How to treat swelling of the prostate

>> believe it or not, men have health issues too! tonight we will take a look a men's health and what they can do to improve it. >> it is well known that men just don't seek medical care as often as they should. part of it is a macho "i can get through this" attitude, but part of it is the self-secure feeling that they can take care of things. they are the fixers, the caretakers of the family and themselves. we will work to address this disconnect between beliefs and needs tonight. first, let's take a look at this week's prairie doc quiz question. the most important risk factor for the diagnosis of aortic aneurysm is:

a. age greater than 65 b. history of having ever smoked c. being male d. all three? we will answer at the end of the show. joining us tonight from. avera medical group pierre, a department of avera st. mary's hospital, pierre, south dakota, is ken bartholomew, m.d. ken, tell us a little about your background. where are you from originally?

>> i grew up in lemon, south dakota. >> you're a lemon, south dakota boy. that's a town of how many? >> probably about 1500 now. >> the size of dee submit. >> yeah. and then i went to pre-med and medical school in utah, did a couple of years of post-grad training in southern california and then went to faulkton, south dakota. >> so your med school was at -- >> university of utah, satellite lake city.

>> then you practiced in faulkton for how long? >> 14 years. >> as the only doc? >> pretty much the whole time i was the only doc in town and really didn't have p.a.s much, then, either. i trained one and then after a while, i got tired of being on call all the time and moved to pierre. >> that's been good? >> very good.

>> there are a few characters you have to work with but other than that -- >> that's true. no names. >> no names. [laughter] also in our studio is dr. eugene park, urology specialists, sioux falls, south dakota. where are you start? >> from a town called rockford, illinois, just on the wisconsin border. did my undergrad at northwestern university with medical school at university of illinois. did my residency in omaha, nebraska and spent a

couple of years in california and came to sioux falls. >> you practiced in california. >> uh-huh. >> you were married at the time. >> engaged and we got married about a year into it. >> so then you were -- so you were in california, i mean, this fabulous spot in california. what happened then, you came back to south dakota. >> yeah, my wife got a little homesick and we had a little girl and decided it was best to be by the family so kind of moved back here.

>> the idea of raising a family in south dakota, kind of hard to beat that. >> yep, yep. so this is a story about men's health today. but, really, if you think about it, men's health is anything and everything. and as a urologist, you deal mostly with men, although you have some issues with women. do you -- how many men versus women in your practice, ken? >> oh, in family practice, it's kind of 50-50. we see everything, pediatrics to 100-year-old patients. >> do you do nursing home care? i do, i'm the medical director at two nursing homes, one in faulkton and one in pierre.

>> how many nursing homes in pierre? >> there's two. >> so if you think about men's issues, what do you deal with more than anything on a daily basis or a weekly basis? >> i'm almost a daily basis, it would be high blood pressure and how it relates to heart disease, stroke, aortic aneurysm, prostate issues, sexual dysfunction issues. >> which is an issue. >> it's an issue that usually we have to bring up, usually,

because they don't want to bring it up, but once you ask the question and open the door, then they're willing to talk. >> how much sexual dysfunction issues do you work with, eugene? >> pretty common. gets more common as the man gets older, so kind of overlaps there with your practice, but they're not so shy once they come to us. >> they've been through it. talked -- finally somebody brought up the issue. >> yep. i found that true, too, they don't bring it up unless you bring it up.

what age do you think people -- let's just talk sex dysfunction in men for a while. what age group do we see the most with that? i mean, we see more often than the elderly but when does it start happening, let's put it that way. >> you'll see a small percentage actually in their 20s and 30s, very low percentage but as each decade goes up, you'll start seeing an increase and once you getaround 50, 60, starts getting more and more prevalent. >> what's the most common cause? >> i think it's a lot of it is multi-factorial, going to be

vascular issues, hypertension is certainly going to contribute to that. some of the diabetes and neurogenic issues so it's kind of a multi-cause -- >> smoking, smoking is a big factor. and alcohol, too much -- heavy drinkers. ken, any thoughts on that? >> no, i think he hit it right there, substance abuse and, you know, lack of healthy lifestyle. >> right. >> you know what i think, too, also, is vigorous exercise i

think helps directly protect that whole system. >> so i'm a fan of exercise and for many, many reasons, but that's certainly another one. it helps with the sexual dysfunction. so i think when i address it, i try to bring people to their healthy lifestyle. what about medications? and testosterone levels, that's another question. the big t. >> testosterone is a tricky she. a lot of people know about it because of all the advertising.

i think some of the companies are getting into a little bit of trouble for all the advertising they've done without any backing but testosterone is just a portion of control of function. the psychology has to be, there the nerves have to be there, the hormones have to be there, the blood supply has to be there. medication-wise, there's several options and they're all good options. you know, there's the cialis and viagras, probably the big ones that people know. a reasonable place to start. >> and another problem is, if you're already on medications

and you start having some sexual dysfunction, you have to look at the drugs first. sometimes you have to take away drugs and change drugs because sometimes it's pharmacology causing it. >> depressant. >> anti-depressant but just a minor amount, nothing like the blood pressure pills. and certainly nothing like alcohol and tobacco, those drugs will kill it. but let's talk about t. when do you measure testosterone in a guy? >> for me it's kind of a last resort, he want to make sure everything else is functioning. i have to make sure that they're truly symptomatic.

a lot of guys think that just because they don't feel like they were 18 anymore when they're 50, they have low testosterone. but aisle screen patients occasionally just to get a baseline level -- >> do you do a serum testosterone, just a plain -- doesn't have to be fasting? >> i actually do a fasting, as a doctor up in michigan who recommends getting a fasting, a little more accurate so i'll ask them to get a fasting. >> in the early morning is better. >> yes, yes. >> so there's timing, you don't want to come in at 5:01 and get your blood drawn

after a long day at the office. >> it will be waning at that time. >> testosterone peaks in the morning. >> so let's ask that question. so let's say normal levels are between what and what? >> depends on the lab but for total testosterone, 250, 300 to 1,000. not a very big range. >> i was thinking 300. so if you get somebody in the 200 range, 150 range, clearly low, do you just say, okay, well, the treatment is, therefore, i'm giving them testosterone or do you have to kind of look at pituitary and do other things?

>> i will check more hormonal access just to make sure there's nothing more global going on, first. >> so explain that. >> so i'll check some regulating hormones, what they call fsh and lh, and if i'm concerned, i can get one for the pituitary to make sure that's not causing adjustments, because if there's something more global going on, you can try to fix that. that will also give you an ideas if something is going wrong with the testicles which is primarily making the testosterone but i'll do that before i start anyone on testosterone, and again i have to make sure they're truly symptomatic.

the other thing i'll do that will screen all men before starting for prostate cancer, because testosterone and prostate cancer is a very bad combination. >> so some people may have high these reason, or if you start replacing and they have prostate cancer -- >> adding fuel to the fire. >> adding fuel to the fire. that's one of the dangers of giving testosterone. >> correct. >> any other things to add? >> the other thing, and if you -- one other thing i always check is thyroid, of course, so

if you give somebody a medication to replace a natural hormone, it shuts down their own production, so you got to be careful about that. if they're just borderline low and you start giving them. testosterone. >> -- testosterone dosing -- >> they stop their own production -- >> it shuts it down and now it's probably not going to come back. maybe it will with time, and so before i ever do that, i really push them on the vigorous exercise, weight resistance exercise that's been shown to -- >> weight lifting raises testosterone.

>> weight-lifting exercise increases testosterone levels. >> just weight loss will increase testosterone levels. >> and if that all fails, then i send them to the urologist. i usually don't start them on it without a consultation. >> i kind of go over them looking at their axes, endocrine axes making sure they don't have something else out of whack and then consider the shots because that's way cheaper than the other options. i really don't prescribe the other methods. but, you know, to a person who's got a low level, it's kind of nice to give them replacement.

some people really appreciate it. >> so, let's move on to this. there is an old three sometimes joke where larry is accused of snoring. he answers that it isn't true because he stayed awake all night to check and never snored once. but snoring is serious and can be an indication of a dangerous breathing problem that requires treatment. they said it was obstructive sleep apnea and that his throat was relaxing so much, his tongue was falling back into his throat and it was -- he was stopping breathing.

i was waiting for him to take his next breath during the night because i laid awake waiting for him to breathe because he would stop breathing all the time. and he in order very loudly. he had a reputation for snoring. >> well, if we have company during the day, and not sleeping too good, i would fall asleep visiting and wake up again. i don't do that anymore. i get rest at night like it's supposed to be. >> they had electrodes all over, they were checking his eye movements, his --

they had brain waves, the heart and his legs, they were checking for restless leg syndrome and stuff, and when the guy came in and was reading that, we heard him say, i cannot believe how this guy stayed awake at night driving truck. and we told him when he came in, the reason that he did was because we prayed every morning before -- every afternoon before he went to work, he drove at night at that time. but it was truly a miracle that he did as well as he did because he stopped breathing over 200 times in that first hour, so they just took the -- all the electrodes and

everything off and put the cpap machine on him, and the next morning, he had tears in his eyes. he said i have never slept so good in my life. and he has been on that cpap machine over 20 years. >> there is a long hose and then this mask is fastened and it's like a night cap. it comes just above the lip. i just sleep real good. >> but i didn't care that the machine made noise, he was breathing. that was the important thing. >> well, with that first machine, got the adapter for it

that you could plug it in the cigarettes lighter in the car, in the van. as our daughter was in texas and we'd drive straight through and took turns driving and i would lay back there and sleep with my cpap machine. i don't leave home without it, if we go anywhere. when i get in bed and pull the covers up over me, when my -- when the light goes out, my eyes go shut and that's it. >> he's much more active and stuff now, too. you can just tell, he's just like a different person since he's gotten a good night's rest. oh, i sleep a lot better, too, because i know he's going to wake up with me in the morning.

>> that's one of those cases where a brilliant diagnostician comes to the fore. i was in the office with him and her and she said, do you think he has sleep apnea. he snores and then has these pauses and doesn't breathe, i'm worried about him. and i went duh. i think he was really the first sleep apnea case i've had, i can't give myself credit for making the diagnosis because mrs. buse did. but the great story is, that it just made a huge difference in his life. i know the australian stories say people have a 33% death rate over those who don't have a 6% difference.

it's like ten times more important than any cholesterol issue and i think for vascular disease and heart disease, so what do you think, ken, about sleep apnea? >> it's absolutely true. i've got a friend who will come through town and it will be getting late at night and i'll say why did not don't you spend the night. he'll say, no, i didn't pack the cpap machine, it's not worth it. i'll just drive home, 100 miles, because it's that important to have it at night. one patient made the comment that was just like eye-opening to me. she said, even the colors are brighter.

>> her brain was that much more awake. >> right, and, you know, the issues of how sleepy they are during the day and the sleep-ness goes away, the fact that they're more alert, they feel better, i think that's a huge deal. so what -- tell me about cpap. there's these other methods, the jaw things and devices and so on. do you recommend those? >> well, you can always try them because they're worried about the cost and everything, and if you have a real mild case, some people report that those appliances help but for the patients who have anything beyond moderate sleep apnea,they're going to do better with the cpap. >> and how does it work?

>> well, kind of imagine have a got a balloon and you blow into it and it opens up but then you suck back and it collapses. well, your throat's doing that all night long when you breathe in and out. especially if you have a thick neck, if you're overweight, have other issues, and so then it collapses and you're in a deep sleep and you don't really notice it until you run out of oxygen and your carbon dioxide build up and then you wake up out of your sleep, you stutter breathe or you actually wake up. you may not know you're awake but your brain is coming up out of

rem sleep so you never get that deep rest. you're constantly 'and down, up and down all night. >> so it gives you pressure so that your -- >> it stays open. >> the balloon is always open, just giving positive -- >> positive airway pressure is the continuous positive airway pressure, that's what it stands for, and always blowing that air. some people who have advanced lung or heart disease, they'll actually bleed oxygen concentrator into that to get extra oxygen but most of them

just need the extra air going in and keeping the airway open to make a difference. >> so, explain a bypass. >> that's a little different. bi is two, so there is an inward and outward pressure change. >> so almost like being on a respirator that's breathing for you but you don't have the tube down your throat. >> right. in fact, it's got even so well refined now that we use it in icu patients who we used to put on a ventilator. [overlapping conversations] >> we can slap that on them and bring them around. >> breathe for them so the machine actually does the breathing for them.

>> so the difference between an obstructive sleep apnea and central apnea is what? >> well, the obstructive is that airway -- that's the local collapse of the airway. central is -- means that your central nervous system is just not signaling correctly.then >> and that's when the bipap is necessary. i used it -- i heard it used to be called ondean's curse, the myth where owndean was so -- i think that was the guy who he made love with one of the god's daughters or something, i don't know what the story was, but the god was mad at him and so she took away his natural drive to breathe so that whenever he fell asleep, he would die.

well, he stayed up for a week, you know, and couldn't stay aweek and couldn't stay awake and finally fell asleep and died. that's the story of ondean and that's the central over the obstructive. he would need the bipap. >> another point about sleep apnea is not just the -- is not just the feeling better the next day, that's obviously important, but it causes high blood pressure, it causes heart failure. that low oxygen all night causes all kinds of cardiovascular complications, and so it can actually not only make you have a better day but it can make you have more days. >> i know that it -- when you are obstructing and you have hypoxia or low oxygen

through the night, you have increased -- it ages you faster, it's increasing aging right there in front of you. so it's an important issue, and i think about obstruction -- obstructive sleep apnea or sleep apnea when? when should we suspect it? what should the wives -- it's more men but it's both women and men. >> about three to one, male to female. >> when should we suspect sleep apnea could be the problem? >> well, i think that anyone with -- when you're doing a work-up for high blood pressure, irregular heart beat, atrial defibrillation, which one out of 10 people will get,

or a sudden heart attack, all of those people need to look at it because it's very much underdiagnosed, i believe. >> and strokes and -- vascular disease is -- >> all vascular. >> the study in australia was that deaths from all causes, including cancer, but including car accidents. >> yes, huge. >> car accidents. >> falling asleep.

>> our patient was a trucker and it scared me when i heard that, and his wife said, yes this is an important point, so it's remarkable how well this man has done, and so -- for so long. there is a lot of things that we can talk about. we can switch back to issues of the urologic sort. and let's talk about the -- prostatic hypertrophy. guys get older, they can no longer pee over the barn. >> peel the paint off the barn. [laughter] >> heard that a couple of times.

>> tell us a little bit about benign prostatic hypertrophy. >> that refers to the enlargement of the prostate. the prostate sits underneath the bladder. kind of hugs the urine channel like a doughnut. >> so let's draw a picture of it. here's a urine out and then it's sort of like an apple that goes around and the -- >> goes right through it. >> goes right through it, so this is a side view and if you looked at it from here, from above, it would be going through it.

>> so as every man gets older, starting around the age of 50, that tissue starts crowding in on the urine channel and creates a physical blockage, and so the common symptoms are going more frequently, going with less force, dribbling after going to the bathroom, getting up at night, needing to push to urinate, sometimes it gets so bad a guy can't go to the bathroom, they have to have a catheter placed. not every man will have that degree of severity but pretty common, as each decades goes by, the chance of having problems like needing a catheter starts going up.

>> now, that urine flow thing, how many times is it benign prostatic hypertrophy, benign, and how many times is it cancer? >> it's very rarely cancer unless it's advanced. the tissue that's causing the obstruction is usually benign tissue so prostate cancer tends to develop in the more outer areas of the prostate, not the areas that create a blockage. now, if you have severe prostate cancer, taking over the entire gland, that can cause an obstruction but usually it's not the prostate cancer. >> so the tumors are oftentimes in the outer side --

>> yes. >> out here, in the rings. >> that's interesting, i hadn't realized that. so the benign pros static hypertrophy, do we need to do any major diagnostic tests aside from echoing the bladder to make sure it isn't full? >> yeah, a lot of people will have a bladder scanner where they can check how much fluid is fluids is left in the bladder after going to the barge. that's an indication. you can usually measure the flow of the urine, see how fast it is. we have ranges for what we expect most men can achieve as far as how quick the flow is.

a lot of it is based on the thinks history, though. it's pretty apparent, usually. now, it could be -- the symptoms could be due to what we call an overactive bladder, where the bladder is irritated and starts quivering and starts making you go more urgently and sometimes the prostate -- enlarged prostates can cause that, sometimes it's difficult to tell between the two but either way, you usually start by releaving okay instruction first and seeing what happens. >> so there are several ways so relieve that obstruction, what would be the way? >> i think most com ownly these days, we start with medication.

there's something called an alpha blocker, it relaxes the muscles of the prostate, makes it easier for guys to go. >> it's pretty quick. >> usually works within a week or so. >> and works right in this region, i mean, let me just... [overlapping conversations] >> makes it a little easier to go. >> and there's muscles around this, that's what the -- are the muscles to stop and open the flow within there and it relaxes those muscles and allows the flow. >> do people have leaky glad years because of that?

>> no, the muscles that keep it dry are sitting in front oft prostate and at the neck of the bladder so doesn't usually cause leakage. some guys it opens up the obstruction, the overactive bladder takes over and they start going more frequently but that's not common. >> how important is a nighttime urine -- i've got to go to the bathroom three times during the night, i have to get up five times in the night, how important is that history? >> it's pretty important but it's very subjective. our guidelines ask us to check for the bother symptoms on people.

some people get up three to five times a night, they don't care. other guys get up once or twice and drivers them nuts, so as long as they're not having problems with kidney failure, the bladders aren't paralyzed from too much damage from obstruction, you can actually let them go. so a lot of times, i won't treat people unless they tell me they have truly bothersome symptoms. >> and you see a big dilated blatter after they've emptied their bladder and it's still full, then you feel like -- so we've talked about alpha blockers.

there's also other treatments for prostate and hypertrophy. what would that be? >> there is a medicine called avadar or -- those drugs will shrink the prostate. they block the conversion of testosterone in the prostate and those drugs will actually shrink the gland down and it kind of makes the gland itself smaller so guys can go to the bathroom better. a lot of people actually combine the two, the two will work better in conjunction with each other. >> a journal of medicine article showed that definitely one plus one is three. >> a lot of times you can actually get off the flowmax

medicine as time goes on, once the gland has shrunk, you can try to do just one. some guys have to do both. >> but like you say, the finasteride is gradual, slow, and makes everything shrink. the flowmax is real fast.but it loses its effect over time. >> yep. >> what is the research showing on the potential for increase in the aggressive tumors? >> that's always been a debate and i think most people will tell you, they don't believe that finasteride causes prostate cancer. i think what's happening is those guys probably had prostate cancer and you shrank

the gland down and made it an easier target to detect them and so... >> so we're going to come back to this. i want to ask about cialis for prostate hypertrophy, that's another thing, and the complications with finesse tried and flowmax but we need to do this. >> we have to choose among our options every day. some of those choices are harder than others. >> she says there's this test,isn't always reliable but let's just do it, and,up, so i've had three, four years of those results and every year it's gone up a little bit and she, knowing that i get a little anxious when it isn't quite

right so that's how i got to see dr. parks. so we got to do a biopsy, which is really a fun experience. that's not true. that's not true at all, but, anyway, we did a biopsy and it came back that out of 12 different samples, six of them had a gleason score of six, which, as he says, just remember that six is at the low end of having really some problems. you will have to go home and decide, do some research and decide. i will help you guide through this and he says, come back, ask questions and we've done that a couple, three times.

went to an oncologist, cancer doctor, oncologist, and he says, you know, you're not going to need my services but you have that possibility, maybe you should do that surgery. yeah, you have your choices. yeah, you have radiation. right now, what the procedure is, the normal procedure is, is that you can go and it's like a half-hour procedure for six weeks every day. [laughter] and when you get done, the same results will happen, same -- it will kill the cancer, that's the ultimate goal. but you'll still have the same complications as the surgery.

so you can go have surgery and this is done with one of those robots which makes it, as he said, you know, in the olden days, surgeons could do just as good a job but nobody's doing it that way anymore because it's so much -- it is faster healing by having smaller incisions than the big open whatever they did before. so then you can have surgery. okay, so the complications are afterwards, aren't great but, you know, you -- in six weeks, you'll be able to find out what complications there are. will you gain your muscle control of your bladder again

and all kinds of fun things that that area controls. but he says we have things to help with you that, if that's the case. so those are the two main things. the radiation and the surgery. and he says, i know i'm a surgeon but i'll say what i think about that. he says if we had surgery, okay, and we miss something, or something happens, well, you just don't have surgery again, but you can have radiation and it will finish the job. but if you had radiation, then i'll have to send you to, like, mayo because we need a different kind of surgeon because the tissue will be not easily sewn or cut.

probably cut is already but sewn back together again so you would have lots of trouble. but both are very good procedures. so when you're young and able to handling the surgery and all that stuff that's going to happen, hopefully my body is young enough it can just go on. okay, son you find out, okay, now i'm 75 and diagnosed because things stopped working, or whatever happens. obviously the cancer can spread, even though it's slow growing, and now i'm going to have surgery and my body is worn out a little bit more, so the procedure is the same but now your whole system is slower

and it's hard to get back on your feet. i mean, that's kind of what is talked about because they caught it early in me, and i have a chance to actually do something about it. >> you know, it's a courageous thing for somebody to stand in front of a camera and talk about cancer that was just discovered so i thank you for doing that, clark. and so he was your patient. and he talked about that you gave him all the options, he went and got another opinion, he did all the studying, and i can tell you he did a lot of studying, i know that. and he's going to have that procedure done after he goes on a sailing trip in the mediterranean.

>> sure. that makes sense to me. >> well, what lessons were important that clark had described there? >> i think he really touched on an important point about the age issue. that's something i didn't really concentrate on during residency, thinking about people's age but the younger you are, the more life expectancy you have in front of you and there is a lot of controversy about whether prostate cancer should be even checked for, should we be screening for it. if you live long enough, most men will die from it anyway. >> or have it.

>> yeah, or have it. for people who don't think about what it's like to have advanced prostate cancer, it's not something that we see much anymore and that was eliminated almost exclusively with the psa. we probably have taken out too many prostates over the years, just because we could find it, starting in the '803s when we had psa, we could detect it early. before that we would have to wait until we had pretty advanced cancer and maybe once in a while we'd be able to stop prostate cancer from getting aggressive but, you know, i tend to think about the age factor, if people are younger and healthier, i do tend to push for aggressive treatment

because they don't want to have metastatic disease in the bones or bleeding in the bladder so there are some other benefits to doing surgery other than just cancer control. >> ken, any comments about that? >> no, i've seen several patients die of metastatic prostate cancer and, you know, my first one was in his 90s but one of them was only around 70 and that's too young when it's spread to all your bones and have a lot of pain and everything, so... >> i have a physician patient who had metastatic prostate cancer and died from it.

he had had a prostatectomy. doesn't taken anything. i've had patients die from complications of prostate surgery. >> sure. >> so there are -- it's a tough issue for me because i've had those experiences, and i'm a little less inclined to do psas. >> but in a younger man, when you discover it in a young man like this, he is at higher risk and particularly with a family history of cancer, gosh, i think it's exactly the right thing. he struggled with it and -- and that was good.

>> i think it is important to bring up for the listening public that when the psa test first came out, we thought, man, this is golden so we were doing it every year and we were sending a lot of people for biopsies that would never have gotten a biopsy before that. one of my patients almost died just from the biopsy, he became septic, his blood pressure crashed, he was in the icu, it was nip and tuck for a few hours just from the, quotes, simple biopsy. >> well, you go through the rectum. >> you go through the dirty rectum.

>> not a clean area. >> and so the health services task force weighed all that information, gleaned all the information for 10, 20 years and they found out that, basically, for everyone we thought we were helping, we were probably hurting one and they're saying it's kind of a wash so let's not be so aggressive and that's why we've backed off and not doing the psa every year. >> right. i believe in the digital rectal exam. the last prostate cancer i discovered was, oh, i'm doing a

colonoscopy and, by the way, i'm going to need to have this guy see dr. park and that's what i di sent him up for the -- for you, i've sent you a number of older people, and so it's not to say that i'm completely against the prostate cancer screening, i'm not hot on the psa. that's how that is. but i certainly do believe that younger people in particular with more aggressive therapy. it's after 75, do you find that prostate cancer at 75, do you -- >> you know, some people won't operate after the age of 70 or

75 but the real rule of thumb, if we think you have a life expectancy greater than 10 years... i've done it maybe two or three times in the past couple years on older guys but all of them, i mean, they're probably healthier than i am and one guy went biking like 100 miles before his surgery, like a day or two before his surgery. and all of their family lived to be, you know, 100, 101. so it is a very selective thing. i don't usually recommend screening past 75. >> ignorance is bliss sometimes.

>> sometimes, but sometimes you get the people who show up out of the blue and someone checks a psa randomly and it's 500. always a dicey question, but for the most part, i will stop -- if they have a history of very low psas, i just go by their symptoms. >> is there a lifestyle thing that a person, a guy could do to protect from prostate cancer it. >> i think there is. my father had prostate cancer and he's the first one in the family. i think the american diet has something to do with it, not a very common thing in asia. you'll see that people who have less of a meat-based diet, more of a mediterranean diet,

they tends to have lower rails of prostate cancer. people are always asking, is there something i can eat to change my psa. i think it's a lifetime accumulation, in general, i tell people a heart-healthy lifestyle is more important than cancer. >> that's a good answer. what do you think? >> i agree and it also -- less heart disease, less colon cancer with that, less fatty prepared meats. >> the smoked meat, i think it's that nitrite that you put in there, that's been -- >> that's the cause of stomach problems in asia, there is a

lot of smoked meats in asia and stomach cancer is big there because of them. >> because of the nitrites. >> and i used to love all that stuff. >> everything in moderation. [laughter] >> everything in moderation. >> well, we've got issues we can talk in men. i want to talk about anger because one of the things, i think there is this condition called depression that's a real deal. i would say a third of all human beings, male and female, get it, but it manifests itself

in -- differently in women than in men, i would say. not generalities, maybe i'm doing too many generalities but i'm just kind of generally saying that in guys it presents oftentimes with anger. let me just throw that at the two of you. my sense is when a guy comes in and he's been angry, i treat them with ssri, i treat them with an anti-depressant. i don't tell them you have depression but you're dealing with -- you're having trouble dealing with your wife and family and your kids and your -- everybody's angering you. let's look at this as an option, see what it does.

what's your take on that? >> i would agree. males just handle it differently and i think it's not just societal, i think it's testosterone. >> o really? >> i absolutely do. we're different, we're different when we're one year old. you know, there's nature and nurture, nature is really important and you watch little kids, they're different at age one, age 2, age 3, and males just handle it differently and

they're much more -- they're aggressive, that's the way we've evolved. the other thing about your comment about depression, just depends on where you want to draw the normal line because i tell people that depression is not -- moods don't do this throughout our lifetime. our moods do this. >> like waves on a sea. >> absolutely, we have highs and lows throughout our life and external and internal things that modulate those but, you know, we all have -- depression is part of life. it's just part of the cycles. it's just that how deep does yours get and how do you handle it?

what's important. >> and if it gets too deep -- >> i think we all have it sometimes. >> you start hitting your wife or blowing your top every time, maybe you need to realize -- too deep. >> maybe you need a little help there. >> i've been sailing this last week in -- out on lake superior, the apostle islands. >> that's right. >> there was no waves, there was no wind. [overlapping conversations]

>> we had a wonderful time,however, but we had no waves, we had no wind. but there was a lot of humor and a lot of music. we sang, we had a guitar, told a lot of stories. >> should have come to pierre and gone on oahe, we always have wind. >> any comments you might have, eugene, about men? you deal mostly with men. >> yeah, really anger specifically. we don't screen too much for that, people are angry, they're usually upset about something specific. though i can't really comment on -- i will say this, there's been a lot of studies. we cut the testosterone in a lot of men with prostate cancer and we have noticed --

depression does happen in men who we kill the testosterone on, and that's something that's becoming more of a focus. >> you can see it. do you start the ssi or anti-depressant medication? >> i will recommend it. i think we all just kind of figured they were depressed because of their prostate cancer but some of these guys, it's a little more than that and if they're really feeling not so well, i kinds of tell them to talk to their regular doctor about getting help. >> a physician wrote a piece in my mind, i think it was 15, 20

years ago in jama, and it was titled something like "the loss of passion" was the word he used, i believe. and he had gone through this -- >> loss of testosterone from therapy. >> right, the therapy took his testosterone to nearly zero and he said it wasn't just the sexual, it was the passion in life. >> it's a tough surgery to get over. a lot of guys i don't think -- a lot of our patients get out the next day from surgery, i think they're surprised by that but psychologically, i think it's a very tough surgery for some guys.

>> the prostate surgery doesn't generally take away testosterone. >> no, but i think some of the side effects are sexual dysfunction and leakage but just the surgery itself, even before you have to worry about -- it does cause some of the -- >> cialis, do you like cialis instead of the prostate -- the prostate shrinking by locking testosterone? >> you know, in my experience, i've kind of found it's either hit or miss. >> it mate work but it may not. >> i use it as an adjunct, i have a lot of samples for 30 days so

i'll give it a try, but it's hit or miss. >> and now, for the answer for tonight's prairie doc quiz question. the most important risk factor for the diagnosis of aortic aneurysm is: the answer is: "d," all three are important. and do you have any comment about that? any -- do you think smoking is more important than the rest? i couldn't find that information. >> i think it is, because when you look at the data about only 50 to 100 cigarettes in your whole life sets you up at higher risk, there's something in there. >> yeah. they talk about the one

screening test, doing one ultrasound between the ages of what, ken? >> after age 50, basically, if you've ever smoked. >> so a guy -- >> females, too, if they smoked. i mean, males will have three times as many aneurysms as females but females get them, too. >> and then they just die suddenly. i've had patients die suddenly from -- and now you can take a catheter in the groin, run up a stint just like in the heart only a big one and capture it, say that -- and it works, what, 80% of the time?

>> bolster it, it's like putting an internal sleeve in there and then the other key thing is high blood pressure needs to be treated because think of that pulse going boom, boom, boom, 75 times a minute, stretching that out. every time it pulses, that aortic gives a little. well, if it's an aneurysm and then it eventually tears -- >> in the '70s, they were talking about not doing surgery but just really lowering the blood pressure, and they were successful. >> so one reason, one big reason for controlling pressures.

>> pressure, yes. i have one gentleman who's not a surgical candidate, just not. he's elderly and he's frail and we've just piled on the medications, got his systolic down -- [overlapping conversations] >> been many years now and we keep checking it, it's not growing. >> all right. we'll be right back after this. >> all around town, from -- to playgrounds, babies are on the move and there are diseases that are on the move, too. and some of these spread easily. to best protect him from 14 serious diseases by the time he

turns two years old, vaccinate him according to the recommended schedule so he can go on about his business and you can have peace of mind. for more reasons to vaccinate, talk to your child's doctor or go to cdc.gov/vaccine. >> talk to a man about a complicated physics-type issue and he will often have some working knowledge about it. ask a guy about the twins or vikings and usually he is following and knows some stats. ask him to fix a mechanical whatsit and commonly he can figure it out. but ask a guy about how many calories are in the biscuits and gravy on his plate and

you'd think you were expecting him to know how to sew on a button or plan a shopping trip. it's amusing to kid around about manly men stereotypes but it's no joking matter that eating too much food and too many calories can bring on heart attacks, strokes, cancer, and early death. and men are usually the big eaters. we find rats live about 40% longer when they are fed about 40% less, and we think humans work the same way. it seems the rats who are onthe "eat anything and everything you want diet" die prematurely, just like humans.

researchers believe those vascular and malignant medical problems are due to premature oxidation, which is, in turn, due to excessive calorie intake. you reduce that oxidative load not by "antioxidants" but by eating less. we're not just talking about obesity, we're talking about learning to eat right. obese or not, we need to realize that having seconds and thirds, constant snacking, ordering high calorie foods, drinking non-satiating sugar or alcoholic drinks, all can be poisonous.

plain and simple, too many calories are dangerous to your health. dietary experts have defined a normal sized man's total goal for a full day of eating should be about 2,000 calories and, to lose weight, about 1,500. not surprisingly, a single fast-food meal often approaches our entire daily caloric need. for example, a loaded big burger with bacon, large fries, and a 12-ounce soft drink adds up to 1,334 calories. try this. ask your smartphone how many calories are in each portion of food you eat for three days, or write it down, keep track, and add up your daily count.

ask for help if needed. knowing calories in food will help you eat less. indeed, men in general usually don't eat enough fruits and vegetables, but the most important error in their modern diet comes from eating too many calories. and, by the way, there are about 400 calories in a single order of biscuits and gravy. >> a big thank you to our guests tonight, ken bartholomew and eugene park, for volunteering their time to travel to our studio and appear on our show. remember, the annual flu season is upon us. if you have not done so already, do not delay, get your

flu vaccine now to reduce your chances of catching the flu bug. 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.