCER, AND WE HAVE GOT THE PERFECT BALANCE.
WE HAVE A SURGEON, AN INTERNIST AND A FAMILY
PHYSICIAN AND ONLY MEDIA GUY NOW, BUT WHAT WE NEED IS YOUR QUESTIONS.
THIS IS YOUR SHOW.
GIVE US A CALL.
1-888-376-6225.
PLEASE.
AND THEN LET'S HAVE SOME FUN WITH YOUR QUESTIONS.
WE CAN TAKE SCREENING, BUT WE CAN TAKE ABOUT -- TALK ABOUT
THE COMPLICATIONS THAT ARE GOING ON AND WE CAN TALK ABOUT
NEW THERAPY, WE CAN TALK ABOUT IMMUNOTHERAPY WHICH IS
SOMETHING THAT I THINK WE OUGHT TO DELVE INTO.
BUT I WANT YOUR QUESTIONS.
I NEED YOUR QUESTIONS.
PLEASE GIVE US A CALL.
SO, DR. ROJAS, PROBABLY THE BUSIEST, THE MOST COMMON THING
YOU DO IN YOUR LIFESTYLE -- YOUR MEDICAL LIFE IS ABDOMINAL
SURGERY OR DO YOU SPEND A LOT OF TIME IN THE CLINIC?
WHAT'S YOUR LIFE LIKE?
>> YOU KNOW, IT'S A BALANCE BETWEEN HALF AND HALF BETWEEN
CLINIC BECAUSE WE HAVE TO SEE THE PATIENTS WHEN THEY COME
AND THEN THE OTHER HALF IS DOING SURGERY, TRY TO TAKE
THOSE CANCERS OUT BEFORE -- MOST OF THE CANCERS THAT I
CARE FOR ARE STAGE, SO WE DETERMINE HOW ADVANCED THEY
ARE BY PERFORMING SURGERY, LOOKING AT LYMPH NODES, STUFF
LIKE THAT, THAT'S WHAT GUIDES THE THERAPY AFTERWARDS.
WE'RE A UNIQUE SPECIALTY BECAUSE WE DO OUR SURGERY, WE
DO OUR CHEMOTHERAPY FOR OUR CANCERS, EVEN THOUGH OUR
FRIENDS, LIKE MARK, YOU KNOW, HE TAKES CARE OF THEM AS WELL.
SO WE WORK AS A TEAM.
VERY OFTEN.
PARTICULARLY WHEN PATIENTS ARE FROM ANOTHER COMMUNITY THAT I
DON'T DO SURGERY OR PARTICIPATE PROVIDING CARE
THAT MARK FOLLOWS, HE TAKES CARE OF THEM THERE, YEAH.
>> IT'S A WHOLE COLLABORATIVE PROCESS, ISN'T IT?
I MEAN, IT'S THE BROOKINGS DOCTOR, IT'S THE ONCOLOGIST IN
SIOUX FALLS TALKING WITH A SURGICAL ONCOLOGIST IN SIOUX
FALLS AND PUTTING IT ALL TOGETHER.
ONE OF THE THINGS THAT WE PROMISED WE'D TALK ABOUT IS SCREENING.
AND, SO, LET'S JUMP RIGHT IN.
WE'VE GOT AN OB/GYN SURGEON AND LET'S TALK ABOUT BREAST
CANCER SCREENING WITH MAMMOGRAPHY.
THERE'S SOME DISCREPANCY, ISN'T THERE, RIGHT NOW --
>> GET AN ANSWER TO YOUR QUESTION.
>> I'LL FLIP IT UP.
LET'S TALK ABOUT OTHER KINDS OF SCREENINGS.
>> LET'S TALK ABOUT PAP SMEARS BECAUSE THAT IS SOMETHING THAT
HAS CHANGED SIGNIFICANTLY SINCE THE TIME THAT I WENT TO MEDICAL SCHOOL.
WHEN I WAS A YOUNG WOMAN AND WENT TO MEDICAL SCHOOL AND WAS
FIRST IN PRACTICE, IT WAS AN ANNUAL PAP SMEAR.
AND YOU STARTED AT THE AGE OF FIRST SEXUAL ACTIVITY AND YOU
JUST KEPT DOING THOSE PAP SMEARS EVERY SINGLE YEAR.
>> EVERY YEAR.
FIRST SEXUAL ACTIVITY OR 18, WHICHEVER CAME FIRST?
>> WHICHEVER CAME, YES, WHICHEVER CAME FIRST.
AND WE TREATED AN AWFUL LOT OF WOMEN FOR LOW-GRADE MINOR
ABNORMALITIES IN THEIR CERVIXES WITH FREEZING
PROCEDURES OR CUTTING PROCEDURES WHERE WE'D ACTUALLY
SHAVE OFF THE ABNORMAL PART OF THE CERVIX.
AND ALTHOUGH WHEN I WENT THROUGH MEDICAL SCHOOL, WE HAD
AN IDEA THAT THERE WAS AN INFECTIOUS COMPONENT TO
CERVICAL CANCER, THAT WAS STILL VERY PRELIMINARY AND WE
DIDN'T HAVE A LOT OF KNOWLEDGE ABOUT THAT AND WE DIDN'T HAVE
AN ABILITY IN THE CLINICAL SETTING TO TEST WITH THAT ROUTINELY.
AND I IMAGINE THAT DR. ROJAS IS KIND OF ON THE LEADING EDGE
OF KIND OF SEEING THE CHANGE IN HOW WE'VE APPROACHED
CERVICAL CANCER SCREENING AND TREATMENT AND PREVENTION WITH THAT HPV VACCINE.
>> NOW WE KNOW THAT ALL CERVICAL CANCER, RIGHT, ALMOST
ALL, IS DUE TO A WART VIRUS THAT IS -- BUT IT ISN'T EVERY
WART VIRUS, IT IS JUST ONLY A CERTAIN NUMBER OF THEM.
>> A CERTAIN SUBTYPES OF THAT WART VIRUS.
THE ONES THAT CAUSE THE WARTS ON YOUR FINGERS AND YOUR TOES
AREN'T THE ONES THAT CAUSE THE CERVICAL CANCER.
>> ALL RIGHT.
DR. ROJAS, YOUR COMMENT ABOUT THE CHANGES THAT'S HAPPENED OVER YOUR LIFE?
>> SURE.
YOU KNOW, WE GET THAT QUESTION VERY OFTEN.
USUALLY PAP SMEAR.
THE PROBLEM IS WE'VE LEARNED QUITE A BIT ABOUT HOW THIS
HAPPENS AND THE ROLE OF THE VIRUS.
IT TYPICALLY AFFECTS WOMEN AT THE AGE OF SEXUAL DEBUT, WHEN
THEY FIRST HAVE INTIMACY.
AND WE ALSO KNOW THAT THERE WILL LIKELY HAVE SOME FORM OF
CHANGE FROM THAT INFECTION, THAT THE BODY IN A PERIOD OF
ONE TO TWO YEARS WILL TAKE CARE ON ITS OWN.
SO THE REASON WHY IT HAS CHANGED IS BECAUSE WE HAVE
COME TO REALIZE THAT ALL THIS UNNECESSARY, SURGICAL
PROCEDURES, AND BOTH PROCEDURES HAVE CONSEQUENCES
LATER ON, WHEN A WOMAN, FOR EXAMPLE, AT A VERY YOUNG AGE
HAS PROCEDURES IN THE CERVIX, THEY MAY HAVE PROBLEMS WITH
PRETERM DELIVERY WHEN THEY GET PREGNANT LATER ON.
AND WE'VE LEARNED THAT THE BODY WILL GET RID OF THAT
FIRST CONTACT INFECTION ON ITS OWN 90%.
THAT'S WHY WE DON'T TEST SO EARLY ANYMORE.
>> SO THE ROUTINE HAS CHANGED.
AND YOU'RE SAYING NOW THAT THE ROUTINE SHOULD BE HOW OFTEN?
>> THAT'S A LITTLE BIT DEPENDENT ON AGE AND RISK
FACTORS, BUT TYPICALLY WHEN A WOMAN IS UNDER 30 WE'LL DO A
PAP SMEAR EVERY THREE YEARS AND OVER 30 IT'S EITHER A PAP
SMEAR EVERY FIVE YEARS OR -- SORRY -- PAP SMEAR EVERY THREE
YEARS OR A COMBINATION OF A PAP SMEAR AND TESTING FOR THAT
HPV VIRUS EVERY FIVE YEARS.
AND WE ALSO KNOW THAT THAT HPV VIRUS IS SOMETHING THAT
DR. HUBER HAS TO DEAL WITH ON A REGULAR BASIS, TOO, BECAUSE
IT IS INVOLVED IN OTHER CANCERS BESIDES JUST CERVICAL CANCER.
IT'S INVOLVED IN RECTAL CANCER, ORAL CANCERS,
LARYNGEAL CANCERS, SO IT'S NOT JUST DR. ROJAS THAT'S GOING TO
DEAL WITH THE CONSEQUENCES OF THIS VIRUS.
AND IT'S NOT JUST DR. ROJAS THAT WILL SEE PATIENTS THAT
ARE BENEFITTING FROM THAT HPV VACCINE THAT I KEEP TALKING ABOUT.
>> ONE COMMENT BEFORE OUR NEXT ROLL-IN.
DR. HUBER, ARE YOU A FAN OF THE HPV VIRUS VACCINATION?
>> OH, DEFINITELY, BEYOND A DOUBT.
I THINK EVERY ADOLESCENT, AND THAT'S BOTH GIRLS AND BOYS,
SHOULD GET THE VACCINE, GET THE SERIES.
I MEAN, I THINK ANYTHING YOU CAN DO TO PREVENT A CANCER,
THERE'S NO REASON NOT TO DO IT.
>> AND WHAT AGE WOULD YOU SAY THAT THOSE KIDS SHOULD GET IT?
>> I BELIEVE IT'S 11 TO 12 YEARS OLD.
>> YEAH.
>> THAT'S USUALLY THE FIRST --
>> CERTAINLY MORE IN MY WHEELHOUSE.
THAT'S THE KIND OF THING THAT I'M DOING.
ACTUALLY, IT'S APPROVED DOWN TO AGE 9.
AND ROUTINELY WE TRY TO GET THOSE KIDS AT 11 TO 12, BUT
YOU CAN ACTUALLY GET THE VACCINE UP TO 26, ON LABEL,
WHERE INSURANCE SHOULD COVER IT.
>> IT DOESN'T ALWAYS COVER IT.
>> ALMOST ALWAYS.
>> REALLY?
IT DOES.
>> ALMOST ALWAYS.
>> MEDICAID?
MEDICAID COVERS IT?
>> MEDICAID COVERS IT, ABSOLUTELY.
>> SO PARENTS WOULDN'T BE BURDENED WITH $200.
>> IT'S NOT AN INEXPENSIVE VACCINE.
BUT, NO, MOST OF THE TIME INSURANCE --
>> THE VALUE IS HUGE.
>> THE VALUE IS HUGE, ABSOLUTELY HUGE.
>> YOU KNOW WHAT?
THERE'S A VERY IMPORTANT THING TO MENTION.
DR. HUBER HIT ON IT.
PEOPLE NEED TO UNDERSTAND, THIS IS CRUCIAL.
I HAVE THREE BOYS, TWO IN THE AGE OF VACCINATION, AND THEY'RE BOTH VACCINATED.
BECAUSE, YOU KNOW, THEY ACT ALMOST AS -- OF THIS VIRUS AND
THAT HAS A LOT OF PROBLEMS.
[ AUDIO CUTTING IN AND OUT ]
IF YOU GET BOYS AND GIRLS.
>> THAT'S RIGHT.
IT'S REALLY IMPORTANT TO GET THE BOYS, TOO.
NOT JUST BECAUSE IT PROTECTS THE GIRLS, IF THE BOYS AREN'T
SPREADING THAT VIRUS TO THEM, BUT THE BOYS HAVE A DIRECT
BENEFIT, TOO, BECAUSE PENILE CANCER IS STRONGLY ASSOCIATED WITH THIS VIRUS.
AGAIN, ANAL AND RECTAL CANCERS ARE STRONGLY ASSOCIATED WITH
THIS VIRUS AND ORAL CANCERS, A LOT OF THEM ARE ASSOCIATED WITH THIS VIRUS.
SO NOT ONLY DOES IMMUNIZING YOUR BOYS PROTECT THE GIRLS,
BUT IT PROTECTS THE BOYS, TOO. AND BOTH OF OUR KIDS ARE FULLY IMMUNIZED AS WELL.
>> AS ARE OUR DAUGHTERS.
THESE ARE HEALTH CARE ISSUES, IT'S IMPORTANT WE BRING IT UP.
>> AND WHAT I ALSO ALWAYS TRY TO REMEMBER -- REMIND MY
PARENTS IS THAT YOUNG PEOPLE DON'T ALWAYS GET TO DECIDE
WHEN THEY'RE SEXUALLY ACTIVE AND THAT'S PARTICULARLY TRUE FOR YOUNG WOMEN.
>> PROTECT THEM, EVEN IF THEY'RE NOT GOING TO BE CHOOSING TO DO --
>> EVEN IF THEY'RE NOT GOING TO BE CHOOSING BECAUSE THE
ONLY THING THAT WOULD BE WORSE THAN BEING SEXUALLY ASSAULTED
WOULD BE GETTING CANCER AS A RESULT OF HAVING BEEN SEXUALLY ASSAULTED.
>> WOW.
>> LIFE IS FULL OF THINGS THAT SEEM TO COME OUT OF NOWHERE TO
INTERRUPT OUR ROUTINE.
>> RUNNING, I WAS RUNNING WITH A PEER RUNNING CLUB THAT I'M
AN ACTIVE MEMBER OF.
ALL OF THE TRAILS WERE COMPLETELY FLOODED.
I PICKED THE ROUTE THAT DAY. AND THE ROUTE TOOK US TO THE
POINT WHERE I HAD A GRAND MAL SEIZURE RIGHT IN FRONT OF THE HOSPITAL.
SO THEY ACTUALLY TOOK ME TO THE EMERGENCY ROOM, THEY FOUND
A TUMOR SIX CENTIMETERS BY TWO CENTIMETERS BY ONE CENTIMETER,
SO IT WAS FAIRLY LARGE.
I WAS 41 AT THE TIME.
HAD TWO LITTLE KIDS.
9 AND 11.
AND, SO, THEN THEY SENT US TO SIOUX FALLS.
AND SIOUX FALLS SAID, THIS IS NOT SOMETHING WE CAN DO HERE.
WHY DON'T YOU JUST KEEP GOING ON TO MAYO.
BECAUSE THEY COULD DO INTEROPERABLE MRIs AT MAYO,
THEY DIDN'T HAVE THAT ABILITY AT SIOUX FALLS AT THE TIME.
SO WE MADE A COUPLE TRIPS OVER THERE TO GET READY.
AND THEN I HAD A SURGEON THERE THAT DID A CRANIOTOMY.
DURING THE PROCESS THE TWO INTEROPERATIVE MRIs TO MAKE
SURE THEY HAD GOTTEN IT ALL.
I THEN -- I CAME HOME.
HEALED UP MY BRAIN.
AND THEN DID SIX WEEKS OF RADIATION.
AND DAILY CHEMO AT THE SAME TIME.
AND THEN I CAME HOME AND DID SIX ADDITIONAL ROUNDS OF
CHEMOTHERAPY, SO FIVE DAYS EVERY 28 DAYS WITH THE CHEMO DRUG.
AND THEN AFTER THAT, IT HAD -- REOCCURRED AND, SO, WE STARTED
AGAIN THAT FIVE DAYS EVERY 28 DAYS THAT I WAS ALLERGIC TO THE CHEMO.
SO I WENT THROUGH THE PROCESS TO BE DESENSITIZED AND THEN
TAKE JUST A DAILY DOSE AND I DID THAT FOR ANOTHER YEAR.
AND THAT WAS FOUR YEARS AGO THIS NOVEMBER WAS MY LAST TREATMENT.
IT WAS TOLERABLE ON A DAILY DOSE.
AND, IN FACT, WE SPENT A LOT OF TIME DISCUSSING WHETHER OR
NOT I SHOULD GO OFF OF IT BECAUSE IT JUST FELT LIKE IF I
WENT OFF, IT WOULD COME BACK.
AND, SO, WE MADE THE JOINT DECISION WITH MY ONCOLOGIST,
OUT OF SIOUX FALLS, TO JUST GO OFF.
BEST DECISION.
NO RECURRENCE.
SO THIS JULY, I'LL BE A SEVEN-YEAR BRAIN CANCER SURVIVOR.
THERE HAD BEEN TIMES PREVIOUS TO THAT WHERE I FELT A LITTLE
LIGHTHEADED OR DIZZY.
BUT USUALLY WITH LAYING DOWN, IT WOULD SEEM TO RESOLVE ITSELF.
AND THERE WERE A COUPLE OF RUNS EARLIER THAT YEAR IN THE
HEAT WHERE I CAME HOME AND I JUST FELT AWFUL.
OBVIOUSLY WHAT HAPPENS, YOUR BODY HEATS UP, IT SWELLS, AND
THAT PUTS PRESSURE ON EVERYTHING.
CANCER CAN BE THE BEST THING THAT HAPPENS TO YOU OR THE WORST THING.
IT'S KIND OF WHAT YOU MAKE IT AND YOUR ATTITUDE THAT GOES ALONG WITH IT.
WELL, I FEEL LIKE THERE ARE A LOT OF LESSONS THAT YOU CAN
LEARN FROM CANCER, HOW TO BE COMPASSIONATE TO PEOPLE, HOW
TO TALK TO PEOPLE THAT HAVE CANCER, HOW TO HELP PEOPLE IN
THEIR DARKEST DAYS.
>> THAT LOVELY LADY AND I SANG A DUET AT THE CONCERT -- OR AT
THE PRESENTATION AT THE CAPITOL ON PANCREATIC CANCER A
FEW MONTHS AGO, AND SHE SANG ALSO WITH HER SON, A BEAUTIFUL VOICE.
AND WE THANK YOU SO MUCH FOR YOUR WILLINGNESS TO BE UNDER
THE GAZE OF A CAMERA.
TELL US ABOUT YOUR CANCER.
THAT'S A REAL PERSONAL --
>> THAT IS VERY PERSONAL.
>> THIS IS YOUR SHOW.
YOUR QUESTIONS ARE KEY TO OUR SHOW DISCUSSION.
CALL IN YOUR QUESTIONS ABOUT CANCER TO 1-888-376-6225 OR
SEND US AN E-MAIL TO ASK@PRAIRIEDOC.ORG AND WE'VE GOT QUESTIONS.
AND I THANK YOU FOR QUESTIONS.
A MAN FROM ALCESTER ASKED THE QUESTION, HOW RELIABLE IS
COLOGUARD IN REGARD TO PRECANCER TESTING STOOL
SAMPLES SENT IN TO SEE IF THERE'S A DANGER?
COLOGUARD IS ONE FORM.
IT USED TO BE HEMOCCULT BUT NOW WE'RE MORE SENSITIVE, IT'S
MORE SENSITIVE THAN HEMOCCULT.
>> WE HAVE A VARIETY OF DIFFERENT WAYS TO SCREEN FOR
COLON CANCER, AND KIND OF THE CLASSIC, THE GOLD STANDARD,
WHAT WE IN THE STATES RECOMMEND IS OUR FIRST CHOICE
FAR AND AWAY IS A COLONOSCOPY.
AND IF ANY OF THESE OTHER TESTS ARE ABNORMAL, YOU STILL
HAVE TO HAVE THAT COLONOSCOPY, ONLY NOW YOU GOT TO PAY FOR IT
BECAUSE NOW IT'S DIAGNOSTIC AND NOT SCREENING.
SO JUST GO GET YOUR SCREENING COLONOSCOPY.
>> THERE IT IS.
[ Laughter ]
AND THAT'S FUNNY WHY THAT'S THE CASE, BUT THE INSURANCE
COMPANIES ARE ENCOURAGING SCREENING AND NOT SO MUCH
ENCOURAGING -- ISN'T THAT CRAZY?
>> IT'S A WHOLE OTHER TOPIC.
>> COLOGUARD.
>> THAT'S ANOTHER STOOL-BASED TEST.
IS THAT DNA BASED?
>> IT SURE IS.
IT'S A DNA-BASED TEST OF THE STOOL.
BUT THE ISSUE IS, IT'S REASONABLY GOOD FOR CATCHING CANCERS.
IT'S NOT VERY GOOD AT CHECKING -- OR CATCHING POLYPS.
AND, REALLY, YOU WANT TO CATCH THESE BEFORE THEY BECOME COLON CANCER.
YOU WANT TO CATCH THEM AT THE POLYP STAGE.
AND, SO, JUST LIKE DR. JOHNSTON SAID, LEADS BACK
TO A COLONOSCOPY, YOU GOT TO GET THE COLONOSCOPY DONE, IF
ANY OTHER TEST IS ABNORMAL, JUST DO THE COLONOSCOPY, BE
DONE WITH THE -- IT'S A DEFINITIVE TEST, YEAH.
>> AND THERAPEUTIC.
THE OTHER THING ABOUT COLONOSCOPY, YOU KNOW, IS THAT
ONE OUT OF THREE IN THIS STATE WHO SHOULD HAVE THE TEST HAVE HAD THE TEST.
AND TWO OUT OF THREE HAVE NOT.
IT'S ONE OF THOSE DEALS, YOU GO IN, YOU DO THE COLONOSCOPY,
THEY'RE TOTALLY OUT, IF THERE'S POLYPS --
>> YOU'RE BREATHING FOR YOURSELF.
YOU'RE BREATHING FOR YOURSELF.
>> RIGHT.
YOU'RE NOT ON A BREATHING MACHINE.
>> NOT TOTALLY OUT.
BUT YOU WON'T REMEMBER IT.
>> YOU'RE SNOOZING.
WON'T REMEMBER A THING.
I'VE WATCHED THIS THING, I'VE HAD MY COLONOSCOPIES PLENTY, AND --
>> AND I'VE HAD MINE.
>> GOOD FOR YOU.
AND, SO, WE RECOMMEND THAT ALTHOUGH I DO A YEARLY
HEMOCCULT TEST WHEN I'M DOING A RECTAL EXAM ON GUYS.
>> AND THAT'S CONTROVERSIAL.
>> I KNOW IT IS.
I KNOW THE RECTAL EXAM IS CONTROVERSIAL, THE HEMOCCULT TEST IS CONTROVERSIAL.
BUT I'M AN OLD GUY.
>> YOU'RE NOT LETTING GO OF THAT.
>> NO, I STILL THINK A YEARLY RECTAL EXAM BECAUSE THERE ARE
REASONS -- THIS IS A BETTER TEST THAN THE PSA, ACTUALLY, I THINK.
BUT THERE'S CONTROVERSY ABOUT THAT.
>> THERE IS CONTROVERSY ABOUT THAT.
>> ALL RIGHT.
A MAN FROM PARKER ASKS, IS ALTERNATIVE MEDICINE AND OTHER
FORMS OF PLANT FOOD MEDICINE HELPFUL IN PREVENTING OR TREATING CANCER?
>> DR. HUBER.
>> WELL, THAT'S A PRETTY BROAD QUESTION.
YOU KNOW, JUST TO VALIDATE THAT APPROACH, THERE ARE
CERTAIN CHEMOS THAT REALLY COME FROM NATURAL SOURCES,
LIKE FROM THE PACIFIC TREE.
WE KNOW THAT INCREASINGLY DIET IS IMPORTANT.
FOR INSTANCE, HIGH FAT, HIGH RED MEAT DIET.
IN TERMS OF TAKING A LOT OF SUPPLEMENTS TO ACTUALLY TREAT
CANCER, THERE'S A LOT OF CLAIMS ON THE INTERNET, BUT WE
DON'T KNOW WITH ANY CERTAINTY IF THEY WORK.
SO WHEN I TALK TO PATIENTS, IF IT'S A CURATIVE INTENSE
SITUATION, I TRY TO DISCOURAGE TAKING COMPLEMENTARY MEDICINE.
ON THE FLIP SIDE, IF IT'S REALLY SORT OF A PALLIATIVE
SORT OF APPROACH, I'M MUCH MORE OPEN TO ANYTHING.
>> AND I THINK THAT AS LONG AS THE PATIENT DOESN'T ABANDON
THE TREATMENT THAT WE HAVE PROVED WORKS FOR THE
ALTERNATIVE MEDICATION, YOU KNOW, AGAIN, FOR PALLIATIVE, THAT SHOULD BE FINE.
>> I THINK THIS WHOLE THING PEOPLE ABANDONING THE
TREATMENT WHEN IT SOUNDS LIKE IT'S PRETTY BAD AND THEIR
CHANCES ARE POOR AND THE STANDARD TREATMENT IS, YOU
KNOW, WE JUST WANT TO GIVE YOU COMFORT, AND NOW YOU FLY TO
MEXICO AND SOMEBODY GIVES YOU --
>> APRICOT.
>> WHATEVER IT MIGHT BE FOR ALL THE MONEY IN THE WORLD AND
YOU DO IT BECAUSE YOU'RE GOING TO DIE AND THEN THEY TAKE YOUR MONEY.
SO, I THINK YOU HAVE TO BE VERY CAREFUL ABOUT THIS KIND OF A THING.
THERE ARE A TON OF PEOPLE WHO WILL TAKE YOUR MONEY FOR PROMISE.
AND I JUST HAVE TO SAY, LOCALLY, WE'VE GOT WONDERFUL,
LIKE, DR. ROJAS AND DR. HUBER AND DR. JOHNSTON, WE'VE GOT
WONDERFUL DOCTORS HERE.
TALK TO THEM FIRST.
AND DON'T DO THE ALTERNATIVE.
>> WHAT I DO WANT TO MENTION IS THAT I'M A HUGE BELIEVER IN
THE IMPORTANCE OF DIET AND KEEPING YOU HEALTHY AND
SUPPORTING YOU THROUGH YOUR CANCER TREATMENT.
I THINK THAT THE HEALTHIER YOUR DIET, THE BETTER OFF YOU ARE.
AND I'M A BIG BELIEVER IN PLANT-BASED DIETS, TOO.
>> YEAH.
>> I WISH I COULD SAY I CAN GIVE UP MEAT.
I HAVEN'T BEEN ABLE TO.
BUT I THINK THERE IS SOME PRETTY GOOD DATA THAT A
VEGETARIAN DIET CAN BE VERY HELPFUL.
>> I THINK THAT CERTAINLY EATING A LITTLE LESS FOOD IS
ONE OF THE BEST ADVANTAGES --
>> A LITTLE LESS FOOD IN GENERAL.
>> AND THAT'S IT.
A WOMAN FROM WORTHINGTON, ABOUT THREE YEARS AGO I WAS
TOLD I HAD A GROWTH ON THE PANCREAS, I DIDN'T CHANGE FOR
A WHILE, BUT NOW IT HAS GROWN.
IT DIDN'T CHANGE FOR A WHILE.
NOW WHAT CAN I DO TO KEEP IT FROM GROWING?
THAT'S A TOUGH ONE.
I THINK YOU NEED TO HAVE TISSUE OF THAT LESION ON THE
PANCREAS, BUT, YOU THOUGH, YOUR DOCTOR SHOULD BE
DIRECTING YOU IN THAT REGARD.
AND THAT'S GENERALLY -- BEFORE I WENT TO SURGERY, I HAD A
PANEL -- A ROOMFUL OF PEOPLE CONSULTING TO MAKE THAT DECISION.
>> AND I DON'T THINK THERE'S ANYTHING YOU CAN DO TO KEEP IT FROM GROWING.
>> NO.
>> AT LEAST THERE'S NOTHING I'M AWARE OF THAT SOMEBODY CAN
DO TO KEEP IT FROM GROWING.
BUT IT'S DEFINITELY SOMETHING THAT NEEDS TO BE CHECKED OUT.
>> OKAY.
A MAN FROM PIERRE HAD A MOTHER THAT DIED FROM PANCREATIC CANCER.
WONDERS IF IT HAS A HEREDITARY COMPONENT?
DR. HUBER.
>> WELL, THAT'S A GOOD QUESTION.
WE ARE RECOGNIZING SOME OF THE GENETIC ABNORMALITIES THAT CAN
CAUSE HEREDITARY PANCREAS CANCER.
FOR INSTANCE, BRCA 2 MUTATION IS ASSOCIATED WITH BREAST AND
OVARY CANCER BUT CLEARLY IS ASSOCIATED WITH PANCREAS CANCER.
IT MAY BE WORTHWHILE TO SEE A GENETIC COUNSELOR, ESPECIALLY
IF THE FAMILY MEMBER WAS YOUNG WHEN DIAGNOSED.
AND THEY OFTEN WOULD LOOK OVER ALL THE OTHER CANCERS IN THE
FAMILY AND CAN ORDER THE RELEVANT GENETIC TESTING THAT THEY NEED INDICATED.
I WILL SAY MOST CASES, THE PANCREAS CANCER JUST OCCUR OUT OF THE BLUE.
THERE IS AN ASSOCIATION WITH SMOKING.
BUT MOST ARE NOT FAMILIAL, BUT WE ARE REALIZING MORE THAT
THERE ARE SOME FAMILIAL CASES.
>> AND FOR YOU, DR. ROJAS, TWO YEARS AGO A WOMAN HAD A BREAST
LUMPECTOMY, A LUMP REMOVED, WITH SOME COMPLICATIONS.
LAST MAMMOGRAM SAID NO GROWTH.
NOW SHE HAS PAIN ON RIGHT SIDE AND CAN FEEL LUMPS.
HOW WILL SHE KNOW IF THIS IS CANCER OR SCAR TISSUE?
>> YOU KNOW, I DON'T DO BREAST CANCER, BREAST SURGERY, BUT MY
BEST RECOMMENDATION FOR THAT PATIENT IS GO AND VISIT WITH
THE SURGEON THAT DID YOUR SURGERY AND HAVE IT EVALUATED.
I MEAN, THAT MAY LEAD TO OTHER TESTS.
ARE WE SEEING SCAR TISSUE?
IS THIS ANOTHER LUMP?
DON'T FORGET TO MENTION THE IMPORTANCE OF THE MAMMOGRAM,
IF DEFINITELY THERE ARE CONCERNS.
>> RIGHT.
THERE'S MORE TESTS, THERE'S ULTRASOUNDS.
>> AND BREAST MRI AND THERE'S KIND OF MORE ADVANCED AND
SPECIALIZED MAMMOGRAPHY.
AND THERE'S SURGEONS THAT HAVE A SPECIAL INTEREST IN BREAST TREATMENT.
THERE'S A HIGH-RISK BREAST CANCER CLINIC DOWN IN SIOUX
FALLS, WHICH IS NOT JUST FOR BREAST CANCER PATIENTS, BUT
FOR PEOPLE THAT ARE AT HIGHER RISK.
YOU KNOW, PEOPLE WITH THE BRCA MUTATION OR PEOPLE WITH
ABNORMAL BREAST EXAMS.
SO, IT'S DEFINITELY SOMETHING THAT YOU SHOULD STAY ON TOP OF.
AND GO SEE SOMEBODY ABOUT IT.
>> YEAH.
A WOMAN FROM MITCHELL IS 90, AND HAS SOME PAINS.
IS THERE A TEST TO SEE IF THERE'S CANCER IN ANY PLACE IN
THE BODY EVEN THOUGH SHE'S NEVER HAD IT?
SHE WONDERS WHY THERE ARE PAINS.
AND I'LL GIVE YOU MY ANSWER ON THAT ONE.
WHEN YOU'RE 90, THERE ARE OFTENTIMES, EVEN WHEN YOU'RE 70, OR 60 --
>> 50.
>> -- OR 50, THERE ARE PAINS.
THEY'VE KNOWN THAT IF YOU DO SCREENING C.A.T. SCANS OF THE
WHOLE BODY, YOU END UP WITH BIOPSIES THAT CAUSE THE -- THE
GREAT STORY, THE GUY HAD A LIVER BIOPSY, GOT INFECTED,
BLOOD, NEEDED MAJOR SURGERY, IT WAS BENIGN, THEN HE HAD
LUNG BIOPSIES FROM THE SAME, YOU KNOW, HIS TOTAL BODY
C.A.T. SCAN, RADIOLOGIST, ENDED UP COLLAPSING HIS LUNG
AND NEEDED A CHEST TUBE AND IT WAS NOT CANCER EITHER CASE AND
THE POINT IS, THERE'S TIMES WHEN YOU JUST -- UNLESS
THERE'S A CLEAR-CUT INDICATION OF SOMETHING THAT WOULD TRULY
IMPROVE YOUR LIFE, YOU DON'T WANT TO GO THERE.
AND AT 90, -- I DON'T GIVE UP ON 90-YEAR-OLDS, BUT I WOULD
SAY A GOOD HISTORY AND PHYSICAL EXAM, TIME WITH YOUR
DOCTOR OR CLINICIAN, AND LET THAT BE YOUR BEST SCREENING TEST.
>> TARGETED TESTING.
THERE'S A LOT OF REASONS THAT PEOPLE HURT.
IT MIGHT BE YOUR MEDICINES.
GETTING RID OF SOME OF YOUR MEDICINES MAY BE HELPFUL.
[ OVERLAPPING CONVERSATION ]
VITAMIN D DEFICIENCY.
THERE'S A LOT OF THINGS THAT CAUSE HURTING.
SO GO VISIT YOUR DOCTOR.
>> VERY GOOD.
A MAN FROM PIERRE, IS THERE A TEST TO DETERMINE WHY THE BONE
MARROW IS NOT PRODUCING ENOUGH RED BLOOD CELLS?
DR. HUBER, IT'S YOUR TERRITORY.
>> SURE.
THE VERY SIMPLE ANSWER IS, THERE'S A TEST CALLED THE
RETICULOCYTE COUNT THAT CHECKS FOR THE NEW FRESH RED CELLS
BEING CRANKED OUT BY THE BONE MARROW.
HOWEVER, IF THERE'S REALLY A QUESTION ON THE BONE MARROW,
DO A BONE MARROW BIOPSY.
WE OFTEN GIVE THAT WITH A LITTLE SEDATION, IT TAKES TEN
MINUTES TO DO IT, IT TAKES MORE TIME TO GET IT SET UP,
THE ROOM IS ARRANGED THAN IT DOES TO ACTUALLY DO IT.
AND THAT IS REALLY THE DEFINITIVE TEST TO GIVE YOU THE ANSWER.
QUESTION ABOUT SOMETHING IN THE BONE.
>> EVERYBODY IS AFRAID OF A BONE MARROW TEST, BUT I'VE
DONE A MILLION OF THEM.
THEY GET DONE WITH IT, THEY GO, OH, THAT WAS ALL?
EVERY ONCE IN A WHILE ONE HURTS.
BUT IF I DO IT RIGHT, IF I DID IT RIGHT, YOU NUMB IT ENOUGH,
GET IT JUST RIGHT, IT IS NOT A BIG DEAL.
>> PARTICULARLY EASY TO SAY AS THE PERSON DOING IT HELD OF
THE PERSON HAVING IT.
>> BUT I'VE BEEN THROUGH A LOT OF HAVING IT LATELY.
>> YOU HAVE BEEN THROUGH A LOT OF HAVING IT.
THERE IS NO QUESTION ABOUT THAT.
>> A MAN FROM PIERRE, IS THERE A TEST TO DETERMINE -- OH,
BONE MARROW, THAT'S RIGHT.
A WOMAN FROM RAPID CITY ASKS THE DOCS TO EXPLAIN UTERINE
CANCER AND ENDOMETRIAL CANCER, WHAT'S THE DIFFERENCE?
>> DR. ROJAS, WHAT'S THE DIFFERENCE?
AND THEN WE'LL GO TO THE ROLL-IN.
>> WELL, YOU KNOW, CANCER IS A GENERAL TERM.
MAIN CANCERS OF THE MAIN PART OF THE UTERUS.
ENDOMETRIAL CANCER IS A CANCER OF THE INNER LINING OF THE UTERUS.
SO YOU CAN HAVE A CANCER OF THE ENDOMETRIUM, SO THE
LINING, OR YOU CAN HAVE A CANCER OF THE MUSCLE, WHICH IS
A DIFFERENT TYPE OF CANCER.
BUT THE GENERAL UTERINE CANCER, MULTIPLE LITTLE REGIONS WITHIN THE UTERUS.
>> DEPENDING UPON WHICH CANCER YOU HAVE, THERE MAY BE A
VARIETY OF TREATMENTS AND OPTIONS FOR YOU AND YOUR PHYSICIAN TO DECIDE AMONG.
>> PROSTATE CANCER IS THE MOST COMMON CANCER IN MEN.
TENDENCY TO TRY AND SCREEN FOR THEM.
IF YOU CATCH THEM EARLIER, THEN THEY'RE CURABLE.
FOR PROSTATE CANCER, THERE'S A BLOOD TEST, CALLED PSA, LIKE I MENTIONED.
IT IS A PROTEIN THAT IS PRODUCED BY THE CELLS OF THE PROSTATE GLAND.
IN GENERAL, MEN, YOU EXPECT THEM TO HAVE SMALLER PROSTATES
AND, SO, THE PSAs TEND TO BE LOWER IN MEN WHO, AS THEY GET
OLDER, THE PROSTATE GLAND GROWS IN SIZE, SO THE PSA
VALUE WILL ALSO SLOWLY CREEP UP.
BUT THE STANDARD SEEMS TO BE FOUR, ANYTHING ABOVE FOUR IS CONSIDERED ABNORMAL.
BUT RECENTLY THE SCREENING CRITERIA HAS LOOSENED UP A
LITTLE BIT BECAUSE THERE ARE A LOT OF PROSTATE CANCERS THAT
ARE VERY SLOW GROW.
THERE ARE STANDARD OPTIONS FOR PROSTATE CANCER IS STARTING
FROM THE MOST INVASIVE TO THE LEAST INVASIVE.
IT ALSO DEPENDS A LOT ON THE GRADE OF THE CANCER, BECAUSE
NOT ALL PROSTATE CANCERS ARE THE SAME.
IF IT'S A VERY LOW-GRADE CANCER AND A VERY SMALL AMOUNT
OF CANCER, WE KNOW THAT THESE CANCERS ARE VERY SLOW GROWING.
AND, SO, A LOT OF TIMES WE CAN EVEN WATCH THEM AND NOT DO ANY ACTIVE TREATMENT.
BUT WE CALL THAT ACTIVE SURVEILLANCE.
AND WHAT THAT MEANS IS THAT WE KEEP CHECKING THEM WITH THE
PSA LEVELS, PHYSICAL EXAMS, AND SOMETIMES REPEATING A BIOPSY.
AS FAR AS ACTIVE TREATMENT IS CONCERNED, THERE'S TWO MAIN
WAYS OF TREATING IT, ONE IS BY SURGERY AND THE OTHER ONE IS BY RADIATION.
THE SURGERY INVOLVES REMOVING THE WHOLE PROSTATE GLAND AND
THEN JOINING THE BLADDER TO THE REST OF URETHRA.
IT USED TO BE DONE TRADITIONALLY BY THE OPEN
METHOD AND NOW OVER THE LAST SEVERAL YEARS MORE AND MORE OF
THESE IN THE UNITED STATES, AT LEAST, ARE BEING DONE USING A ROBOTIC TECHNOLOGY.
AS FAR AS RADIATION IS CONCERNED, THERE ARE TWO DIFFERENT
WAYS OF DOING RADIATION.
ONE IS BY GIVING EXTERNAL BEAM RADIATION THERAPY.
THAT INVOLVES RADIATION GIVEN IN SHORT, SMALL DOSES EVERY
DAY AND TYPICAL COURSE CONSISTS OF ONE TREATMENT
EVERY DAY, MONDAY THROUGH FRIDAY, WITH THE WEEKEND BREAK
FOR ABOUT A YEAR AND A HALF TO NINE WEEKS.
THERE'S ANOTHER RADIATION THAT IS CALLED PROSTATE
BRACHYTHERAPY, AND THAT INVOLVES PLACING THE RADIATION
SEEDS INTO THE PROSTATE, SEEDS ARE LIKE TINY GRAINS OF RICE
THAT WE PLACE INTO THE PROSTATE USING SPECIAL NEEDLES AND USING ULTRASOUND.
AND NOWADAYS THERE ARE MORE RESEARCH BEING DONE ON DOING
WHAT IS CALLED CRYOTHERAPY WHERE YOU ACTUALLY FREEZE THE PROSTATE.
AND NOW THERE'S RESEARCH GOING ON TO SEE IF YOU CAN TREAT
ONLY PART OF THE PROSTATE, NOT THE WHOLE PROSTATE.
SO THERE ARE MORE EXPERIMENTAL STUDIES BEING DONE IN THAT
REGARD RIGHT NOW.
>> WE THANK DR. BHAT FOR THAT INFORMATION, THERE'S A LITTLE
CLIP OF THE ACTUAL SURGERY IS KIND OF THRILLING.
WE'VE GOT A LOT OF GOOD QUESTIONS AND WE'RE GOING TO
RUN THROUGH THEM QUICKLY.
FACEBOOK VIEWER, IN HER LATE 50s, WAS DIAGNOSED WITH
BREAST CANCER A FEW YEARS AGO AFTER SOME TESTS, THEY SAID
SHE HAD TWO DIFFERENT TYPES OF CANCER.
SHE RECENTLY QUIT SMOKING, SMOKED SINCE SHE WAS A TEENAGE PERSON.
COULD SMOKING HAVE CONTRIBUTED TO BREAST CANCER AND TWO
DIFFERENT TYPES OF CANCER?
AND I'M GOING TO ASK DR. ROJAS.
>> I COULD PROBABLY JUMP IN.
>> MARK JUMP IN.
>> SMOKING IS PROBABLY LESS ASSOCIATED WITH BREAST CANCER
THAN THE TYPICAL SMOKING-RELATED CANCER LIKE
TONGUE OR BLADDER CANCER, SOME OTHERS.
IT'S HARD TO KNOW ABOUT THE TWO DIFFERENT CANCER TYPES
WITHOUT KNOWING SPECIFIC, SOMETIMES THERE'S INVASIVE BREAST CANCER.
I THERE'S 101 REASONS NOT TO SMOKE, ESPECIALLY WHEN IT COMES TO CANCER.
DON'T BEAT YOURSELF UP OVER COULD THERE BE A RISK OF BREAST CANCER.
THE KEY IS JUST TO PUT THAT BEHIND YOU.
[ AUDIO CUTTING OUT ]
>> AND GO FORWARD.
SPEAKING OF SMOKING.
SMOKERS WHO HAVE HAD MORE THAN 30 YEARS OF SMOKING A PACK A
DAY OR 15 YEARS OF TWO PACKS A DAY, THAT KIND OF A THING,
PEOPLE TALK ABOUT LOW-DOSE C.A.T. SCANS --
>> HIGH-RESOLUTION C.A.T.
SCANS AS A SCREENING TEST TO TRY TO FIND THOSE CANCERS WHEN
THEY'RE REALLY SMALL AND REALLY EARLY AND REALLY TREATABLE.
>> SO WE SHOULD START TO -- AT WHAT AGE?
>> 50, IF I RECALL CORRECTLY.
DR. HUBER, DOES THAT SOUND CORRECT TO YOU?
>> I THINK IT WAS 55 ON THE LUNG SCREENING.
>> AND THAT'S THE U.S.
PREVENTIVE SERVICES.
THEY'RE A GROUP OF CONSERVATIVE --
>> THEY'RE VERY CONSERVATIVE.
>> SO THEY SAY ONCE A YEAR FOR SMOKERS.
>> UNTIL YOU HAVE NOT BEEN A SMOKER FOR 15 YEARS.
SO IF YOU QUIT 15 YEARS AGO, YOU DON'T NEED THAT SCREENING.
BUT UNTIL THAT POINT, THEY RECOMMEND THAT SCREENING.
>> AND IF YOU'VE EVER SMOKED, THEY'RE RECOMMENDING IT IN
MAYO AT 60 TO HAVE AN ULTRASOUND OF YOUR ABDOMINAL AORTA.
WHICH IS NOT SCREENING FOR CANCER, BUT IT'S SCREENING FOR ABDOMINAL ANEURYSM.
SO YOU GO WITH THAT IDEA?
I RECOMMEND, YOU KNOW, THOSE ULTRASOUND PEOPLE THAT TRAVEL
AROUND THE STATE, I THINK MOST OF IT IS NOT APPROPRIATE, BUT
I THINK THE ABDOMINAL ULTRASOUND SCREEN FOR MEN WHO
SMOKED OR PEOPLE WHO HAVE SMOKED --
>> IT'S IMPORTANT TO REMEMBER THAT WITH THE AFFORDABLE CARE
ACT, ANYTHING THAT'S RECOMMENDED BY THE U.S.
PREVENTIVE SERVICES TASK FORCE WITH THE HIGH-GRADE
RECOMMENDATION IS SUPPOSED TO BE COVERED BY YOUR INSURANCE.
>> AND IF IT ISN'T, SHOUT.
>> SHOUT.
I MEAN, THERE ARE EXCEPTIONS, INSURANCE COMPANIES HAVE
MANAGED TO MAKE EXCEPTIONS FOR THEMSELVES.
BUT THAT LUNG CANCER SCREENING, THAT ABDOMINAL
ANEURYSM SCREENING, YOUR PAP SMEARS, YOUR MAMMOGRAMS, YOUR
COLONOSCOPIES, THOSE ARE SUPPOSED TO BE COVERED.
>> OKAY.
QUICKLY NOW, WE'VE GOT A BUNCH OF QUESTIONS.
>> OKAY, ALL RIGHT.
>> A WOMAN FROM EDGERTON WOULD LIKE TO KNOW ABOUT METAPLASTIC
CANCER, IS THERE ANY NEW NEWS ABOUT METAPLASTIC CANCER?
MARK HUBER, YOU'RE UP.
>> WE SEE THAT IN BREAST CANCER.
IT'S A RARE SUBTYPE OF BREAST CANCER.
IT'S KNOWN TO BE RELATIVELY MORE AGGRESSIVE.
BUT THAT'S DEFINITELY SOMETHING YOU WANT TO HAVE
TREATED AS -- TREATED AT A BIGGER CENTER.
[ AUDIO DISTORTED ]
WE HAVE A BOARD THAT DISCUSSES SOME OF THESE COMPLEX CASES.
FORTUNATELY, NOT VERY COMMON.
BUT REALLY SHOULD GO TO A SPECIALIST AND HAVE IT CHECKED OUT.
>> IT'S A TOUGHER DIAGNOSIS.
DR. ROJAS, A WOMAN FROM ABERDEEN ASKS THE DOC'S
OPINION ON OVARIAN CANCER AND IF THERE'S A BLOOD TEST KNOWN AS A 126?
>> SO, YEAH, THERE'S A BLOOD TEST THAT WE USE, CALLED A CA
125 THAT REALLY SHOULD NOT BE USED FOR SCREENING BECAUSE
IT'S VERY NONSPECIFIC.
I MEAN, YOU MAY HAVE A COLD, THE FLU.
BUT THAT DOES HELP US IF A PATIENT HAS A MASS AND WE GO
TO THE O.R. TO REMOVE IT THINKING IT MAY BE CANCER, THE
CA 125 IS ELEVATED AND SHE HAS A CANCER, THEN WE CAN USE THAT
TEST TO FOLLOW PROGRESS OF THE PATIENT AND HOW SHE DOES AFTER
THE CANCER TREATMENT.
BUT THAT TEST SHOULD NOT REALLY BE USED TO TRY TO PICK
UP CANCER BECAUSE YOU MAY, AGAIN, CAUSE A LOT OF HARM
DOING UNNECESSARY TESTS.
>> AND YOU MAY BE ARTIFICIALLY REASSURED THAT THERE'S NOT A PROBLEM.
>> WHEN THERE IS.
>> WHEN THERE IS A PROBLEM.
SO IT'S NOT A GOOD SCREENING TEST.
BOTTOM LINE.
>> AND IS AVERA DOING SOME RESEARCH ON GYNECOLOGICAL
CANCERS RIGHT NOW, DR. ROJAS?
>> YEAH.
WE HAVE A COUPLE OF RESEARCH, YOU KNOW, ON THE TREATMENT
SIDE AND SPECIFICALLY HAVE OUR OWN INTERNAL CLINICAL STUDY
THAT HAVE BEEN DESIGNED BY SOME OF OUR --
[ INDISCERNIBLE ]
NEW DRUGS, NEW COMBINATIONS, WITH DRUGS THAT WE HAVE
COMBINED, AND SEEN GOOD RESULTS IN THOSE PATIENTS.
WE HAVE ANOTHER TRIAL COMING UP TESTING OTHER POTENTIAL,
SCREENING, OTHER TESTS CAN BE DONE TO PICK UP THE CANCER.
>> OKAY.
AND I WAS GOING TO ASK YOU, DR. HUBER, WE TALKED ABOUT
IMMUNOTHERAPY AS NEW THINGS.
PEOPLE WERE HEARING A LOT OF THINGS ABOUT IMMUNOTHERAPY,
WHAT WOULD BE A TAKE-HOME MESSAGE THAT PEOPLE WOULD LIKE TO HAVE?
I MEAN, WE'RE GOING TO NEED TO GET BACK TO QUESTIONS.
BUT QUICKLY, TAKE-HOME ABOUT IMMUNOTHERAPY OR DIFFERENT KINDS OF CANCER?
>> WELL, I'D SAY, RICK, THAT'S REALLY REVOLUTIONIZED MANY
DIFFERENT TUMOR-TYPE TREATMENTS OVER THE LAST FIVE TO EIGHT YEARS.
IT'S HARD TO KEEP UP ON ALL THE F.D.A. APPROVALS THAT ARE COMING OUT.
I WILL SAY THAT IT'S VERY WELL TOLERATED.
SIDE EFFECTS ARE MUCH LESS AND MUCH MORE MANAGEABLE THAN
CHEMOTHERAPY AND IN ABOUT EIGHT OR TEN TUMOR SITES WHERE
IT'S APPROVED, IT'S OFTEN THE PREFERRED TREATMENT.
JIMMY CARTER IS 95 YEARS OLD AND BEING TREATED FOR MELANOMA.
YOU DO NOT GIVE A 95-YEAR-OLD REGULAR CHEMO.
SO I THINK THAT SPEAKS TO HOW WELL IT WORKS.
>> YOU'RE NOT REALLY TREATING THE CANCER.
YOU'RE UNLEASHING THE POTENTIALS OF YOUR OWN IMMUNE
SYSTEM TO FIGHT THE CANCER FOR YOU.
SO THAT'S VERY VERY --
>> LIKE MAGNIFIES THE SYSTEM IN THE HUMAN BODY TO FIGHT.
>> THAT'S EXACTLY IT.
>> THANK YOU ON THAT.
WE HAVE A WATERTOWN WOMAN ABOUT BLADDER CANCER, ARE
THERE OPTIONS BESIDES CHEMOTHERAPY, ALSO IF ROBOTIC SURGERY IS AN OPTION?
SO, -- BUT THERE'S A LOT ABOUT BLADDER CANCER,
DEPENDING UPON HOW MUCH IT SPREAD.
>> HOW INVASIVE IT IS.
>> AND A LOT OF IT THEY'LL SURGICALLY REMOVE THE TUMORS
THAT ARE WITHIN THE BLADDER AND THEN THEY'LL FLUSH THE
BLADDER WITH CHEMOTHERAPY AND REMARKABLE RESULTS WITH THAT.
BUT YOU GOT TO DEPEND ON YOUR PERSONAL DOCTOR ON THAT AND
SOMETIMES IT SPREADS.
AND YOU HAVE TO TALK ABOUT CHEMO.
ANYTHING ELSE THAT EITHER ONE OF YOU -- ANY OF YOU WOULD
LIKE TO SAY ABOUT THAT?
QUICKLY.
WE'LL MOVE FORWARD THEN.
>> ANY BLOOD IN THE URINE NEEDS TO BE CHECKED OUT.
THAT'S MY TAKE-HOME MESSAGE.
>> IT MIGHT BE A LITTLE LATE FOR HER, BUT IF YOU SEE BLOOD
IN YOUR URINE, GO TO THE DOCTOR.
>> GET IT CHECKED OUT.
>> AND ADVANCED IMMUNE THERAPY WORKS VERY WELL IN BLADDER CANCER.
THERE'S ACTUALLY FIVE OF THE IMMUNE THERAPY DRUGS APPROVED IN BLADDER CANCER.
SO THERE'S BEEN SOME CHANGES FOR THE BETTER.
>> WE HAVE A BUNCH OF QUESTIONS THAT NEED TO BE
ANSWERED THAT WE WON'T GET TO AT THIS TIME, SO, YOU GO TO
FACEBOOK, GO TO FACEBOOK, AND LOOK UP PRAIRIE DOC AND THEN
WE'LL RIGHT NOW, AFTER THE SHOW, WE'LL FINISH THE QUESTIONS IF WE DON'T GET --
WHAT WE DON'T GET TO.
FATHER DIED OF COLON CANCER IN 1984.
SINCE THEN, CALLER HAS A COLONOSCOPY EVERY FIVE YEARS.
HE'S 79 NOW.
SHE IS.
SHOULD SHE CONTINUE GETTING THEM EVERY FIVE YEARS?
>> YOU KNOW, THE SHORT ANSWER WOULD BE NO.
BUT THE MORE NUANCED ANSWER WOULD BE, IT DEPENDS ON HER STATE OF HEALTH.
>> YES.
>> IF SHE'S A VERY HEALTHY, VIGOROUS PERSON WHERE I'M NOT
EXPECTING THAT SHE'S GOING TO DIE FROM SOMETHING ELSE IN THE
NEXT FIVE TO TEN YEARS, THEN I WOULD CONTINUE DOING IT.
>> I WOULD.
>> ON THE OTHER HAND, IF SHE HAS A BAD HEART AND BAD LUNGS
AND UNCONTROLLED DIABETES, IT'S TIME TO STOP.
>> RIGHT.
WHAT'S THE NEWEST TREATMENT USED FOR PANCREATIC DUCTILE CANCER?
DR. HUBER.
WE'RE OUT OF TIME.
>>> AND NOW, FOR THE WINNER OF TONIGHT'S PRAIRIE DOC QUIZ QUESTION.
TRUE OR FALSE?
THE AMERICAN COLLEGE OF OB-GYN RECOMMENDS YEARLY MAMMOGRAMS BEGINNING AT 40.
HOWEVER, THE AMERICAN ACADEMY OF FAMILY PHYSICIANS RECOMMEND
THAT ANNUAL MAMMOGRAMS START AT 50.
TRUE OR FALSE?
DEB?
>> TRUE.
AND OTHER ORGANIZATIONS RECOMMEND EVERY TWO YEARS.
SO THERE'S A LOT OF DIFFERENT RECOMMENDATIONS.
>> A LOT OF DISCREPANCY.
IN FACT, FOR WOMEN AGE 40 AND ABOVE, WITH AVERAGE RISK FOR
CANCER, THE AMERICAN COLLEGE OF OB-GYN AND THE AMERICAN
COLLEGE OF RADIOLOGY RECOMMEND YEARLY MAMMOGRAMS.
BUT THE THE AAFP, THE ACP, AND THE U.S. PREVENTIVE TASK FORCE
RECOMMEND THAT FOR 40 TO 49-YEAR-OLDS LETTING THE
INFORMED PATIENT DECIDE, BUT YEARLY MAMMOGRAMS FOR THOSE 50 OR OLDER.
IT WAS NORMAN COOLMAN FROM PIPESTONE WHO ANSWERED THE QUESTION CORRECTLY.
NORMAN, THANK YOU FOR PARTICIPATING AND A BOOK WILL
BE IN THE MAIL TO YOU SOON.
WE'LL BE RIGHT BACK.
>> IN A WORLD WHERE SELFIES ARE SEEMINGLY INNOCENT, SOMETHING LURKS.
[ SUSPENSEFUL MUSIC ]
AND NO ONE IS SPARED.
>> HOW GOES IT?
>> IT'S FLU SEASON.
[ WHISTLING ]
>> SCREENING FOR CANCER IS LIKE FISHING FOR WALLEYE.
IF YOU HAVE THE RESOURCES, YOU CAN BUY A GOOD FISH-FINDER TO
SEE WHERE THE FISH MIGHT BE.
WHEN THE FINDER INDICATES THAT THERE ARE FISH DOWN BELOW YOUR
BOAT OR ICE HOUSE, YOU KNOW THERE MIGHT BE WALLEYE, BUT
THEY ALSO COULD BE CARP, NORTHERN, OR WEEDS, AND NOT WALLEYE.
IF YOU DECIDE TO DROP YOUR HOOK, SOMETIMES YOU CATCH A BIG ONE.
OKAY, THIS IS NOT A PERFECT METAPHOR, BUT SCREENING FOR
CANCER OFTEN REQUIRES ADVANCED AND EXPENSIVE TECHNOLOGY WHICH
IS NOT ALWAYS ACCURATE.
SOMETIMES YOU FIND NOTHING, AND SOMETIMES YOU FIND A
DANGEROUS CANCER THAT CAN BE TREATED.
SCREENING FOR CANCER IS WHEN THERE ARE NO SYMPTOMS.
THIS IS DIFFERENT THAN WHEN CANCER IS DISCOVERED BECAUSE
OF SYMPTOMS, LIKE WHEN LUNG CANCER INDUCES COUGHING WITH
BLOODY SPUTUM OR COLON CANCER CAUSES BLOOD IN THE STOOL, FOR EXAMPLE.
EXAMPLES OF SCREENING WOULD INCLUDE YEARLY LOW-DOSE C.T.
LUNG SCANS IN 55 TO 85-YEAR-OLDS WHO HAVE SMOKED A
PACK FOR 30 OR MORE YEARS, OR COLONOSCOPY EVERY 10 YEARS IN
PEOPLE 50 OR OLDER.
EXPERTS MEASURE THE VALUE OF SCREENING IN SEVERAL WAYS.
FIRST, WHAT ARE THE COSTS OF THE TEST AND THE COSTS OF ANY
FURTHER TREATMENT THAT MIGHT FOLLOW.
'COSTS' SHOULD MEAN THE FINANCIAL COST TO PATIENTS, TO
INSURANCE COMPANIES, OR TO THE GOVERNMENT, BUT MEASURING
COSTS SHOULD ALSO INCLUDE PAIN AND EMOTIONAL SUFFERING TO
PATIENTS THAT MAY RESULT FROM TESTING.
A SECOND WAY TO MEASURE VALUE FOR SCREENING COMES FROM
MEASURING HOW SENSITIVE THE TEST MAY BE.
IF IT ISN'T SENSITIVE ENOUGH, THEN IT WILL MISS CANCERS.
IF IT IS TOO SENSITIVE, THEN IT WILL INDICATE CANCER EVEN
WHEN THERE IS NO CANCER OR NO DANGER FROM HARM BY TUMOR OR CANCER.
A THIRD ISSUE IS THE AGE AND WELL-BEING OF THE PATIENT BEING TESTED.
IF THE INDIVIDUAL IS VERY ELDERLY OR ILL, SCREENING MAY BE INAPPROPRIATE.
THE POINT IS THAT WHILE SCREENING CAN BE LIFE SAVING,
IT IS NOT ALWAYS A GOOD IDEA.
SO, AFTER DOING YOUR OWN RESEARCH ON THE TOPIC, WHEN
ASKING YOUR PHYSICIAN OR CARE PROVIDER ABOUT A SCREENING
TEST, REALIZE THE COMPLEXITY OF THIS ISSUE, AND PLEASE
DEPEND ON THE WISDOM AND EXPERIENCE OF YOUR CARE PROVIDER.
THESE ARE COMPLICATED WATERS AND WE ALL COULD USE A GOOD FISHING GUIDE.
>> I THOUGHT THAT WAS PRETTY GOOD.
A GOOD FISHING GUIDE.
>> KNOW WHERE YOUR MIND IS.
>> YEAH.
A BIG THANK YOU TO OUR GUESTS, DR. MARK HUBER, AND DR. LUIS
ROJAS, FOR JOINING US VIA SKYPE FROM SIOUX FALLS, AND
DR. DEB JOHNSTON FOR VOLUNTEERING TO COME TO OUR
STUDIO AT SOUTH DAKOTA STATE UNIVERSITY, YEAGER MEDIA CENTER, IN BROOKINGS.
WE SINCERELY APPRECIATE EVERYONE'S EFFORTS TONIGHT.
YOUR EXPERIENCE AND INSIGHTS MADE THIS SHOW SUCCESSFUL.
IN SOUTH DAKOTA, AS IN THE UNITED STATES, WE ARE
EXPERIENCING WIDESPREAD INFLUENZA ACTIVITY RESULTING
IN 15 DEATHS AND 320 HOSPITALIZATIONS.
IN SOUTH DAKOTA.
THE MAJORITY OF FLU ILLNESS HAS BEEN AMONG THOSE 50 YEARS OF AGE AND OLDER.
INFLUENZA VACCINE IS THE PRIMARY WAY TO INTERRUPT FLU ACTIVITY.
WHILE NOT 100% EFFECTIVE AT PREVENTING ILLNESS, FLU
VACCINATION LOWERS YOUR RISK OF BEING HOSPITALIZED WITH FLU
COMPLICATIONS AND DYING FROM INFLUENZA.
WE STILL HAVEN'T SEEN INFLUENZA PEAK IN SOUTH
DAKOTA, AND THERE'S STILL PLENTY OF BENEFIT TO GETTING YOUR FLU SHOT TODAY.
OR TOMORROW.
GETTING YOUR FLU SHOT NOW WILL STILL OFFER SOME PROTECTION IN
THE NEXT FEW MONTHS.
THAT DOES IT FOR TONIGHT.
FROM ALL OF US HERE AT "ON CALL WITH THE PRAIRIE DOC,"
UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE.
AND GO TO FACEBOOK.
CATCH IT AFTER HOURS.
>> MUSIC HAS CHARMS TO SOOTHE A SAVAGE BEAST, BUT IT ALSO MAY BE ABLE TO HEAL.
THE HEALTH BENEFITS OF MUSIC, NEXT TIME "ON CALL WITH THE PRAIRIE DOC."
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