>> MEN OFTEN WAIT AND WAIT TO AVOID GOING TO THE DOC AND THEN IT COULD BE TOO LATE.
MEN'S HEALTH: PROSTATES, TESTICLES, BLADDERS,
AND ALL THAT STUFF TONIGHT "ON CALL WITH THE PRAIRIE DOC."
>> MAJOR FUNDING FOR "ON CALL WITH THE PRAIRIE DOC" HAS BEEN PROVIDED BY:
>> AVERA IS A PROUD SPONSOR OF "ON CALL" ON SOUTH DAKOTA PUBLIC BROADCASTING.
>> LARSON MANUFACTURING IS PROUD TO SUPPORT "ON CALL TELEVISION" AS IT CONTINUES TO
OPEN DOORS FOR IMPORTANT MEDICAL INFORMATION.
>> AND BY THE SOUTH DAKOTA FOUNDATION FOR MEDICAL CARE,
THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION FOR SOUTH DAKOTA.
>> AND WITH THE ONGOING SUPPORT OF THESE INDIVIDUALS AND INSTITUTIONS...
>> GOOD EVENING AND WELCOME TO "ON CALL WITH THE PRAIRIE DOC."
IT MAY BE A CULTURAL NORM OR IT MAY BE INGRAINED IN THE BASIC MENTAL MAKEUP OF MEN,
BUT WE JUST PUT OFF SEEKING MEDICAL ASSISTANCE AS LONG AS POSSIBLE.
THE FACTS ARE, THOUGH, THAT WE WOULD BE BETTER OFF IF WE
VISITED THE DOCTOR A BIT MORE OFTEN.
MEN ARE JUST AS COMPLICATED AS THE FEMALE OF THE SPECIES,
JUST CONSTRUCTED A LITTLE DIFFERENTLY.
THAT ALTERNATE DESIGN NEEDS ATTENTION TO KEEP EVERYTHING WORKING THE WAY IT SHOULD.
>>> FIRST, LET'S TAKE A LOOK AT THIS WEEK'S PRAIRIE DOC QUIZ QUESTION.
TRUE OR FALSE? ACTIVE SURVEILLANCE, WHICH MEANS JUST MONITORING
PROSTATE CANCER WITH LAB AND X-RAY AND GOING WITHOUT SURGERY, RADIATION,
OR CHEMOTHERAPY, IS AN OPTION IN SOME PROSTATE CANCERS? 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 MEN'S HEALTH
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 TONIGHT IS DR. EUGENE PARK AND DR. NATHAN BOCKHOLT, BOTH OF UROLOGY
SPECIALISTS, SIOUX FALLS, SOUTH DAKOTA. THANK YOU, BOTH, FOR JOINING US.
>> THANKS FOR HAVING US. >> THIS IS YOUR SECOND TIME ON THE SHOW.
I CAN REMEMBER, YOU'RE KIND OF A QUIETER SPEAKER, SO DON'T HESITATE TO SPEAK UP.
BUT PEOPLE ARE WATCHING, YOU HAD SOME RESPONSES AFTER YOU WENT HOME.
>> PEOPLE DEFINITELY RECOGNIZED ME AFTERWARDS. >> THERE YOU GO. >> UM-HUM.
>> AND NATE, YOU'VE SEEN THIS SHOW BEFORE WITHIN THE STUDIO,
WHAT WAS THAT EXPERIENCE? >> A GOOD EXPERIENCE.
I SPENT A MONTH WITH YOU. YEARS AGO. >> HOW MANY YEARS AGO?
>> I HATE TO COUNT HOW MANY.
I HAD AID PATIENT THE OTHER DAY -- I HAD A PATIENT THE OTHER DAY,
SAW AN OLDER GENTLEMAN IN HIS 90s, YOU LOOK REALLY YOUNG, WHAT ARE YOU, 55?
I WAS, LIKE, I'M GETTING -- [ LAUGHTER ] -- I'M GETTING TOO OLD.
BUT, YEAH, IT'S BEEN OVER A DECADE NOW.
>> I'LL MAKE A COMMENT THAT YOU WERE A GREAT STUDENT, IT
WAS A PLEASURE, AND AFTER SPENDING A MONTH WITH ME ON
INTERNAL MEDICINE IS PROBABLY WHY YOU WENT INTO SURGERY. >> YEAH.
>> I DON'T KNOW. I DON'T KNOW ABOUT THAT.
ONE OF THE MOST COMMON THINGS THAT YOU GUYS SEE IS KIDNEY STONE ISSUES.
HOW DOES THAT GO? EUGENE, TELL ME A LITTLE BIT MORE ABOUT THAT.
>> WE KIND OF SEE THEM ALL HOURS OF THE DAY, WE SEEM IN
OUR CLINICS, WE'LL SEE THEM FROM REFERRALS FROM THE E.R.,
CLASSIC, WORST PAIN OF MY LIFE, BLOOD IN THE URINE, I MEAN, KIND OF THE THINGS,
SURPRISINGLY, A NUMBER OF PEOPLE IN THE AREA GET STONES.
>> AND YOU HAVE THE SAME EXPERIENCE? >> SAME EXPERIENCE.
IF YOU LOOK AT MAPS OF THE UNITED STATES OVER THE LAST, YOU KNOW, 10, 20 YEARS,
THE PREVELANCE IN ALMOST EVERY STATE IS GOING UP.
AND HAS TO DO WITH DIETS AND LACK OF EXERCISE AND WEIGHT AND DIABETES,
ALL THOSE ARE CONTRIBUTING FACTORS TO HAVING KIDNEY STONES.
>> WELL, WE'RE HAVING AN EPIDEMIC OF DIABETES AND OF WEIGHT ISSUES.
AND THAT DEFINITELY IS PART OF IT.
BUT, SO WHAT COULD I DO TO PREVENT A KIDNEY STONE? >> DRINK A GLASS OF WATER.
>> EAT MORE -- >> STAY HYDRATED, TRY TO SEPARATE THOSE CRYSTALS FROM
COMING TOGETHER, KEEP YOURSELF FLUSHED OUT. >> YEAH.
>> AND NOW THERE ARE GUIDELINES THAT SHOW THAT IF YOU MAKE AT LEAST TWO AND A
HALF LITERS OF URINE A DAY, YOUR RISK OF KIDNEY STONES GOES DOWN.
AND THERE'S BASICALLY FOUR FACTORS, LIKE EUGENE WAS SAYING, FLUIDS, FLUIDS, AND --
>> FLUIDS AND FLUIDS. >> YEAH. >> FOUR. FLUIDS, FLUIDS, FLUIDS, FLUIDS.
AND SALT. SALT IN THE DIET, IS NOT USUALLY WHAT YOU ADD, IT'S
WHAT'S IN THE FOOD THAT YOU'RE EATING, SO THE MORE SALT IN YOUR DIET,
THE MORE CALCIUM THAT ENDS UP GOING INTO YOUR URINE.
>> THAT'S INTERESTING, I DID NOT KNOW THAT.
>> YOU SEE A LOT OF PEOPLE ON THESE NEW DIETS, HIGH-PROTEIN DIETS, PROFILE,
THE MORE PROTEIN IN THE DIET, IT AFFECTS THE PH IN THE URINE,
IT AFFECTS THE STONE, LOW SALT, CITRATE THAT'S IN ORANGE JUICE, LEMONADE,
THINGS LIKE THAT, IT'S ACTUALLY PROTECTIVE FOR STONES.
>> WHAT ABOUT CALCIUM? I KNOW THAT THERE'S SUPPLEMENTS THAT PEOPLE TAKE,
YOU GET IT WITH TUMS BUT YOU ALSO GET IT WITH MILK BUT YOU ALSO GET IT WITH
CALCIUM-SUPPLEMENTED ORANGE JUICE, CALCIUM-SUPPLEMENTED, THIS AND THAT,
IS THAT PART OF IT?
>> IT'S USUALLY NOT A DIETARY THING, UNLESS YOU HAVE A VERY SPECIFIC ABSORPTION ISSUE.
YEAH, IT'S USUALLY NOT A DIETARY THING, MORE OF A SALT INTAKE ISSUE.
>> THEY'VE LOOKED AT ELIMINATING CALCIUM FROM THE DIET, THEY HAD TWO GROUPS OF
PEOPLE, THEY ELIMINATED CALCIUM IN ONE GROUP'S DIET AND THEN THEY HAD JUST A
NORMAL AMOUNT OF CALCIUM WITH LOW, MODERATE PROTEIN, LOW SALT, THEY HAD MUCH FEWER --
LOWER INCIDENCE OF STONES.
WHAT THEY THINK IS, YOU KNOW, OUR GUT MAKES OXALATE, IN A DAY,
SO MUCH IS AND SO LOW CALCIUM DIET, YOU'RE NOT BINDING THAT OXALATE, SO YOU
END UP ABSORBING MORE AND HAVE HIGHER RISK FOR STONES.
A LOT OF WOMEN THAT ARE ON CALCIUM CARBONATE SUPPLEMENT,
I'LL HAVE THEM TAKE CITRIC, AS WELL AS PROTECTIVE FOR BONE HEALTH AS WELL AS FOR STONES.
>> POST MENOPAUSAL, YOU DON'T WANT THEM TO BE OFF CALCIUM,
RISK OF FRACTURES, THINGS LIKE THAT.
>> I'VE OFTEN SAID THE BEST THING FOR KIDNEY STONES, FOR OSTEOPOROSIS IS EXERCISE.
YOU KNOW, THE AMOUNT OF -- >> WEIGHT BEARING. >> WEIGHT BEARING, POUNDING,
DO YOU THINK THAT PREVENTS STONES?
>> DIET AND EXERCISE HELP. I HEARD A FAMILY DOC REALLY SIMPLE FLIGHT IT FOR --
SIMPLIFIED IT FOR ME ONE TIME, HE TELLS PATIENTS,
HEART HEALTHY LIFESTYLE AND DIET ARE GOOD FOR STONES. EASY TO REMEMBER.
>> I KNOW THAT THAT ISN'T A MEN'S HEALTH ISSUE BECAUSE WOMEN GET KIDNEY STONES, TOO,
BUT I COULDN'T HELP MYSELF BECAUSE YOU SEE A LOT OF STONES.
AND IT'S A MISERABLE THING WITH A PAIN OF A SMOOTH MUSCLE TUBE BLOCKAGE, PEOPLE VOMIT,
THEY CAN'T GET A COMFORTABLE POSITION, THEY'RE MOVING ALL OVER THE TABLE IN THE ROOM.
>> YEAH. >> SO THAT'S A TOUGH THING. >> YEAH.
THAT'S ONE THING, I THINK PEOPLE HAVE A MISCONCEPTION THAT UROLOGISTS JUST SEE MEN,
YOU KNOW, BECAUSE UROLOGISTS ARE AT THE FOREFRONT OF MEN'S HEALTH
BUT WOMEN HAVE KIDNEYS AND BLADDERS AND KIDNEY STONES, INCONTINENCE, KIDNEY
CANCER, BLADDER CANCER, WE SEE KIDS.
BUT I THINK, YOU KNOW, YOU HAVE THIS MISTHOUGHT THAT WHEN YOU GO TO THE UROLOGIST,
YOU SEE AN OLDER GENTLEMEN IN THE WAITING ROOM BUT THAT'S NOT THE CASE.
>> SO LET'S MOVE TO A MEN'S HEALTH QUESTION AND IT'S ONE
THAT'S PROBABLY ON THE TOP OF A LOT OF PEOPLE'S MINDS, AND THAT HAS TO DO WITH PSA,
PROSTATE SPECIFIC ANTIGEN SCREENING BLOOD TEST.
AND IF IT'S ABNORMAL, WHAT DO YOU DO? WHAT IS THE RIGHT THING TO DO
AND, YOU KNOW, DO YOU BELIEVE IN THE DIGITAL RECTAL EXAM, A
LOT OF PEOPLE ARE DUMPING THAT PARTICULAR TEST.
LET'S TALK ABOUT PROSTATE CANCER SCREENING.
WHAT'S THE BEST PROSTATE CANCER SCREENING PLAN? EUGENE?
>> I USUALLY RECOMMEND STARTING SCREENING AT THE AGE OF 55.
EVEN OUR SOCIETY'S ASKING US TO BE A LITTLE LESS AGGRESSIVE ABOUT SCREENING.
SO PEOPLE WHO ARE AT HIGH RISK FOR DISEASE, LIKE HAVING A
FAMILY HISTORY OR FIRST-DEGREE RELATIVE, LIKE A FATHER OR BROTHER,
I'LL SCREEN THEM ONCE A YEAR. I DO DO THE RECTAL EXAM,
PARTLY SO THAT I KNOW WHAT THE PROSTATE FEELS LIKE,
TO MAKE SURE I DON'T MISS SOMETHING. REALLY ABNORMAL.
BUT ALSO GIVES ME A LITTLE BIT MORE INFORMATION ABOUT THE SIZE OF THE PROSTATE,
PROSTATE HEALTH CAN GIVE ME CLUES ABOUT HOW WELL PEOPLE ARE GOING TO
THE BATHROOM, IF THEY'RE HAVING PROBLEMS GOING TO THE BATHROOM.
>> BY THE WAY, YOU ALSO CHECK THE STOOL FOR BLOOD AND YOU'VE
GOT A DOUBLE SCREEN FOR COLON CANCER.
I MEAN, I THINK IT'S AN IMPORTANT TEST WE SHOULD STILL BE DOING IT.
>> SURE. >> EVERY YEAR AFTER 50 IN MEN. GO ON. I INTERRUPTED YOU.
>> OH, NO. AND I'VE BEEN BACKING OFF ON SCREENING PEOPLE WITH LOW
RISKS, SO IF THERE'S NO REAL RISK FACTORS,
I'LL GIVE THE OPTION OF CHECKING EVERY OTHER YEAR INSTEAD OF EVERY YEAR.
>> LOW RISK OR PEOPLE WITHOUT FAMILY HISTORY. >> WITHOUT FAMILY HISTORY,
LOW PSAs, INITIALLY, WHO PEOPLE -- NORMAL RECTAL EXAMS.
>> YEAH, THERE YOU GO. NATE, WHAT'S YOUR FOLLOW-UP, YOU DISAGREE, YOU AGREE?
IT'S A CONTROVERSIAL SCENARIO. >> IT IS.
IT WAS A HOT TOPIC, UNITED STATES PREVENTIVE SERVICE TASK FORCE
GAVE IT A GRADE "D" RATING. THE AMERICAN UROLOGIC ASSOCIATION WAS UP IN ARMS
ABOUT THIS, AND THE UROLOGIC ASSOCIATION KIND OF CHANGED
THEIR TUNE A LITTLE BIT AND THEY USED TO START SCREENING AT 40, NOW IT'S 55 TO 69,
PEOPLE THEN DON'T HAVE, YOU KNOW, THEY'RE NOT HIGH RISK WITH
FAMILY HISTORY OR AFRICAN AMERICAN --
>> AFRICAN AMERICAN HAVE A HIGHER RISK OF PROSTATE CANCER. >> YUP.
THE CHECKING, DOING THE RECTAL EXAM AND
THE PSA EVERY OTHER YEAR INSTEAD OF EVERY YEAR.
NOW THEY HAVE, IN ANY SCREENING, THEY HAVE THIS COINED TERM OF SHARED DECISION MAKING.
SO, WHEN YOU HAVE SOMETHING --WHEN YOU HAVE A SCREENING LIKE THAT THAT'S CONTROVERSIAL,
IT INVOLVES A DISCUSSION WITH YOU AND YOUR PATIENT.
>> PATIENT SHARES THE RESPONSIBILITY GOING YES OR NO. >> A LITTLE BIT.
I THINK WE'RE MOVING MORE FROM A PATERNALISTIC WAY OF DEALING WITH PATIENTS TO MORE OF,
YOU KNOW, -- >> MATERNALISTIC. [ LAUGHTER ] MATERNALISTIC MEANING THE DOCTOR SAYS --
>> THIS IS WHAT WE'RE GOING TO DO, GETTING THE PATIENT ON BOARD BECAUSE,
YEAH, IT IS CONTROVERSIAL BECAUSE, YOU KNOW, THE PREVELANCE AND
INCIDENCE RATIO IS A LOT DIFFERENT. MOST PEOPLE DON'T DIE FROM THEIR PROSTATE CANCER,
THEY DIE WITH IT.
BUT THERE DEFINITELY ARE THE PATIENTS THAT YOU WANT TO FIND AHEAD OF TIME
BECAUSE THERE IS A LEAD TIME WITH ANY SCREENING TEST, LIKE WITH THE PSAs ELEVATED,
YOU FIND CANCER, THAT'S ABOUT SIX OR SEVEN YEARS BEFORE THAT THEY
ACTUALLY HAVE LOCALIZED SYMPTOMS FROM THEIR CANCER.
>> OFTENTIMES WHAT WILL HAPPEN, OKAY, IT LOOKS LIKE
THERE IS AN ELEVATED PSA, YOU CAN FEEL A HARD LESION ON THE DIGITAL EXAM.
OKAY, WE'LL DO A BIOPSY. DO A BIOPSY, THEY CAN SAY, WELL,
THIS IS GRADE "A" OR 10 OR 1 OR 2. WHAT ARE THE GRADES AND WHAT DOES THAT GRADING MEAN?
>> YOU'RE TALKING ABOUT THE GLEASON SCORE.
>> YEAH, THE GLEASON SCORE ON THE BIOPSY OF THE PROSTATE.
>> SO THE GLEASON SCORE IS DETERMINED BY HOW THE CELLS FROM THE BIOPSY LOOK ON THE MICROSCOPE.
USE CRITERIA TO GAUGE HOW AGGRESSIVE THEY THINK THE PROSTATE CANCER IS.
TYPICALLY ON A BIOPSY WILL GO FROM 6 TO 10. 6 IS THE MOST COMMON TYPE OF PROSTATE CANCER,
WHEN WE TALK ABOUT PROSTATE CANCER BEING SLOW GROWING AND NOT VERY AGGRESSIVE.
>> SAY THAT AGAIN. >> WHEN YOU HEAR THAT PROSTATE CANCER NOT BEING AGGRESSIVE,
SLOW GROWING, YOU'RE TYPICALLY TALKING ABOUT THE GLEASON 6 CANCERS.
>> RIGHT. >> MORE AGGRESSIVE THEY GET, 10 IS A AGGRESSIVE DISEASE THAT YOU DON'T WANT TO HAVE.
>> THAT'S REALLY PREDICTABLE, I MEAN, IF YOU HAVE A GLEASON 10 --
>> YOU'VE GOT TO BE LOOKING FOR IT SOMEWHERE ELSE.
>> YEAH, IT SPREAD, YOU'RE WORRIED.
>> THE PSA, AS WELL AS THE HISTOLOGY OR WHAT IT LOOKS LIKE UNDER THE MICROSCOPE IS
GOING TO PUSH YOU INTO A CERTAIN DIRECTION, DO I NEED TO BE WORRIED ABOUT IT
SOMEWHERE ELSE, DO I NEED TO JUST CONSIDER IT LOCALIZED,
ALL OF THAT COMES INTO, YOU KNOW, DO I SCREEN, JUST LIKE THE ORIGINAL TRUE/FALSE
QUESTION, DO THEY NEED, YOU KNOW, CURATIVE INTENT OR DO THEY JUST NEED SIMPLE OBSERVATION.
>> VERY INTERESTING QUESTION. AND WE COULD HAVE MORE QUESTIONS FROM YOU.
WE REALLY DO APPRECIATE YOUR QUESTION.
>>> A UROLOGIST SEES MANY DIFFERENT PROBLEMS AND DISEASES.
SOME OF THESE ARE MORE OR LESS RELATED, SOME HAVE THEIR OWN SPECIAL NEEDS FOR TREATMENT.
>> SINCE I'M A UROLOGIST AND I DEAL WITH CONDITIONS OF THE KIDNEY, BLADDER, PROSTATE,
COMMON CONDITIONS I TREAT IS KIDNEY TUMORS, KIDNEY STONES,
BLADDER CANCERS, PROSTATE PROBLEMS, PROSTATE CANCERS.
SO, SYMPTOMS LIKE FOR KIDNEY STONES, WHAT MOST COMMON SYMPTOM WOULD BE LIKE FLANK
PAIN, BLOOD IN THE URINE, SOMETIMES THEY'LL COME IN WITH -- THEY USUALLY COME INTO
THE EMERGENCY ROOM WITH SEVERE PAIN, NAUSEA, VOMITING, BLOOD IN THE URINE.
IF THEY'RE DEALING WITH PROSTATE ISSUES, SOMETIMES THEY'LL HAVE TROUBLE PASSING
THEIR URINE, CONTROLLING THEIR URINE, BLOOD IN THE URINE.
THE ONLY WAY TO DIAGNOSE PROSTATE CANCER IS DOING THE BLOOD TEST AND EXAM.
BUT THEN YOU ALSO TELL THEM THAT JUST BECAUSE ABNORMAL DOESN'T MEAN IT'S CANCER.
BUT WE HAVE TO DO A BIOPSY TO FIND OUT IF IT'S CANCER OR NOT BECAUSE IF WE DON'T SCREEN
THEM, A LOT OF TIMES WHEN WE DIAGNOSE PROSTATE CANCER IT'S TOO LATE TO CURE THEM BECAUSE
IT ALREADY SPREAD. THE ONLY WAY TO DO THAT IS BY DOING THE PSA BLOOD TEST.
SOMETIMES THEY'LL COME IN WITH PROBLEMS WITH EJACULATION, LIKE PREMATURE EJACULATION,
BUT MOST COMMONLY IT'S FOR ERECTILE DYSFUNCTION. THEY ARE NOT ABLE TO HAVE,
EITHER NOT ABLE TO HAVE A NORMAL ERECTION OR THEY CAN HAVE AN ERECTION BUT IT
DOESN'T LAST LONG ENOUGH TO BE ABLE TO HAVE SATISFACTORY SEXUAL INTERCOURSE.
ONE THING THAT HAS CHANGED OUR TREATMENT
A LOT IS THE DISCOVERY OF VIAGRA FOR ERECTILE DYSFUNCTION. ABOUT 20 YEARS AGO.
BEFORE THAT, THEY DID NOT HAVE THAT OPTION.
AND THEN WE'D BE DOING MORE INVASIVE TYPES OF TREATMENTS.
BUT WITH THE ADVENT OF VIAGRA, NOW OTHER PILLS, CIALIS, IT'S A LESS INVASIVE WE ARE
TREATING ERECTILE DYSFUNCTION AND ALTHOUGH IT DOESN'T WORK FOR EVERYONE,
IT IS DEFINITELY THE FIRST THING THAT WE GO TO. THE OTHER THING I CAN THINK OF
IN UROLOGY AND THIS IS NOT SPECIFIC TO MEN AND WOMEN, TOO, WITH KIDNEY STONES.
BEFORE I'D SAY MORE THAN 30 YEARS AGO, WE HAD TO DO OPEN SURGERY ON ALL KIDNEY STONES.
NOW WE HAVE A LOT OF DIFFERENT EQUIPMENT AVAILABLE, NICE SCOPES, WE CAN GO IN WITHOUT
MAKING INCISIONS AND EITHER BREAKING STONES UP WITH A LASER OR WE CAN DO -- BREAK UP
THE STONES WITH A SHOCK WAVE MACHINE. UROLOGYHEALTH.ORG. UROLOGYHEALTH.ORG.
IT'S RUN BY THE AMERICAN UROLOGY ASSOCIATION FOUNDATION.
AND IT'S MEANT FOR UROLOGY CONDITIONS FOR THE GENERAL POPULATION TO READ ABOUT IT,
WHAT ARE THE SYMPTOMS, WHAT ARE THE COMMON CONDITIONS THAT UROLOGISTS TREAT.
AND THAT'S A VERY NONBIASED, VERY WELL-RESEARCHED SITE.
>> THIS IS YOUR SHOW AND YOUR QUESTIONS ARE KEY TO OUR SHOW
DISCUSSION, SO CALL IN YOUR QUESTIONS ABOUT MEN'S HEALTH
TO 1-888-376-6225. OR SEND US AN EMAIL TO ASK@PRAIRIEDOC.ORG.
THAT WAS A NICE DISCUSSION WITH Dr. BHAT,
AND HE TALKED ABOUT ROBOTIC SURGERY JUST A BIT.
IS THAT SOMETHING THAT YOU GUYS DO?
>> KIND OF TAKING OVER, IT'S VERY HARD TO FIND PEOPLE WHO
DO THE OLDER VERSION OF REMOVAL OF THE PROSTATE THESE DAYS.
>> FOR A WHILE THERE WAS NO DIFFERENCE BETWEEN THE REGULAR VERSION AND THE ROBOTIC.
NOW WE HAVE SCIENTIFIC DATA THAT SAYS YOU CAN PRESERVE MORE FUNCTION.
WHAT'S THE REASON TO DO ROBOTIC?
>> ROBOTIC JUST ALLOWS EASIER RECOVERY. YOU KNOW, WE KNOW DOCUMENTED BLOOD LOSS IS LESS.
THERE'S A QUESTION IF CONTINENCE IS A LITTLE BIT -- IS GAINED QUICKER.
BUT THE TREATMENT OF PROSTATE CANCER IS SO CONTROVERSIAL BECAUSE WE OVERTREAT PROSTATE
CANCER. AND IT'S A CANCER THAT'S SO LINKED TO FUNCTION. YOU KNOW?
WE TAKE OUT A KIDNEY TUMOR, SOMETIMES THE PATIENT DOESN'T
EVEN REMEMBER WHAT SIDE THEY HAD THEIR SURGERY ON.
BUT WHEN YOU HAVE A CANCER THAT'S TREATED, THAT'S SO LINKED TO URINARY FUNCTION,
SEXUAL FUNCTION, IT CAN IMPACT YOUR DAILY LIFE EVERY DAY.
SO THE DAYS OF, YOU KNOW, INCONTINENCE AND NEVER HAVING AN ERECTION AGAIN,
I THINK THOSE HAVE CHANGE A LITTLE BIT WITH ROBOTICS.
MOST RESIDENTS NOW THAT ARE COMING OUT OF TRAINING BASICALLY, THERE'S PROBABLY
SOME RESIDENCIES THAT THEY DON'T KNOW HOW TO DO AN OPEN PROSTATECTOMY ANYMORE.
>> AND A THOUSAND MILLION -- >> IN THE END, A GOOD SURGEON DOES THEIR SURGERY WELL.
SO THE ONES THAT DO GOOD OPEN SURGERY, OF COURSE THERE ARE.
ARE THERE ONES THAT DO BAD ROBOTIC SURGERY? THERE IS.
BUT I JUST THINK THAT TECHNICALLY WE CAN SHOW A VIDEO JUST ABOUT ROBOTIC
AND DISCUSS A LITTLE BIT ABOUT JUST THE BENEFITS THAT IT PROVIDES.
>> NOW, WE'VE GOT A VIDEO, LET'S LOOK AT THIS VIDEO.
CAN YOU EXPLAIN WHAT'S GOING ON THERE? >> YEAH.
SO WITH ROBOTICS PEOPLE THINK THAT THE ROBOT DOES THE OPERATING.
BUT BASICALLY YOU'RE SITTING DOWN AT A CONSOLE WHERE THE CONSOLE YOUR FINGERS ARE
ACTUALLY MOVING THESE INSTRUMENTS, LIKE THERE'S A SCISSORS, THERE'S A SCISSORS
IN THE RIGHT HAND, AND THEN THERE'S ANOTHER INSTRUMENT CALLED THE BIPOLAR OR MARILIN
IN THE LEFT HAND. >> GET RID OF IT RIGHT THERE.
>> VERY SIMILAR TO A VIDEO GAME.
>> SO, THE BLADDER IS UP ABOVE YOU. WE CAN GO TO THE NEXT CLIP.
YOUR PROSTATE IS THE ORGAN THAT SITS BETWEEN YOUR BLADDER AND THE URETHRA.
CONTIGUOUS WITH THE BLADDER. HERE'S DEMONSTRATION, THE BLADDER IS DOWN HERE, AND THE
SURGEON IS BASICALLY DISSECTING THE BLADDER OFF OF THE PROSTATE.
AND THE PROSTATE GLAND IS RIGHT HERE. CAN GO TO THE NEXT.
SO, HERE IS THE URETHRA. THIS STRUCTURE RIGHT HERE. SO, PART OF THE SURGERY IS
TAKING THE PROSTATE AND THE BLADDER AND SEPARATING THOSE TWO STRUCTURES.
AND THEN DISSECTING THE PROSTATE OFF OF THE URETHRA. AND YOU CAN SEE, YOU'RE
GETTING A GLIMPSE OF THE CATHETER RIGHT THERE. WE'LL GO TO THE NEXT.
SO, AFTER THE PROSTATE IS REMOVED, YOU HAVE TO SEW THE
BLADDER, WHAT THEY'RE DOING HERE NOW, SEWING THE BLADDER BACK TO THE URETHRA.
SO WHAT MAKES THIS SURGERY CRITICAL IS NOT ONLY DO YOU HAVE THE SPHINCTER MUSCLE DOWN
HERE, AFTER THE PROSTATE IS OUT, RESPONSIBLE FOR YOUR
CONTINENCE, BUT YOU ALSO HAVE THE NERVES FOR ERECTIONS THAT RUN RIGHT HERE.
SO SURGERY, DEPENDING ON THE EXTENT OF YOUR CANCER, YOU KNOW, AND VARIOUS OTHER
ANATOMICAL DIFFERENCES OF THEIR PROSTATE CAN MAKE IT CHALLENGING TO SPARE THE
NERVES AND GET A GOOD LENGTH OF THE URETHRA.
BUT I JUST THINK THE VISUALIZATION FROM ROBOTICS AND THE SUTURING, YOU KNOW,
YOU HAVE MANY MORE DEGREES OF FREEDOM OF SUTURING THAN YOU DO DOING OPEN SURGERY.
>> THIS IS THE CATHETER? >> THAT'S THE CATHETER.
>> THAT LIGHT RED? >> YUP. >> THAT'S JUST THE CATHETER,
YOU'RE GOING TO RETIE THE URETHRA AROUND THE CATHETER?
>> THEY'RE USING THAT TO SHOW YOU WHERE THE URETHRA IS.
THE TRUE BENEFIT HERE, ESPECIALLY IN THIS PART OF THE
SURGERY, YOU CAN ACTUALLY SEE WHAT YOU'RE DOING.
THE OLD SURGERY, YOU WERE KIND OF SEWING THINGS BLINDLY, YOU'RE TYING KNOTS BLINDLY,
YOU REALLY COULDN'T SEE.
HERE, YOU CAN SEE THE CAMERA MOVING IN AND OUT, FIRST OF
ALL, HIGH DEFINITION, THE OPTICS ARE REALLY GOOD, SECOND OF ALL, THERE'S TWO LENSES
THERE, SO EVERYTHING'S RENDERED IN 3D.
SO YOU ACTUALLY HAVE DEPTH PERCEPTION.
BUT YOU CAN BRING THAT CAMERA RIGHT UP THERE SO YOU CAN ACTUALLY SEE EXACTLY WHAT
YOU'RE DOING, YOU CAN PRECISELY PLACE THOSE SUTURES THERE.
AND I THINK FROM A TECHNICAL STANDPOINT, YOU CAN JUST DO A
MORE PRECISE JOB SEWING THINGS BACK TOGETHER RIGHT THERE.
>> STILL A MAJOR SURGERY, I THINK, WITH LAPAROSCOPIC AND ROBOTICS, YOU SEE THE SMALL
INCISIONS ON THE OUTSIDE AND YOU THINK THAT SOMETHING SMALL WENT ON IN THE INSIDE.
IT'S NOT NECESSARILY TRUE. IT'S STILL A MAJOR OPERATION AND
IT HAS A RISK AND COMPLICATIONS.
>> WOW, THAT'S REALLY NEAT. YOU KNOW, MY QUESTION IS, YOU
MENTIONED THAT URINARY INCONTINENCE IS A PROBLEM.
THAT OFTENTIMES IS TEMPORARY. CORRECT?
>> USUALLY. >> USUALLY. CONTINENCE COMES BACK, PEOPLE CAN CONTROL THEIR LEAKING.
>> USUALLY HEALING WILL HAPPEN WITHIN THAT FIRST YEAR.
I TELL PEOPLE TO BE PATIENT, KIND OF EXPECT A YEAR BEFORE WE KNOW WHERE THINGS SETTLE.
>> WEAR A LITTLE PAD FOR A YEAR OR SO. >> YOU CAN.
SOME PEOPLE GET CONTINENCE FASTER THAN OTHERS.
WE SOMETIMES HAVE THEM DO EXERCISES, KAGEL EXERCISES, WOMEN DO SOMETIMES,
TO HELP STRENGTHEN THE MUSCLES, TO KIND OF GAIN FUNCTION. BUT, YEAH, I MEAN,
SOMETIMES -- WE HOPE THAT PEOPLE WILL BE PRETTY DRY,
MAYBE THEY'LL HAVE TO USE A PAD OR TWO. BUT IDEALLY, THEY'RE GOING TO BE VERY DRY.
BUT NOT EVERYBODY IS GOING TO HAVE THAT OUTCOME.
THERE ARE SOME PEOPLE WHO WILL HAVE SIGNIFICANT INCONTINENCE.
>> THE OTHER ONE IS SEXUAL DYSFUNCTION. EXPLAIN THAT PROBLEM.
>> WELL, MEN ARE MADE UP WITH BASICALLY FOUR DIFFERENT NERVE SETS.
YOU HAVE A MISSION, EJACULATION, ERECTIONS, ORGASM
OR SENSATION, BUT THE NERVES THAT RUN NEXT TO THE PROSTATE
JUST ARE RESPONSIBLE FOR ERECTIONS. SO DOING A SURGERY, DEPENDING ON THE EXTENT OF THE DISEASE,
SOMETIMES YOU HAVE TO TAKE THOSE NERVES, SO IT MAKES IT
DIFFICULT TO GET NATURAL ERECTIONS, SO, THAT'S GOING TO RESULT IN REQUIRING
SUPPLEMENTATION AFTERWARDS IN VARIOUS FORMS.
>> SUPPLEMENTATION MEANING? >> PILLS, INJECTIONS, PUMP.
AND THEN THE LAST RESORT IS CALLED A PENILE PROSTHESES.
>> THOSE ARE -- BUT THEY HAVE THE REST OF IT. THEY DON'T LOSE THE OTHER PARTS.
>> THEY HAVE NOWHERE NEAR THE NERVES FOR SENSATION.
>> WOW.
>> NO SENSATION BUT YOU'LL LOSE THE EJACULATION BECAUSE YOU'RE GETTING RID OF THOSE
STRUCTURES DURING SURGERY. >> ALL RIGHT. BUT THE ORGASM IS STILL THERE?
>> YES. >> THAT'S REASSURING. >> HAVE YOU EVER SAID ORGASM ON THIS SHOW EVER BEFORE?
>> OH, PROBABLY A COUPLE OF TIMES. >> I DON'T THINK SO. I DON'T THINK SO. [ LAUGHTER ]
>> I DON'T HAVE THE INHIBITORY, ASK MY WIFE. NO FILTER.
>> YEAH. >> SO, WE HAVE SOME GOOD QUESTIONS.
AND I APPRECIATE, I APPRECIATE THE QUESTIONS.
WITHIN THE LAST TWO YEARS, HUSBAND HAS LOST LOTS OF WEIGHT.
DOWN TO BONE AND FLESH. IS STILL ACTIVE, ANY REASON HE
COULD BE LOSING SO MUCH WEIGHT? WHY IS HE LOSING WEIGHT?
THAT'S NOT SPECIFIC TO UROLOGY. I'LL GIVE YOU A QUICK ANSWER.
A LOT OF REASONS. SOME OF THEM ARE G.I. TRACT REASONS.
SOME OF THEM ARE EMOTIONAL REASONS. SOMETIMES THERE IS CANCER.
SOMETIMES THERE'S AN INFECTION. I THINK THE MAJOR THING IS, THOUGH, WHEN PEOPLE LOSE
WEIGHT LIKE THAT, YOU NEED TO BE CHECKED OUT.
AND, SO, THAT'S A TAKE-HOME MESSAGE I WOULD LOVE FOR YOU ALL TO HAVE.
MEN DON'T ALWAYS COME IN AND BE SEEN WHEN THEY SHOULD.
AND WEIGHT LOSS IS ONE REASON TO COME IN AND SEE THE DOCTOR. ADD ANYTHING MORE? OKAY.
89-YEAR-OLD, VERY ACTIVE, GOOD HEALTH, TAKES TWO TAM EWE
LOWSIN EACH MORNING, TWO TYLENOL OR TWO ALEVE AND FINDS IT DECREASES THE DISCOMFORT,
AMOUNT OF TIME HE NEEDS TO GET UP AT NIGHT, WONDERING WHAT
THE DOCTORS THINK ABOUT THAT REGIMEN FOR GETTING UP, PREVENTING HAVING TO GET UP AT NIGHT.
LET'S TALK ABOUT NIGHTTIME NOCTURIA, NIGHTTIME URINE. EUGENE.
>> VERY COMMON, STARTS AROUND THE AGE OF 50.
YOU KNOW, I FOCUS MORE ON THE BOTHER WITH PEOPLE.
YOU KNOW, THERE ARE GUYS WHO GET UP A COUPLE TIMES A NIGHT, DOESN'T BOTHER THEM,
THERE ARE GUYS THAT GET UP MANY TIMES A NIGHT, IT DOESN'T BOTHER THEM.
I HAVE GUYS THAT GET UP ONCE A NIGHT, IT BOTHERS THEM.
BEING ON TWO FLOMAX, IF YOU'RE HAPPY WITH IT, YOU FEEL LIKE YOU'RE EMPTYING,
CHECK YOUR UROLOGIST, THEY SEE THAT YOU'RE EMPTYING, YOU'RE NOT
GETTING INFECTION, I DON'T SEE A PROBLEM WITH THAT.
>> AS AN INTERN, MY ONLY PROBLEM WITH FLOMAX AND THE OTHER
IN THAT GROUP IS THAT A LOT OF TIMES YOU GET UP TO GO TO THE BATHROOM AND THEN YOUR
BLOOD PRESSURE DROPS. YOU GET ORTHOSTATIC HYPOTENSION.
AS LONG AS YOU'RE NOT LIGHTHEADED WHEN YOU STAND UP,
YOU CAN STAND UP, CATCH YOUR PRESSURE BEFORE YOU CHARGE
AWAY FROM THE BED, THEN THAT'S FINE.
BUT YOU HAVE TO BE AWARE OF BEING AT RISK
OF THAT PARTICULAR GROUP OF PROSTATE MEDICINES. I'M UP TWICE A NIGHT.
AND I'VE OFTEN SAID THAT IF YOU'RE UP ONE TIME AT NIGHT, YOU'RE HEALTHY.
TWICE A NIGHT, YOU'RE AN OLDER GUY. AND NO BIG DEAL. WHOOP.
FEMALE CALLER IS BOTHERED WITH KIDNEY STONES SEVERAL YEARS AGO.
SHE WAS TOLD TO DRINK DISTILLED AND WARM WATER.
IS THIS A GOOD WAY TO PASS KIDNEY STONES?
WHY THE DISTILLED AND WARM WATER AND WHAT'S THE OTHER TREATMENT OPTIONS? NATE?
>> I NEVER HEARD THAT, DISTILLED WATER.
>> WORRIED ABOUT THE MINERALS IN THE WATER.
>> THERE'S SOME THOUGHT ABOUT, ARE YOU DRINKING SOFT WATER,
DO YOU LIVE SOMEWHERE WHERE YOU HAVE WELL WATER SO THE AMOUNT OF SOLUTE IN THE WATER
CAN INCREASE YOUR RISK.
THE BIG TAKE-AWAY IS PEOPLE THAT HAVE A HISTORY OF KIDNEY STONES, YOU KNOW,
IN A GOOD WORKUP, YOU SHOULD TAKE A LOT OF TIMES A SURGICAL DISEASE
AND MAKE IT A MEDICAL DISEASE, WHERE PEOPLE THAT HAVE A HISTORY THEY NEED A WORKUP,
WHICH IS CALLED A 24-HOUR URINE COLLECTION WHERE YOU CHECK THE URINE FOR 24 HOURS,
YOU DO A FEW LABS JUST TO MAKE SURE THERE'S NOT A METABOLIC PROBLEM.
>> HYPERPARATHYROID OR SOMETHING LIKE THAT?
>> JUST HAD A PATIENT NOT TOO LONG AGO,
THAT'S GETTING THEIR PARATHYROID GLANDS TAKEN OUT.
BUT, YOU KNOW, SOMETIMES JUST EVEN BEHAVIORAL CHANGES, YOU
CAN ELIMINATE THE GROWTH AND RECURRENCE OF THEIR STONES. >> ALL RIGHT.
LIKE YOU SAID EARLIER, LOTS OF WATER. I THINK TAP WATER'S A GOOD THING.
>> I THINK IT'S THE VOLUME OF WATER THAT'S MORE IMPORTANT
THAN THE ACTUAL WHAT TYPE OF WATER. >> YEAH.
I HAVE NOT BEEN A BIG PUSHER OF WATER IN MY PRACTICE. A LOT OF PEOPLE SAY, OH, YEAH,
DRINK A LOT OF WATER BECAUSE THIS IS A HEALTHY THING.
WHEN YOU'RE TALKING WITH UROLOGISTS WHO DEAL WITH
KIDNEY STONES, OKAY, WE NEED TO DRINK WATER.
>> WELL, THERE'S A NICE MIX BECAUSE YOU START DRINKING TOO MUCH WATER,
THEN YOU'RE BOTHERED BY YOUR FREQUENCY AND URGENCY.
>> YOU'RE UP 20 TIMES AT NIGHT. OF COURSE, YOUR SODIUM DROPS. >> YEAH.
>> 89-YEAR-OLD -- 65-YEAR-OLD MAN FROM KIMBALL HAS A VERY LOW TESTOSTERONE COUNT.
65. LOW TESTOSTERONE. DOCTOR SAID THEY MIGHT PUT HIM
ON HORMONE TREATMENT TO FIX THE ISSUE.
WHY WOULD HIS TESTOSTERONE BE LOW?
AND WHAT DO YOU RECOMMEND FOR PEOPLE WITH LOW TESTOSTERONE?
SHOULD WE BE TESTING ALL THESE PEOPLE FOR TESTOSTERONE LEVELS?
>> DEPENDS IF HE HAS SYMPTOMS. >> WHAT SYMPTOMS?
>> WELL, A LOT OF TIMES SYMPTOMS, IT'S FATIGUE, SOMETIMES IT CAN BE LIKE --
>> EVERYBODY'S GOT FATIGUE. >> DEPRESSIVE SYMPTOMS.
>> A LOT OF PEOPLE ARE DEPRESSED.
>> THEY JUST DON'T HAVE THE ENERGY TO DO WHAT THEY'RE USED TO DOING.
LOW SEXUAL DESIRE. LOW LIBIDO.
BUT, YOU KNOW, I'M IN THE KIND OF THE GROUP THAT
I TREAT SYMPTOMS AND NOT JUST THE NUMBER.
BUT USUALLY A TESTOSTERONE LESS THAN 300 IS WHAT'S CALLED LOW TESTOSTERONE.
AND TREATMENT MAKES THESE MEN FEEL BETTER, GIVES THEM MORE ENERGY, THERE'S SOME QUESTION,
CAN IT HELP WITH ERECTILE FUNCTION, BUT THERE'S SOME RISKS TO GOING ON TESTOSTERONE.
>> AND THOSE RISKS ARE? >> WELL, WE HAVE TO FOLLOW THEIR PSA.
YOU HAVE TO FOLLOW THEIR BLOOD COUNTS.
>> BECAUSE YOU WORRY ABOUT PROSTATE CANCER. >> YOU JUST HAVE TO CHECK THAT.
IS IT STILL SAFE? IT'S STILL SAFE TO DO TESTOSTERONE EVEN IN PATIENTS
THAT HAVE HAD PROSTATE CANCER TREATMENT, BUT ANOTHER ONE IS
WHERE THE BLOOD COUNT GETS TOO HIGH, YOU HAVE TO CHECK BLOOD
COUNTS AS WELL WHEN YOU'RE ON TESTOSTERONE. >> RIGHT.
BACK YEARS AGO, I DID A LOT OF THIS AND I KIND OF BACKED OFF
AS MY PATIENT POPULATION GOT OLDER AND OLDER AND I TESTED LESS,
BUT WHEN I FOUND A LOW TESTOSTERONE, SYMPTOMATIC, I'D TREAT IT WITH TESTOSTERONE
SHOTS THAT ARE CHEAPER THAN THE TOPICAL AND THE PATCHES AND ALL THAT.
THEY'RE MARKEDLY CHEAPER. WHAT'S YOUR TAKE ON THAT, EUGENE?
>> THEY'RE CHEAPER, IT'S MORE ACCESSIBLE TO PEOPLE.
THE PROBLEM IS, YOU KIND OF DEVELOP THESE PEAKS AND VALLEYS THEN.
SO YOU GET THIS BIG SURGE, PEOPLE FEEL GREAT, AND THEN AS
THEY GET TO THE END OF THEIR CYCLE, THEY START FEELING NOT SO GREAT.
SO IF YOU CAN GET THE PATCHES OR THE CREAMS, THINGS LIKE
THAT, YOU GET A MORE STEADY STATE AS FAR AS THE LEVEL OF TESTOSTERONE.
BUT YOU'RE RIGHT, IT IS MUCH CHEAPER. SOMETIMES THAT'S -- THAT'S A FACTOR.
>> THERE'S SOME OTHER ENDOCRINE WORKUP THAT YOU CAN DO TO SEE,
IS IT TESTICULAR FAILURE?
>> I THINK TOO MANY PEOPLE DON'T ACTUALLY DO -- WHY THE TESTOSTERONE IS LOW.
>> SOMETIMES IT'S NOT JUST A SHOT OR A CREAM.
SOMETIMES A PILL WILL HELP DEPENDING ON WHERE THE DEFECT
IS COMING FROM OR WHERE THE LOW COUNTS ARE COMING FROM.
>> YOU WAIT FOR SYMPTOMS BEFORE YOU SCREEN.
YOU DON'T SCREEN EVERYBODY AT A CERTAIN AGE? >> NO.
>> IF I'M 80, I'M LOW TESTOSTERONE, WHAT WOULD YOU SAY TO THAT?
>> I'VE SEEN SOME STUDIES TALK
ABOUT THE BENEFITS OF ACTUALLY GIVING IT TO OLDER MEN FOR REASONS FOR MUSCLE GAIN.
>> YEAH. >> HEALTH REASONS. SOMETIMES IT'S DEPRESSION ISSUE.
YES, FOR COGNITION. I THINK FROM A HEALTH STANDPOINT,
IF WE'RE TALKING ABOUT GAINING MUSCLE MASS, GETTING THEM MORE HEALTHY,
I THINK THAT'S ACTUALLY REASONABLE, BUT IF WE'RE DOING
IT JUST BECAUSE THEY'RE TIRED, YOU KNOW, THE COMPANIES ACTUALLY GOT IN TROUBLE
RECENTLY BECAUSE THEY WERE ADVERTISING SO WIDELY,
BASICALLY ASKING EVERYONE OVER 50 THAT DON'T FEEL LIKE THEY'RE 18 ANYMORE. NO ONE --
>> BUY MY PATCHES BECAUSE THEY'RE REALLY PROFITABLE FOR US.
>> BUT, YEAH, I MEAN, YOU HAVE TO GO BY THE SYMPTOMS.
YOU CAN HAVE A LOW TESTOSTERONE, ACTUALLY NOT HAVE ANY OF THOSE SYMPTOMS. >> YEAH.
YOU CAN HAVE A GENTLEMAN WITH A TESTOSTERONE OF 200 WITH
REALLY MINIMAL SYMPTOMS OR 350 AND THEY HAVE A LOT OF SYMPTOMS.
>> PEOPLE FORGET TESTOSTERONE IS JUST A COMPONENT TO SOME OF THESE SYMPTOMS.
IT'S NOT LIKE TESTOSTERONE CONTROLS SEXUAL FUNCTION OR CONTROLS, YOU KNOW,
DEPRESSION, THINGS LIKE THAT. JUST A PART OF WHAT MAY BE ADDING TO THAT.
>> THE ONE THING THAT ALWAYS DREW ME AWAY FROM USING
TESTOSTERONE SUPPLEMENTATION WAS I HAD A NUMBER OF PATIENTS
WHO HAD WIDESPREAD PROSTHETIC CANCER, TO THE BONE, IN PARTICULAR, AND BASICALLY WE
TURNED OFF THEIR TESTICLES WITH MEDICINE OR -- AND WE DID A LOT OF THIS IN THE OLDER
DAYS, WOULD JUST REMOVE THE TESTICLES AND THEN YOU DIDN'T NEED TO TAKE PILLS, IT WAS
MUCH CHEAPER. LONG TERM. AND THE CANCER WOULD GO AWAY.
WHICH MAKES ME WORRY ABOUT GIVING OLDER PEOPLE WHO YOU
THINK YOU KNOW THEY'RE GOING TO HAVE SOME LEVEL OF PROSTATE CANCER,
I MEAN, WHAT DO THEY SAY, 50 TO 75% WILL HAVE PROSTATE CANCER AT 85?
IF YOU JUST DID AUTOPSIES IN EVERYBODY. SO THERE'S THE ONLY RUB TO THAT.
ANY COMMENT ON THAT, NATE?
>> I MEAN, YOU HAVE TO SCREEN THEM. I MEAN, AT THAT AGE, YOU KNOW,
IT'S A WHOLE LEVEL OF CONTROVERSY, SHOULD WE EVEN BE, AFTER 70, EVEN SCREENING
MEN FOR PROSTATE CANCER, LET ALONE, YOU KNOW, TRYING TO FIND IT.
SO THEY ARE SYMPTOMATIC, YOU DO TESTOSTERONE SUPPLEMENTATION, THEY'RE
FEELING BETTER, YOU CAN CHECK A PSA TO MAKE SURE IT DOESN'T JUMP SIGNIFICANTLY.
>> YEAH. >> JUST MONITORING, WATCHING THEM.
>> ANY DRUG HAS SIDE EFFECTS AND TESTOSTERONE'S NO DIFFERENT.
>> OKAY. IS THERE A HOME TEST TO DETERMINE IF THE BLADDER IS
VOIDING COMPLETELY DUE TO RESTRICTION FROM AN ENLARGED PROSTATE?
THAT'S A REALLY PRETTY GOOD QUESTION.
>> IT'S CALLED PASSING THE CATHETER ON YOUR OWN. >> YEAH.
YOU KNOW, HOW MUCH DO YOU HAVE LEFT?
SO, OFTENTIMES WE USED TO DO, IN ONE NURSING HOME I HAVE AN ULTRASOUND MACHINE
AND I CAN SEE HOW MUCH IS IN THE BLADDER AFTER THEY'VE EMPTIED THEIR BLADDER.
YOU KNOW, HAVE THEM EMPTY THEIR BLADDER, THEN SEE HOW MUCH IS LEFT.
ANOTHER PLACE, JUST PUT A CATHETER IN THERE AND SEE HOW
MUCH IS LEFT INSTEAD OF AN ULTRASOUND MACHINE.
EITHER WAY, WHAT'S THE MAGIC NUMBER?
WHEN SOMEONE EMPTIES THEIR BLADDER AND THEN THERE IS HOW MUCH LEFT,
YOU KNOW THERE'S A PROBLEM?
>> I DON'T THINK THERE IS A MAGIC NUMBER.
I THINK THAT AS WE GET OLDER, WE'RE NOT GOING TO BE AS
EFFICIENT -- OUR BODIES AREN'T AS EFFICIENT, SO, FOR ME, I
WILL ACTUALLY BE OKAY WITH A HIGHER NUMBER, IF YOU'RE NOT EMPTYING COMPLETELY,
SO LONG AS YOU'RE NOT HAVING PROBLEMS LIKE BLADDER STONES OR URINARY
TRACT INFECTIONS OR KILLING OFF YOUR KIDNEYS BECAUSE THE PRESSURE IS TOO HIGH.
THERE'S SOME GUYS WHO DON'T, THEY GO ALONG, THEY DON'T EMPTY COMPLETELY, THEY DO FINE.
I DON'T NECESSARILY FEEL LIKE THERE'S A PROBLEM,
AS LONG AS THEY'RE NOT HURTING THEIR KIDNEYS.
BUT I WILL SAY, THE YOUNGER YOU ARE, THE MORE ABNORMAL THAT IS.
SO A LOWER NUMBER MAY BE A LITTLE BIT MORE UNUSUAL IN SOMEONE WHO'S YOUNGER.
>> YEAH. LET'S GO TO THAT QUESTION ABOUT BLADDER CATHETERS.
I HAVE A PATIENT WHO HAD GONE TOO LONG WITH BENIGN PROSTATIC
HYPERTROPHY AND HIS BLADDER GOT STRETCHED AND STRETCHED,
THE MUSCLES THAT WERE NORMALLY EMPTYING KIND OF GAVE UP.
FINALLY, THE PROSTATE WAS BENIGN PROSTHETIC, THEY DID A ROTOR ROOTEDDER,
TOOK THE PROSTATE OUT OF THERE, BUT NOW HE HAS A BLADDER THAT DOESN'T WORK.
HE PUTS A CATHETER IN THERE THREE OR FOUR TIMES A DAY, AND THERE'S NO PROBLEM.
YOU HAVE A LOT OF PATIENTS WHO DO THAT? >> YUP.
>> I KNOW THAT TWO OF MY PATIENTS USE A CATHETER.
THEY CLEAN IT AND THEY REDO IT.
AND THEY NEED A NEW CATHETER ABOUT EVERY THREE TO SIX MONTHS.
THEY USE THAT SAME OLD CATHETER FOR THREE TO SIX MONTHS.
BUT RIGHT NOW THE BIG DEAL IS A BRAND-NEW CATHETER EVERY TIME. WHICH IS HUGELY EXPENSIVE.
AND YOU KNOW FULL WELL THAT BOTH GROUPS, WHETHER YOU'RE
GETTING A BRAND-NEW CATHETER EVERY TIME OR WHETHER YOU'RE JUST CLEANING THAT CATHETER
CAREFULLY AND GOING FOUR TIMES A DAY WITH THAT SAME CATHETER
THAT'S KEPT IN A BATH THAT'S STERILIZING, THAT THEY'RE ALL
GOING TO HAVE SOME BACTERIAL GROWTH IN THOSE BLADDERS.
WHAT'S YOUR COMMENT ABOUT THAT ISSUE OF HAVING TO USE A NEW CATHETER EVERY TIME?
YOU SOUNDED LIKE YOU KIND OF LIKED THAT IDEA.
>> THE RATES OF INFECTION OR I SHOULD SAY CLINICALLY RELEVANT
INFECTIONS IS A LITTLE BIT LOWER, BUT YOU'RE RIGHT,
ANYBODY THAT HAS ANY FOREIGN BODY EVER IN THEIR BODY, ESPECIALLY THEIR BLADDER,
THEY'RE GOING TO BE COLONIZED WITH BACTERIA, EVERY TIME YOU
CHECK A URINE CULTURE, A LOT OF TIMES IT WILL SHOW INFECTION.
IS THAT CLINICALLY RELEVANT OR NOT?
USUALLY NOT UNLESS THEY'RE HAVING SYMPTOMS LIKE FEVERS OR PAIN.
BUT THERE'S DEFINITELY A BENEFIT TO CLEAN INTERMITTENT
CATHETERIZATION WHERE THAT BLADDER STILL GOES THROUGH ITS
FILL AND EMPTY CYCLE AND THE RATE OF PROBLEMATIC INFECTIONS
IS MUCH LESS THAN HAVING AN INCATHETER.
>> THAT'S ABOUT IT? YOU AGREE?
>> I REMEMBER WHEN THE WHOLE ISSUE OF CLEAN -- FRESH CATHETER EVERY TIME CAME OUT,
INSURANCES WEREN'T REALLY COVERING THAT INITIALLY.
I THINK THAT'S CHANGED OVER TIME, MORE INSURANCES WILL PAY FOR IT.
SO IT'S BECOMING LESS OF A FINANCIAL -- I REMEMBER WHEN
PEOPLE HAD TO PAY FOR EACH INDIVIDUAL CATHETER, WHICH WAS A BIG DEAL.
I THINK THAT'S BECOMING A LITTLE LESS.
BUT ANYONE I CAN TRY TO CONVINCE TO CATHETERIZE
THEMSELVES OVER HAVING AN INCATHETER, I TRY TO DO THAT. BUT NOT EVERYBODY CAN.
SOMETIMES THE MANUAL DEXTERITY THING. >> THAT'S THE THING.
WE CAN COME UP WITH A NUMBER OF WAYS TO DECREASE THE OUTLET RESISTANCE,
LIKE OPENING UP THE PROSTATE OR THESE VARIOUS MEDICATIONS, BUT THERE'S REALLY NO MEDICINE
OR TREATMENT OR SURGERY THAT MAKES THE BLADDER CONTRACT BETTER THAT'S EFFECTIVE.
>> YEAH, WE HAVE TWO GROUPS OF MEDICINES THAT HELP WITH A PERSON WHO HAS BENIGN
PROSTATIC HYPERTROPHY THAT'S BLOCKING THE FLOW, ONE IS THE FAST-ACTING ONE,
FLOMAX IS THE BRAND NAME OF ONE.
AND THEN THERE'S ANOTHER THAT BASICALLY REDUCES TESTOSTERONE EFFECT ON THE PROSTATE.
THE FIRST ONE HAS THE SIDE EFFECT OF MAKING YOU PASS OUT
WHEN YOU GET UP IN THE MIDDLE OF THE NIGHT, LOWERS YOUR BLOOD PRESSURE.
BUT FOR THE MOST PART, IT WORKS PRETTY WELL IN SOME PEOPLE.
THE SECOND ONE REALLY GRADUALLY WORKS BETTER AND BETTER OVER A LONG PERIOD OF TIME.
BUT IT LOSES -- BUT IT BLOCKS THE TESTOSTERONE
AND YOU END UP WITH SEXUAL DYSFUNCTION MOSTLY. HOW DO YOU USE THOSE MEDICINES?
WHEN DO YOU NOT USE THEM?
>> THE MEDICINE YOU'RE TALKING ABOUT THAT SHRINKS THE GLAND
DOWN WORKS BETTER ON PEOPLE WITH BIGGER PROSTATES.
AND THAT'S WHERE THE PHYSICAL EXAM THAT WE TALKED ABOUT EARLIER IS IMPORTANT TO GET AN
IDEA OF HOW BIG THAT GLAND IS.
IT'S NOT AS EFFECTIVE IN PEOPLE WITH SMALLER GLANDS.
SO IF I SEE SOMEONE, I FEEL THEIR GLAND IS NOT VERY SMALL, PROBABLY LESS LIKELY TO
RECOMMEND THE MEDICINE THAT SHRINKS THE GLAND.
VERSUS SOMEONE WITH A BIGGER GLAND. YOU ALWAYS MENTION THE SEXUAL DYSFUNCTION.
THERE'S SOME GUYS WHO JUST WON'T EVEN RISK IT.
>> THE SEXUAL FUNCTION IS IMPORTANT TO THEM. >> YES.
SO THEY DON'T EVEN WANT TO POTENTIALLY RISK LOSING SEXUAL FUNCTION,
IT'S NOT SOMETHING THAT I OFFER. >> YEAH.
>> WELL, THAT'S THE THING, YOU KNOW, YEARS AGO, RESECTION OF
THE PROSTATE WAS THE MOST COMMON PROCEDURE IN THE COUNTRY.
BUT WITH THE ADVENT OF THESE MEDICINES, GRANTED, WITH THE MEDICINES THAT SHRINK THE
PROSTATE, IT JUST STOPS THE NEXT HORMONE BEYOND TESTOSTERONE, DIHYDROTESTOSTERONE.
SO THEIR TESTOSTERONE ACTUALLY CAN GO UP A LITTLE BIT.
STILL, YOU KNOW, YOU HAVE SOME OF THOSE MEN THAT HAVE SEXUAL DYSFUNCTION,
BUT I THINK THE PUSH FOR BOTH THOSE MEDICINES,
TWO LARGE RANDOMIZED STUDIES SHOW THAT PEOPLE THAT WERE ON
BOTH MEDICINES THAT HAD ENLARGED PROSTATES DID BETTER.
BUT THERE ARE SOME MEN THAT HAVE NO DESIRE TO TAKE TWO
MEDICATIONS FOR THE REST OF THEIR LIFE.
THEY'D RATHER HAVE SOME SORT OF PROCEDURE, OPEN UP THE PROSTATE,
AND OTHER ONES WANT TO AVOID SURGERY AT ALL COSTS AND WILL STAY ON THE MEDICINES.
>> I'LL TAKE THE TURP, I THINK WE SHOULD DO MORE,
I LIKE AVOIDING MEDICINES WHEN YOU CAN. THAT'S FROM AN INTERNIST.
60-YEAR-OLD MALE, PSA HAS ALWAYS BEEN LESS THAN ONE UNTIL RECENTLY WHEN IT WAS 18.
ANTIBIOTIC WAS GIVEN, PSA DROPPED TO TWO.
WHAT IS YOUR RECOMMENDATION FOR FOLLOW-UP TESTING? >> UF.
I ALWAYS WATCH THOSE CAREFULLY.
IN THAT SITUATION, IT'S VERY COMMON TO GET SOMETHING CALLED
PROSTATITIS OR INFLAMMATION OF THE PROSTATE. >> AN INFECTION? >> YEAH.
A LOT OF THINGS CAN EFFECT THE PSA, INCLUDING INFECTION, AND INFLAMMATION.
SO WHEN YOU SEE A SUDDEN SPIKE LIKE THAT, IT GOES DOWN AFTER TREATMENT,
USUALLY OKAY WATCHING IT, BUT I ALWAYS JUST WATCH IT JUST IN CASE THAT'S
SOME SORT OF A PATTERN WHERE THE NUMBER STARTS RISING OVER TIME.
I WOULD JUST CHECK IT, THE PSA FROM TIME TO TIME. >> AND A RECTAL EXAM.
>> FREQUENT URINATION EVERY HOUR DURING THE DAY AND WAS
WONDERING WHAT THE ISSUE WAS OR THE REASON.
CAN NORMALLY MAKE IT A COUPLE HOURS DURING THE NIGHT, BUT STILL REMAINS AN ISSUE.
FREQUENCY OF URINATION. NATE?
>> I THINK THE THING THAT'S BEEN SHOWN TO BRING MEN TO THE
DOCTOR OR THE UROLOGIST IS NOCTURIA. >> TIME URINE. >> YUP.
I TRY TO GET A HANDLE ON, ARE THEIR DAYTIME SYMPTOMS AS BAD AS THE NIGHTTIME SYMPTOMS?
BECAUSE SOMETIMES NIGHTTIME SYMPTOMS AREN'T ALWAYS A RESULT OF A BLADDER OR
PROSTATE ISSUE, SOMETIMES IT'S SLEEP APNEA, FLUID OVERLOAD,
EDEMA, SWELLING IN THE LOWER EXTREMITIES. >> YEAH, HEART FAILURE.
>> HAD IN THOSE PATIENTS I ALWAYS MONITOR HOW WELL THEY'RE EMPTYING THEIR
BLADDER, WHAT'S THEIR LEVEL OF BOTHER, AS LONG AS THEIR URINE'S CLEAN, YOU CAN TRY THE
VARIOUS MEDICATIONS THAT WE STARTED BEFORE, AND SEE IF YOU CAN IMPROVE THEIR FREQUENCY,
URGENCY. BUT THOSE KIND OF TWO GROUPS OF SYMPTOMS.
THE SYMPTOMS THAT ARE MORE LIKE OVERACTIVE, LIKE FREQUENCY, URGENCY, BUT THEN
THERE'S THE OBSTRUCTIVE TYPE SYMPTOMS WHERE PEOPLE HAVE SLOW FLOWS, HARD TO GET STARTED,
I FEEL LIKE I'M NOT EMPTYING SO I KIND OF TRY TO SEE PRIMARILY WHERE THEIR SYMPTOMS LIE.
>> RIGHT. URINARY INFECTIONS EVERY SIX WEEKS. HAS TAKEN ANTIBIOTICS,
SPOKEN WITH INFECTIOUS DISEASE PHYSICIANS REGARDING THE INFECTIONS.
THEY DISCOVERED IT WAS AN ANTIBIOTIC-RESISTANT INFECTION,
WHAT OPTIONS ARE THERE FOR TREATMENT? >> EUGENE? [ LAUGHTER ]
>> I HAVE A COMMENT, TOO. >> I MEAN, THAT'S -- I DON'T THINK IT'S A SIMPLE SOLUTION.
THERE CAN BE A LOT OF DIFFERENT CAUSES. YOU COULD BE EMPTYING YOUR --
THEY MAY NOT BE EMPTYING THEIR BLADDER COMPLETELY. >> YEAH.
>> IT COULD BE A FOREIGN BODY LIKE A STONE THAT'S GETTING INFECTED.
STONES ARE NOTORIOUS FOR HARBORING BACTERIA AND THEY
WON'T GO AWAY UNTIL YOU TREAT STONES.
>> NEED TO SCOPE THEM, DON'T YOU? >> SOMETIMES YOU'VE GOT TO SCOPE THEM.
I WOULD AT LEAST START OFF WITH A C.T. TO MAKE SURE IT'S NOT A KIDNEY STONE.
MAKE SURE THEY'RE EMPTYING THEIR BLADDERS COMPLETELY.
YEAH, THERE'S A WHOLE HOST OF THINGS THAT COULD BE GOING ON.
>> YOU KNOW, I THINK WE OVERTREAT BLADDER INFECTIONS, A LOT OF -- LIKE WE KNOW,
80% OF ALL WOMEN IN A NURSING HOME ARE GOING -- >> ASYMPTOMATIC BACTERIA.
>> ASYMPTOMATIC BACTERIA. YOU CAN JUSTIFY AN ANTIBIOTIC EVERY TIME YOU TURN AROUND.
YOU ARE KNOW, THEY ACT A LITTLE BIT DIFFERENT,
OH, BLADDER INFECTION, HERE'S AN ANTIBIOTIC. THERE GOES THEIR NORMAL FLORA.
THEIR MICROBIOME IS WIPED OUT, THAT'S A BAD THING. WANT TO AVOID ANTIBIOTICS.
I'VE USED A LOT OF VITAMIN C SUPPLEMENTS TO PREVENT URINARY TRACT INFECTIONS.
YOU TAKE THE -- THESE WOMEN IN THE NURSING HOME, PUT THEM ON VITAMIN C FOUR TIMES A DAY,
I KNOW THE STUDIES ARE NOT REALLY BACK, BUT I HAVE SEEN IT, I HAVE SEEN IT,
IT WORKS, DO YOU AGREE? >> THE STUDIES ARE CONFLICTING.
I MEAN, THERE'S A LOT OF THINGS THAT WE FEEL THAT DECREASE INFECTIONS, BUT, YOU KNOW,
THAT'S A WHOLE DISCUSSION, IS THE DATA REALLY REAL-WORLD EXPERIENCE, WHERE
YOU HAVE, YOU KNOW, INCREASE FLUIDS, YOU KNOW, IN WOMEN URINATING BEFORE OR AFTER
INTERCOURSE, BUT THERE'S DEFINITELY --
>> PARTICULARLY IF THEY'RE IN THE NURSING HOME. THAT WAS A JOKE. I'M SORRY.
OKAY, GO AHEAD. [ LAUGHTER ] >> I CAUGHT IT, YEAH. YOU KNOW, THERE'S SOME -- --
>> WE'VE GOT ONE MINUTE, THREE QUESTIONS.
>> THERE'S SOME BENEFIT WITH, LIKE, VAGINAL ESTROGEN AND PROBIOTICS AND THINGS LIKE
THAT THAT YOU CAN ACTUALLY UTILIZE INSTEAD OF ANTIBIOTICS. THAT DECREASE THE RISK.
>> YES OR NO. I'M GOING TO, EUGENE, A CALLER FROM MITCHELL SAYS, IS THERE
ANY RESEARCH IN THE MEDICATIONS FOR ERECTILE
DYSFUNCTION THAT HAVE SIDE EFFECT OF DECREASING HEARING? >> HEARING?
I KNOW THAT SOMETIMES YOU CAN HAVE VISUAL CHANGES. THERE ARE RECEPTORS IN THE EYES.
>> I'VE HEARD VISUAL CHANGES BUT I HAVEN'T HEARD THE HEARING PROBLEM.
>> HUM-UM. >> CAN YOU EXPLAIN -- >> HE'S JUST NOT HEARING HIS WIFE SAY NO.
I'M NOT INTERESTED. THAT'S WHAT I WAS THINKING. >> YEAH.
CAN YOU EXPLAIN A TURP OPERATION IN 30 SECONDS?
>> IT'S -- >> T-U-R-P. >> LIKE A HOT MELON BALLER, SCOOPS OUT THE PROSTATE.
>> I THINK OF IT AS AN ORANGE, ORANGE PEEL, YOU GO IN THERE WITH THE SCRAPE,
YOU SCRAPE OUT THE ORANGE, YOU LEAVE THE PEEL.
>> PEYRONIE'S DISEASE, WHAT IS THAT? >> CURVATURE OF THE PENIS.
>> CHRONICALLY ERECTED PENIS. >> MUCH HIGHER PREVELANCE THAN WHAT'S DOCUMENTED.
>> SO THAT'S A REAL DEAL. >> YUP.
>> SOMEONE CALLED IN AND SAID, HOW AM I DOING, AND I CAN'T TELL YOU THAT.
>> I'M DOING GOOD.
>>> AND NOW, FOR THE WINNER OF TONIGHT'S PRAIRIE DOC QUIZ QUESTION. TRUE OR FALSE?
ACTIVE SURVEILLANCE, WHICH MEANS JUST MONITORING PROSTATE CANCER WITH LAB AND
X-RAY AND GOING WITHOUT SURGERY, RADIATION, OR CHEMOTHERAPY,
IS AN OPTION IN SOME PROSTATE CANCERS? TRUE OR FALSE? AND THE ANSWER IS TRUE!
IT WAS GLORIA PUTTS OF SIOUX FALLS, SOUTH DAKOTA, WHO ANSWERED THE QUESTION CORRECTLY.
THANK YOU, GLORIA, FOR PARTICIPATING AND A BOOK WILL BE IN THE MAIL TO YOU SOON.
WE'LL BE RIGHT BACK AFTER THIS.
>> FOR MORE THAN 16 YEARS, THE PRAIRIE DOC ORGANIZATION HAS
ENDEAVORED TO ENHANCE HEALTH AND DIMINISH SUFFERING BY
PROVIDING USEFUL INFORMATION BASED ON SCIENCE IN A RESPECTFUL AND COMPASSIONATE MANNER.
PRAIRIE DOC PHYSICIANS AND HEALTH PROFESSIONALS CONTINUE TO ANSWER YOUR QUESTIONS EACH
WEEK CREATING A VAST PRAIRIE DOC LIBRARY OF MEDICAL INFORMATION AVAILABLE TO YOU
AND YOUR FAMILY 24 HOURS A DAY. MAKE SURE YOU DON'T MISS A THING.
FOLLOW THE PRAIRIE DOC ON FACEBOOK AND YouTube FOR
FREE AND EASY ACCESS TO THE ENTIRE PRAIRIE DOC LIBRARY.
>> RECENTLY, I RECEIVED A, MEANT TO BE HUMOROUS, EMAIL
THAT EXPLAINED WHY LIFE IS SIMPLER FOR MEN THAN FOR WOMEN.
"OUR LAST NAME ALWAYS STAYS THE SAME, THE GARAGE IS MOSTLY ALL OURS,
MECHANICS TELL US THE TRUTH, WE GET EXTRA CREDIT FOR THE SLIGHTEST ACT OF THOUGHTFULNESS,
OUR UNDERWEAR IS ONLY $8.85 FOR A THREE-PACK, WE CAN PLAY WITH TOYS ALL OUR LIVES,"
AND, FINALLY, "WE DO THE SAME WORK BUT GET MORE PAY."
THE LAST ZINGER STRUCK A DISSONANT CHORD.
I KNOW THAT, EVEN THOUGH THINGS HAVE BEEN GETTING BETTER OVER TIME FOR WOMEN,
EQUAL RIGHTS AND EQUAL PAY IS A GLASS CEILING THAT HAS NOT YET BEEN BROKEN.
AFTER ALL, IT HAS BEEN LESS THAN 100 YEARS SINCE WOMEN HAVE HAD THE RIGHT TO VOTE;
THE GENDER WAGE GAP CONTINUES; VIOLENCE AGAINST WOMEN PERSISTS; AND POVERTY AND
HOMELESSNESS IS WORSE FOR WOMEN, ESPECIALLY SINGLE MOTHERS.
PLAIN AND SIMPLE: UNFAIR DISCRIMINATION TOWARD WOMEN PERSISTS.
BECAUSE OF THESE INJUSTICES, THERE HAS BEEN SOME SOCIETAL REJECTION OF DISCUSSION ABOUT
THE DIFFERENCES BETWEEN THE SEXES AS POLITICALLY INCORRECT.
I GET THAT, BECAUSE, DESPITE SOME IMPROVEMENTS IN SOCIETAL EQUALITY, THERE REMAINS
PERPETRATED BIGOTRY AGAINST THOSE "DIFFERENT," WHETHER LGBTQ, PEOPLE OF DIFFERENT
COLOR OR SIMPLY PEOPLE OF DIFFERENT GENDER. HOWEVER, FROM A MEDICAL
STANDPOINT, THERE ARE IMPORTANT AND REAL DISSIMILARITIES BETWEEN WOMEN
AND MEN, WHICH ARE SOLELY BASED ON PHYSIOLOGY, LIKE HORMONAL DIFFERENCES THAT
INFLUENCES BEHAVIOR AND SIZE DIFFERENTLY. FOR EXAMPLE, IN A STUDY
APPLYING TOPICAL TESTOSTERONE TO HALF OF A LARGE GROUP OF NORMAL MEN,
THE MEN WITH INCREASED TESTOSTERONE WERE LESS WILLING TO CHECK
THEMSELVES FOR MISTAKES AND APPEARED OVERCONFIDENT. THIS COULD EXPLAIN WHY MEN,
WHO NATURALLY PRODUCE MORE TESTOSTERONE THAN WOMEN, ARE USUALLY MORE RELUCTANT TO
ADMIT WHEN A PROBLEM BECOMES OBVIOUS AND LESS WILLING TO SEEK HELP OR ASK FOR DIRECTIONS.
ANOTHER EXAMPLE. THE AVERAGE U.S. ADULT MAN WEIGHS 196 POUNDS AND IS 5
FEET 9 INCHES TALL WHILE THE AVERAGE ADULT WOMAN WEIGHS 168 AND IS JUST UNDER 5 FEET 4.
INCIDENTALLY, AVERAGE U.S. PEOPLE WEIGH ABOUT 30 POUNDS MORE THAN THEY DID 50 YEARS AGO.
RECOGNIZING THE PHYSICAL DIFFERENCES BETWEEN THE SEXES
SHOULD NOT MEAN EITHER SEX IS INFERIOR.
WE SHOULD COMBAT UNJUST INEQUALITIES WHILE EMBRACING WHAT MAKES US UNIQUE.
UNDERSTANDING THE BIOLOGICAL DIFFERENCES BETWEEN THE SEXES SHOULD SIMPLY ALLOW US TO FIND
TREATMENT FOR MEDICAL AND BEHAVIOR PROBLEMS AND HOW TO BEST LOVE AND SUPPORT EACH OTHER.
>>> A BIG THANK YOU TO OUR GUESTS, DR. EUGENE PARK AND
DR. NATHAN BOCKHOLT, BOTH OF UROLOGY SPECIALISTS, SIOUX FALLS,
FOR VOLUNTEERING TO -- DEAR FRIENDS, THANK YOU SO MUCH FOR VOLUNTEERING TO COME
TO OUR STUDIO IN YEAGER HALL ON THE SOUTH DAKOTA STATE UNIVERSITY CAMPUS IN BROOKINGS.
THEIR DEDICATION TO THE PEOPLE OF SOUTH DAKOTA IS GREATLY APPRECIATED AND MEANINGFUL.
THANK YOU FOR YOUR INFORMATION AND INTELLIGENCE HERE. 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.
>> PICK UP YOUR PHONE OR JUMP ON THE INTERNET, YOU DIRECT THE SHOW WITH YOUR QUESTIONS,
YOU MAY "ASK ANYTHING" - NEXT TIME - "ON CALL WITH THE PRAIRIE DOC."
>> ALL OF US WANT OUR FAMILY, NEIGHBORS AND FRIENDS TO HAVE THE ABILITY TO MAKE
APPROPRIATE DECISIONS ABOUT THEIR HEALTH CARE.
TO DO SO, THEY NEED ACCESS TO INFORMATION FROM RELIABLE SOURCES,
LIKE Dr. HOLM AND HIS GUEST PHYSICIANS. HELLO, I'M STEPHANIE HERSETH
SANDLIN, AND I SERVE ON THE VOLUNTEER BOARD OF DIRECTORS OF THE HEALING WORDS
FOUNDATION, A 501c3 ORGANIZATION ESTABLISHED TO SUPPORT THE WORK OF THE PRAIRIE DOCS.
WITH YOUR CHARITABLE DONATION, YOU CAN HELP THE FOUNDATION
CONTINUE TO OFFER FREE AND EASY ACCESS
TO THE ENTIRE LIBRARY OF PRAIRIE DOC HEALTH EDUCATION PROGRAMS.
THIS MISSION IS SO VERY IMPORTANT TO RURAL COMMUNITIES AND RESIDENTS, IN PARTICULAR,
ACROSS SOUTH DAKOTA AND NEIGHBORING STATES. PLEASE CONSIDER A PERSONAL OR CORPORATE GIFT.
JUST GO TO PRAIRIEDOC.ORG TO FIND MORE INFORMATION ON HOW YOU CAN HELP. THANK YOU.
>> MAJOR FUNDING FOR "ON CALL WITH THE PRAIRIE DOC" HAS BEEN PROVIDED BY:
>> AVERA IS A PROUD SPONSOR OF "ON CALL" ON SOUTH DAKOTA PUBLIC BROADCASTING.
>> LARSON MANUFACTURING IS PROUD TO SUPPORT "ON CALL TELEVISION" AS IT CONTINUES TO
OPEN DOORS FOR IMPORTANT MEDICAL INFORMATION.
>> AND BY THE SOUTH DAKOTA FOUNDATION FOR MEDICAL CARE, THE MEDICARE QUALITY
IMPROVEMENT ORGANIZATION FOR SOUTH DAKOTA.
>> AND WITH THE ONGOING SUPPORT OF THESE INDIVIDUALS AND INSTITUTIONS...
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