Transcript: Urololgy | Apr 14, 2000

(music plays)

The opening sequence shows different sets of hands performing activities on a wooden table such as pulling petals from a daisy, drawing a big red heart, tuning a violin, flipping through the pages of a book, cooking, and pouring a glass of red wine.
In animation, the title appears inside the shape of a house: “More to life.”

Maureen Taylor sits in a studio with yellow walls and a small TV set in the background, which reads “More to life.”

Maureen is in her late thirties, with wavy blond hair in a bob. She’s wearing a gray blazer over a coral turtleneck sweater.

Maureen says WELCOME TO “MORE
TO LIFE.”
IN A FEW MINUTES WE'LL TAKE
YOUR QUESTIONS FOR UROLOGIST
DOCTOR RICHARD CASEY.
HE CAN TALK ABOUT SEXUAL
DYSFUNCTION, PROSTATE CANCER,
AND A PROBLEM THAT PLAGUES A
LOT OF WOMEN, URINARY
INCONTINENCE. IT EFFECTS ONE
IN FOUR WOMEN AN ONE IN TEN
MEN IN CANADA.
ADULTS LOSE BLADDER CONTROL
BECAUSE OF WEAK MUSCLES
AFTER CHILD BIRTH, INJURIES,
DISEASES, IT CAN BE THE SIDE
EFFECT OF MEDICATIONS OR
SURGERY, AND NOBODY WANTS TO
TALK ABOUT IT.
BUT TWO PEOPLE FROM THE
OTTAWA AREA WANT OTHERS TO
KNOW THAT IN MOST CASES
INCONTINENCE CAN BE
MANAGED OR EVEN CURED.

A video rolls.

A woman in her mid-fifties says THE BIGGEST EMOTION THAT
IS ATTACHED TO THIS -- YOU
FEEL YOU SHOULD BE ABLE TO
DO SOMETHING AND YOU DON'T
SEEM TO BE ABLE DO IT.

A man in his late fifties says IT WAS THE MOST IMPORTANT
THING, MUCH MORE TERRIBLE
THAN HAVING BEING IMPOTENT.
ALL YOUR DIGNITY IS OUT, YOU
KNOW.

A caption reads “Judy Fox. Physiotherapist, Ottawa Hospital.”

Judy is in her late forties, with short wavy brown hair. She wears a white shirt and a black vest.

She says A HALF MILLION PEOPLE
SUFFER FROM INCONTINENCE IN
CANADA.
JUST TO SHOW THAT
INCONTINENCE IS PROBABLY THE
LAST THAT WOULD SUBJECT IS,
THE FACT THAT 45 PERCENT OR 50 PERCENT OF
THE PEOPLE WHO HAVE
INCONTINENCE DON'T EVEN TELL
THEIR GENERAL PRACTITIONERS
ABOUT IT, ARE CERTAINLY NOT
THE FOR MANY YEARS.
I THINK THAT WILL SUGGEST TO
YOU THAT THERE IS A BIG
PROBLEM HERE.

The woman in her mid-fifties says I AM 56 YEARS OLD.
AND PROBABLY THE FIRST
INDICATION OF INCONTINENCE
THAT I EXPERIENCED WAS IN
THE LATE 30s AGE GROUP.
AND I HAD A BLADDER REPAIR
WHEN I WAS 42.
BEFORE THE BLADDER REPAIR I
WAS VERY CAREFUL TO WEAR
EXTRA PADS.
I HAD A HYSTERECTOMY TWO
YEARS BEFORE BUT HERE I WAS
WEARING PADS AGAIN.
AND I FOUND THAT I WAS EVEN
HAVING THOSE PADS QUITE
OFTEN DURING THE DAY.

- ON ACCOUNT
OF THE BLADDER REPAIR I'M
TOLD ABOUT MAYBE TWO YEARS
AGO I FELT THAT EVERYTHING
WAS FINE.
BUT AS WITH ALL SURGERIES IN
THAT VEIN THERE IS A LIFE
SPAN TO THEM.
I WASN'T AWARE OF THAT.
AND I STARTED TO HAVE THE
THE SAME SYMPTOMS OF IF I
COUGHED I WOULD START TO
LEAK.
IF I SNEEZED IT WAS THE SAME
THING.
AND IT GOT PROGRESSIVELY
WORSE TO THE POINT THAT I
WAS DOING ALL THE WRONG
THINGS TO TRY TO CORRECT
THIS.
I STOPPED DRINKING AS MUCH
LIQUID.
YOU DON'T DRINK AS MUCH
LIQUID.
THE URINE BECOMES MUCH MORE
CONCENTRATED, THE
BLADDER WALLS GET IRRITATED
AND IT CAUSES EXACT REVERSE
TO WHAT YOU WANTED TO DO.

The man in his late fifties says I'M HEMATO-ONCOLOGIST.
I DEAL WITH CANCER PATIENTS.
I HAD TO HAVE THE
MEDICAL SPECIFIC FOR ME
BECAUSE I HAD CANCER
OF THE PROSTATE AND RIGHT
AWAY AFTER THE SURGERY WE
TOOK THE URINE CATHETER AND
BIG DIAPER.
AND IT WAS VERY HARD FROM
THE FIRST MOMENTS.
I STAYED ALMOST ONE YEAR
COMPLETELY INCONTINENT.
I USED TO CHANGE EVERY TIME
I GO OUT.
EVERY TIME I STAND UP I HAVE
TO CHANGE.
I KNOW EXACTLY WHEN A
PATIENT COMES TO ME NOW,
WITH ALL THE EMOTION AND ALL
THE STRESS OF WHAT HE IS FEELING.
BECAUSE I USED TO SPEND ALL
NIGHT NOT SLEEPING BECAUSE
IT IS ALL THE TIME IN YOUR
HEAD TURNING AROUND, HOW
COME, YOU KNOW.
THE DIFFERENCE BETWEEN
BEFORE AND NOW, I USED TO BE
JUMPING EVERYWHERE.
NOW I CANNOT EVEN GO DOWN
THE STAIRS.

The woman in her mid-fifties says ONE OF THE THINGS YOU
HAVE TO BE AWARE OF WITH
INCONTINENCE IS TO AVOID
PASSING BLOATED FOODS.
IF YOU HAVE AN INCONTINENCE
PROBLEM AND ARE YOU GOING TO
GO SHOPPING YOU EITHER HAVE
TO GO SHOPPING IN AN AREA
WHERE YOU KNOW THERE ARE
WASHROOMS THAT ARE EASILY
ACCESSIBLE OR YOU HAVE TO
MAKE SURE THAT YOUR SHOPPING
TIME IS GOING TO BE SHORT
ENOUGH THAT YOU CAN GO TO
THE WASHROOM BEFORE YOU
LEAVE THE HOUSE AND MAKE IT
BACK IN TIME.
SO IT’S AN EXTRA FACTOR TO
EVERYTHING YOU DO IN YOUR
DAILY ROUTINE.

The man in his late fifties says IT DOESN'T MATTER, BUT
THIS IS VERY IMPORTANT, YOU
KNOW, IT MAKES YOU CLEAN.
IT MAKES YOU -- I TELL YOU
SOMETHING, I CANNOT GO AND
PRACTICE AT THE CLUB ANY
MORE.
I CANNOT GO.
BECAUSE IF I GO TO CHANGE
FROM ONE TO ANOTHER ONE,
JUST A DRIP, IF I GO TO TAKE
MY SHOWER EVERYBODY WILL SEE
I HAVE A DIAPER.

The woman in her mid-fifties says ONE OF THE JOBS THAT I
HAD WAS I WORKED AS AN
INFORMATION OFFICER AND I
WAS WORKING WITH THE PUBLIC
ON A ONE-TO-ONE BASIS.
IF I HAD NOT HAD THE THE
BLADDER REPAIR SURGERY WHEN
I DID HAVE IT, I WOULD NEVER
HAVE BEEN ABLE TO CONTINUE
WORKING.
AT THE MOMENT I AM NOT
WORKING OUTSIDE THE BUT
I DO INCOME TAX PREPARATION
AS A SMALL BUSINESS.

Judy says THERE ARE MEDICATIONS
WHICH CAN BE USED TO HELP
INCONTINENCE.
OFTEN PEOPLE HAVE SURGERY
THEY WILL GET 100 PERCENT RECOVERY
STRAIGHTAWAY.
BUT IT MAY NOT LAST FOR ALL
THAT LONG IT MAY ONLY LAST
THREE TO FIVE YEARS.
IF THEY ARE GOING A MORE
CONSERVATIVE ROUTE OF HAVING
EXERCISES, BEHAVIOUR
MODIFICATION AND LOOKING AT
DIET AND LIFESTYLE THAN THE
THE CHANCES ARE THAT 80 PERCENT OF
THEM WILL BE IMPROVED, MUCH
IMPROVED AND WILL YOU
PROBABLY GET 50 TO 60 PERCENT WHO
WILL BE COMPLETELY CURED.

She sits in front of a computer screen and points at a wave chart.

She says YOU CAN SEE HOW MUCH
SHARPER YOU ARE GETTING.
THE EXERCISES THAT
PEOPLE DO TO TRY TO STRENGTHEN
PELVIC FLOOR WITH KEGEL
EXERCISES, IF WE CAN SHOW
THEM WHAT HAPPENS WHEN THEY
ARE TRYING TO TIGHTEN THE
MUSCLES THEN THEY CAN SEE
VISUALLY YES, I'M TIGHTENING
AND THIS IS SHOWING ME THAT
SOMETHING IS RISING OR
SOMETHING IS FALLING.

The man in his late fifties says I AM VERY HAPPY.
I HAVE MUSCLES THAT CONTRACT
FOR A LONGER TIME AND
MUSCLES THAT REACT FOR A
SHORTER TIME AND YOU HAVE TO
WORK ON THE LONG-RANGE
CONTRACTION MUSCLES AND THE
SHORT RANG CONTRACTION
MUSCLES AND BOTH TOGETHER.
AND THIS HAS HELPED ME A
LOT.
IT PAGES A BIG DIFFERENCE.

The woman in her mid-fifties says WHEN ARE YOU STANDING
GETTING YOUR MEALS READY YOU
CAN EVEN DO THEM WHEN ARE
DRIVING YOUR CAR AND TOP AT
A RED LIGHT.
I'M GETTING BETTER AND I
KNOW THAT BY KEEPING ON
WORKING ON THEM I WILL GET
TO THE POINT WHERE I CAN
STAVE OFF NEVER BLADDER
REPAIR FOR AS LONG AS
POSSIBLE.

Judy says YOU STILL BECOME WORRIED
ABOUT THE PROBLEM OF
INCONTINENCE PARTLY BECAUSE
OF INSTITUTIONALIZATION, NOT
WANTING TO BE
INSTITUTIONALIZED BECAUSE OF
THE INCONTINENCE AND FEARING
IF THEY DO BECOME
INSTITUTIONALIZED THEN THEY
ALSO DO BECOME INCONTINENT.
THEY WANT TO HIDE IT BECAUSE
IT IS A TABOO SUBJECT IS A
LOSS OF CONTROL, THEY ARE
LOSING CONTROL OVER THEIR
LIVES.
THEY DON'T WANT ANYBODY TO
KNOW ABOUT IT MAYBE THEY ARE
UNABLE TO WALK QUITE AS FAR
AS THEY WERE ABLE TO BEFORE
BECAUSE OF ---, MAYBE
THEY ARE NOT HEARING OR
SEEING AS WELL, THESE ARE
THINGS THAT THEY CAN
PROBABLY COME TO TERMS WITH
BUT ACTUALLY LOSING CONTROL
OF STOOL OR URINE IS TOO
MUCH TO HANDLE.

The woman in her mid-fifties says I THINK AS MORE PEOPLE
HIT INTO THE 50s AND LARGER
POPULATION, THE BABY BOOMERS
HITTING IN THAT AGE GROUP
WHERE THERE IS A MUCH HIGHER
PREVALENCE OF IT, IT IS
GOING TO BECOME A MUCH MORE
OPEN SUBJECT.

The man in his late fifties says WE SHOULD TALK ABOUT IT
MORE.
I DON'T THINK WE CAN STOP,
THAT'S T YOU KNOW, I'M IN
THIS SITUATION, I'M
INCONTINENT, YOU CAN ALWAYS
DO SOMETHING.

Back in the studio, Maureen says THERE ARE SOME NEW
ADVANCES IN TREATING URINARY
INCONTINENCE.
THERE ARE ALSO SOME CLONES
OF VIAGRA HITTING THE
PHARMACY SHELVES AND NEW
ADVANCES IN PROSTATE
SURGERY.
WE WILL TALK ABOUT ALL OF
THESE THINGS WITH MY GUEST
TODAY DOCTOR RICHARD CASEY IS A
UROLOGIST AND DIRECTOR OF
THE MAYO HEALTH
CENTRES IN OAKVILLE.
IF YOU HAVE A QUESTION ABOUT
SEXUAL DYSFUNCTION,
INCONTINENCE OR YOUR
PROSTATE GIVE US A CALL.
IN TORONTO DIAL
416-484-2727.
CALL US LONG-DISTANCE TOLL-FREE
AT 1-888-411-1234 AND YOU
CAN SEND YOUR QUESTIONS VIA
E-MAIL TO “MORE TO LIFE” AT
TVO.ORG.
NICE TO SEE YOU HERE, HI.

The caption changes to “Doctor Richard Casey. Urologist.”

Doctor Richard Casey is in his forties, clean-shaven and with short wavy brown hair. He wears glasses, a gray suit, dark gray shirt and gunmetal tie.

Richard says PLEASURE TO BE HERE.

Maureen says URINARY
INCONTINENCE, YOU WERE
SAYING DURING THE TAPE THERE
ARE SOME NEW DRUGS TO TREAT
THAT, TELL ME ABOUT THOSE.

Richard says MOST OF IT OCCURS IN
FEMALES.
AS UROLOGISTS WE TREAT
FEMALES AS WELL THERE ARE
TWO OR THREE NEW DRUGS IN
DEVELOPMENT THAT WILL RELAX
THE BLADDER AND MAKE
PEOPLE'S BLADDER CAPACITY
MUCH BETTER AND ELIMINATE A
LOT OF THE TROUBLESOME
SYMPTOMS.
MOST PATIENTS THAT COME TO
ME COME BECAUSE THEY ARE
GOING TO THE BATHROOM
ALL THE TIME AND IT IS
INTERFERING WITH THEIR
QUALITY OF LIFE AND THEY
WANT TO STOP PEEING SO
FREQUENTLY AND BE DRY.

Maureen says DOES THE BLADDER
HAVE TO BE RELAXED.
I THOUGHT THE PROBLEM
WAS THE BLADDER WAS ALREADY
TOO RELAXED.

Richard says THE MUSCLES AROUND THE
BLADDER ARE TOO RELAXED.
PEOPLE THAT ARE INCONTINENT
USUALLY -- MOSTLY WOMEN,
THEY HAVE HAD A FEW WOMEN.
THEY MIGHT OVERWEIGHT, MAYBE
THEY SMOKE AND HAVE A
PERSISTENT COUGH WHICH
PUSHES THEIR BLADDER DOWN SO
THE PELVIC FLOOR THAT KEEPS
IT SPORTED IS RELAXED.
BUT ALSO THAT PULSE THE
BLADDER DOWN SO IT GETS A
BIT IRRITATED.
SO IF YOU CAN RELAX THE
BLADDER SO IT HAS A BETTER
CAPACITY MAYBE YOU WON'T BE
AS WET.

Maureen says COULD YOU DO THIS
WITHOUT DRUGS.

Richard says YOU CAN DO PELVIC FLOOR
BIOFEEDBACK AVAILABLE TO
SOME PEOPLE ON PRIVATE
HEALTH PLANS THERE ARE
PELVIC FLOOR EXERCISES YOU
CAN DO.
YOU CAN LOSE WEIGHT, GET
INTO SHAPE AND QUIT SMOKING.

Maureen says THEY TELL YOU TO
DO THOSE EXERCISES WHEN ARE
YOU PREGNANT.
DO THEY WORK.
DO I HAVE TO DO THEM.

Richard says NO, BUT ABOUT 50 PERCENT OF
PATIENTS WE SEE CAN BE
TREATED WITH CONSERVATIVE
METHODS, RESTRICTION OF
FLUIDS, AVOIDING CAFFEINE
CONTAINING BEVERAGES,
KNOWING WHERE THE BATHROOMS
ARE SO THEY DON'T GET TOO
FULL AND THE EXERCISES ARE
HELPFUL.

Maureen says CAFFEINE IS A DIURETIC?

Richard says IT IS A BLADDER
STIMULANT.
A LOT OF MALE PATIENTS FIND
IF THEY DON'T DRUNK AS MUCH
COFFEE THEY DON'T HAVE TO
PEE AS FREQUENTLY.

Maureen says URGE TO URINATE
AND THE LEAKING THEY ARE
BOTH PART OF BEING
INCONTINENT.

Richard says IT’S A SPECTRUM. THERE ARE
PATIENTS THAT JUST LOSE
WATER WHEN THEY COUGH OR
SNEEZE AND HAVE NO URGENCY
OR FREQUENCY.
THESE ARE PATIENTS WITH
MULTIPLE CHILDBIRTH AND
PROBABLY OBESE.
THE OTHER END OF THE
SPECTRUM THERE ARE THE
PEOPLE THAT HAVE TO ME ALL
THE TIME AND KNOW WHERE
EVERY BATHROOM IS IN EVERY
MALL WHERE THEY GO.
BUT MOST PATIENTS HAVE A
MIXED PICTURE.

Maureen says INTO YOU KNOW
THOSE THREE HOUR MOVIES, I
CANNOT MAKE IT THREE HOURS.

Richard says I CAN DRINK ONE OF THOSE
EXTRA LARGE INTO…

Maureen says BIG GULP? AND STAY
THROUGH THE WHOLE MOVIE?

Richard says UH-HUH.

Maureen says CAN YOU TRAIN
YOUR BLADDER TO NEED TO GO
LESS FREQUENTLY.

Richard says PART OF THE TREATMENT OF
INCONTINENCE IS A BLADDER
DRILL OR BLADDER TRAINING TO
STAY WITH IT, HOLD YOUR
URINE A LITTLE LONGER BUT
YOU CAN'T DO THAT OUT IN
PUBLIC OR WHEN ARE YOU
SHOPPING BECAUSE IF YOU DO
HAVE AN ACCIDENT YOU ARE
EMBARRASSED.

Maureen says OKAY.
LET'S MOVE INTO VIAGRA.
HOW MANY PRESCRIPTIONS AS OF
THE END OF JANUARY, 535,000
PRESCRIPTIONS FILLED FOR
VIAGRA IN CANADA ALONE.

Richard says IT IS A LOT.

Maureen says HOW MANY DID YOU
DO.

Richard says 529,000 IT IS THE
ONE-YEAR ANNIVERSARY OF
VIAGRA.
IT HAS BEEN A SUCCESS STORY
FOR THE COMPANY AND FOR
PATIENTS THAT HAVE NEEDED
SOMETHING TO TAKE IT IS A
GREAT DRUG IT WORKS IN MOST
PATIENT WES HAVE USED IT ON.
VERY FEW SIDE EFFECTS AND
THE CARDIAC SIDE EFFECTS
THAT WE ARE WORRIED ABOUT
PRODUCING HEART DISEASE
HASN'T REALLY BEEN A PROBLEM
INTO NO.

Maureen says WHAT IS UPRIMA?

Richard says WITH PFIZER HAVING SUCH A
SUCCESS WITH ONE DRUG ALL
THE OTHER COMPANIES HAVE
BEEN DEVELOPING DRUGS AND
UPRIMA IS THE FIRST
DEVELOPED BY A QUEEN'S
RESEARCHER SO IT IS A
CANADIAN DRUG IT HAS BEEN
AROUND FOR A LONG TIME
CALLED APOMORPHINE.
WE USED TO GIVE IT TO
PATIENTS WHO HAVE TAKEN
OVERDOSES TO MAKE THEM
THROWN UP.
THEY WOULD YAWN AND GET A
GREAT ERECTION.
SO THE FORMULATION WAS
CHANGED.
IT HAS GONE THROUGH A NUMBER
OF CLINICAL STUDIES AND IT
LOOKS LIKE IT IS A GOOD
ADDITION TO THE ORAL
THERAPIES FOR ERECTILE
DYSFUNCTION IT WORKS DIFFERENTLY
THAN VIAGRA, ON A PART OF
THE BRAIN THAT CONTROLS
ERECTION IT MAY BE SAFE FOR
PATIENTS THAT VIAGRA ISN'T
SAFE FOR YOU.
IT IS THOSE PATIENTS ON
NITROGLYCERIN.

Maureen says DOES IT STILL MAKE YOU THROW UP?

Richard says THERE IS A BIT OF NAUSEA, IN
MAYBE ONE IN 30 PATIENTS BUT
CLINICAL TRIALS AND WE WERE
INVOLVED IN SOME CLINICAL
TRIALS REALLY RENT PANNED
OUT THAT MANY PATIENTS HAVE
PROBLEMS WITH NAUSEA.
SO IT IS A PRETTY GOOD DRUG.

Maureen says OKAY.
WE ARE GOING TO TALK ABOUT
VIAGRA, UPRIMA, URINARY INCONTINENCE,
PROSTATE, SEXUAL DYSFUNCTION
ALL THOSE THINGS THIS
AFTERNOON WITH DOCTOR RICHARD
CASEY, HE IS A UROLOGIST SO
GIVE US A CALL,
416-484-2727.
LONG DISTANCE,
1-888-411-1234.
AND THE E-MAIL ADDRESS IS
MORETOLIFE@TVO.ORG.
ANN IS IN KITCHENER. HI ANN.

Ann says THANKS FOR TAKING MY CALL.
I HAVE A QUESTION, KIND OF
EMBARRASSING I GUESS IT IS
ABOUT MY HUSBAND'S PENIS.
IT HAS A REAL -- A CURVE IN
IT AND I WAS WONDERING
WHETHER THERE IS ANYTHING
THAT CAN BE DONE FOR THAT
BECAUSE IT IS UNCOMFORTABLE
FOR ME.

Richard says HAS HE ALWAYS HAD THE
CURVE OR SOMETHING THAT
DEVELOPED IN THE LAST COUPLE
YEARS.

Ann says IN MY OPINION IT IS
GETTING A LITTLE WORSE.

Richard says WELL, YOUR HUSBAND
PROBABLY HAS A CONDITION
CALLED PERONI'S DISEASE.
I MIGHT SEE FOUR OR FIVE MEN
IN THE OFFICE EVERY WEEK,
IT IS DUE TO SCAR TISSUE ON
THE PENIS AND IT TETHERS IT
IS SO YOU GET A BANANA-LIKE
EFFECT.
I'M SURPRISED ARE YOU HAVING
A PROBLEM WITH PAIN BECAUSE
MOST PARTNERS DON'T COMPLAIN
OF PAIN BUT THERE ARE
PROCEDURES THAT CAN BE USED
TO STRAIGHTEN IT OUT.
HE SHOULD GO TO HIS FAMILY
DOCTOR WHO WOULD REFER HIM
TO A UROLOGIST.

Maureen says DO THEY INVOLVE
SURGERY.

Richard says MINOR SURGICAL PROCEDURES,
A LITTLE NIP AND TUCK CAN
STRAIGHTEN IT OUT.

Maureen says OKAY.
SO IT IS A DAY SURGERY.

Richard says DAY SURGERY.
IT IS IMPORTANT SURGERY
BECAUSE IT IS ON AN
IMPORTANT PART OF HIS BODY
BUT HE SHOULD SPEAK TO A
UROLOGIST ABOUT IT.

Maureen says THANK YOU, ANN.
A QUESTION FROM LAURYN.
A PROSTATE BIOPSY TWO
YEARS AGO WHICH TESTED
NEGATIVE. I'M 60 YEARS OLD AND AM
CURIOUS WHETHER TO HAVE
FURTHER PSA TESTING AND WHAT
ARE THE ODDS THAT I WILL BE
PROSTATE CANCER-FREE IN THE
FUTURE.

Richard says TOUGH QUESTION.
HE SHOULD CONTINUE TO CEASE
HI DOCTOR ON A YEARLY BASIS
AND CONTINUE TO HAVE PSAs
AND RECTAL EXAMINES.
ONE BIOPSY DOESN'T MEAN YOU
DON'T HAVE CANCER.
IF YOU TAKE PEOPLE WITH
NEGATIVE BIOPSIES WHO WERE
BIOPSIES FOR GOOD REASON
ABOUT ONE IN FIVE WILL HAVE
CANCER ON THE NEXT BIOPSY SO
HE SHOULD CONTINUE TO SEE
HIS DOCTOR AND GET YEAR --
YEARLY PSA.

Maureen says THAT A GOOD
SCREENING TOOL.

Richard says IT IS PART OF A GOOD
SCREENING PROGRAMME, PSAs
ARE THE BEST TEST WE HAVE
FOR PROSTATE CANCER AND WE
RECOMMEND THAT ALL MEN OVER
THE AGE OF 50 HAVE IT DONE
ON A YEARLY BASIS
PARTICULARLY IF THEY ARE?
A HIGH RISK GROUP F THEIR
FATHER'S OR BROTHERS HAVE
PROSTATE CANCER.
BUT HAS TO BE COMBINED WITH
A PHYSICAL EXAMINATION AND
DIGITAL-RECTAL EXAM IT IS A
GOOD TEST.

Maureen says ARE THEY
IMPROVING IT.
I READ RECENTLY THEY MIGHT
BE ABLE TO GET RID OF
FALSE-POSITIVES.

Richard says THEY INVENTED A TEST
CALLED FREE PSA WHICH COSTS
MORE MONEY.
THAN THE NON-FREE PSA.
AND THAT MAY IN PATIENTS
THAT HAVE A SLIGHTLY
ELEVATED PSA REDUCE THE NEED
FOR BIOPSIES.
BUT IT IS NOT A BIG
IMPROVEMENT IT IS STILL UP
TO THE INDIVIDUAL UROLOGIST
AND THE PHYSICAL
EXAMINATION.
WE ARE GETTING BETTER BUT WE
STILL HAVE A LONG WAY TO GO
BEFORE WE HAVE A TEST THAT
TELLS US WHETHER YOU HAVE
CANCER OR NOT.

Maureen says WHAT IS YOUR
ADVICE TO YOUNGER MEN WHO
DON'T WANT TO HAVE IT COME
BACK POSITIVE S THERE
ANYTHING THAT THEY CAN DO IN
LIFESTYLE.

Richard says SURE.
THERE IS A LOT OF THINGS
THAT CHANGING YOUR DIET OR
HAVING A HEALTHY DIET
REDUCES YOUR RISK OF HAVING
PROSTATE CANCER.
A DOCTOR AT SUNNYBROOK
HOSPITAL DID A STUDY LOOKING
AT LOW FAT DIETS, A DIET
RICH IN LYCOPENES, TOMATOES
AND VITAMIN E
SUPPLEMENTATION MAY REDUCE
YOUR RISK OF HAVING PROSTATE
CANCER TO THAT WHAT IT IS IN
THE ASIAN COMMUNITY WHICH IS
ABOUT HALF OF NORTH AMERICA.

Maureen says I INTERVIEWED
HIM.
HE HAS HIS PATIENTS MAKE UP
A COCKTAIL OF TOMATOES AND
STUFF LIKE THAT.

Richard says WE CALL IT PASTA SAUCE.

Maureen says IT IS DEFINITELY
PROCESSED TOMATOES.
KELLY IS IN OTTAWA.
HELLO.

Kelly says THANKS FOR TAKING MY
CALL.
I HAVE A TWO AND A
HALF-YEAR-OLD SON WHO ISN'T
CIRCUMCISED AND WE ARE
HAVING A HARD TIME PULLING
HIS FORESKIN BACK HE HAS HAD
TWO URINARY TRACK INFECTIONS
AND I WONDER WHAT I CAN DO
TO HELP PULL THE
FORESKIN BACK AN HELP TO
PREVENT THE BLADDER
INFECTIONS.

Richard says FIRST STOP TRYING TO PULL
IT BACK.
MANY BOYS WILL HAVE A
FORESKIN THAT IS NOT
RETRACTABLE UP UNTIL THE
AGE OF SIX.
ALL ARE YOU GOING TO DO IS
CAUSE HUM SOME DISCOMFORT
AND YOU MAY AGGRAVATE THE
PROBLEM.
SO DON'T PULL BACK HIS
FORESKIN IF IT DOESN'T COME
BACK EASILY.
AS FOR URINARY TRACT
INFECTIONS, WAS HE SICK, DID
HE HAVE A FEVER AND
HOSPITALIZED.

Kelly says HE HAD A DISCHARGE.

Richard says A DISCHARGE IS NOT
NECESSARILY URINARY TRACT
INFECTION IT MAY BE A BIT
YOU UNCOMFORTABLE.
I WOULD LEAVE THE FORESKIN
ALONE WHEN YOU BATH HIM, SEE
IF YOU CAN PULL IT BACK
EASILY BUT IF YOU CAN'T,
FORGET ABOUT IT NATURE
WILL BRING IT BACK OVER THE
NEXT COUPLE OF YEARS.

Maureen says DO YOU HAVE BOYS.

Richard says I HAVE THREE BOYS.
MY CHILDREN WILL NEVER TALK
TO ME.
I DON'T BELIEVE IN SIR SUM
SIGNIFICANCE SO I DO IT
BECAUSE I THINK IT IS A BAD
IDEA.
IT IS PAINFUL FOR THE
CHILDREN.
IT DOESN'T REALLY HAVE MUCH
IMPACT WHEN THEY ARE OLDER
AND GOD GAVE US A FORESKIN.

Maureen says MINE IS NOT
WATCHING.
WE DIDN’T
CIRCUMCISE HIM AND I DON'T
DO ALL THAT PULLING STUFF.

Richard says BOYS ARE AMERICAN DANCE
FREE.
YOU INSTRUCT THEM TO DO IT
WHEN IT BECOMES THEIR
FAVOURITE PLAYTHING AROUND
THE AGE OF FOUR, MOST BOYS
PULL IT BACK ON THEIR OWN.

Maureen says AND THAT IS OKAY.

Richard says THAT IS OKAY.

Maureen says OKAY.
THANKS, KELLY.
CHRIS IS IN BANGKOK, HI,
CHRIS.

Chris says HI.
IT IS KIND OF A STRANGE
QUESTION BUT USUALLY THE
VIAGRA IS ONLY GIVEN TO THE
MEN.
BUT MY FAMILY DOCTOR HAS PUT
ME ON IT.
BECAUSE I HAD A HYSTERECTOMY
11 YEARS AGO.
AND I WONDERED HAVE YOU EVER
HEARD OF IT, WOMEN HAVING
IT.

Maureen says I THINK YOU HAVE
GIVE TEN TO WOMEN IN A
STUDY.

Richard says I HAVE.
AND OUTSIDE OF STUDIES, WELL,
FIRST OF ALL VIAGRA HAS VERY
LITTLE SCIENTIFIC EVIDENCE
THAT IT WILL HELP WOMEN.
BUT IT MAKES SENSE THAT A
DRUG THAT WILL IMPROVE
PELVIC BLOOD FLOW MIGHT
IMPROVE SEXUAL RESPONSE IN
WOMEN OR AT LEAST SEXUAL
SATISFACTION.
YOU HAVE A FAIRLY
PROGRESSIVE DOCTOR, I HAVE
TO TIP MY HAT TO HIM BECAUSE
WE ARE NOW LOOKING AT WOMEN
THAT HAVE HAD PELVIC SURGERY,
WHICH MAY HAVE INTERFERED
WITH PELVIC BROOD FLOW AND
THERE MAY BE AN INDICATION
FOR USING VIAGRA BUT THESE
STUDIES ARE IN PROGRESS.
I DON'T SEE A REAL HARM IN
IT ALTHOUGH I WOULD NOT WANT
TO USE IT IN WOMEN THAT ARE
IN CHILD BEARING AGE WHO MAY
GET PREGNANT.

Maureen says YOU THINK THERE
MAY BE SOME PROBLEM WITH
VIAGRA.

Richard says I DON'T KNOW.
HOW HAS THIS WORKED WITH YOU,
THE VIAGRA.

Chris says IT HAS WORKED GREET.
MY HUSBAND CAN'T BELIEVE IT.

Richard says WELL, GOOD.
I MEAN IT COULD BE A PLACEBO
EFFECT T COULD BE A THE
DRUG'S EFFECT BUT THERE IS
SCIENTIFIC EVIDENCE THAT
SUGGESTS IT COULD BE USEFUL
PARTICULARLY IN THE TYPE OF
POPULATION THAT ARE YOU,
PELVIC SURGERY.

Maureen says DOES IT DO
ANYTHING FOR YOUR DESIRE TO
HAVE SEX OR IS IT JUST, YOU
KNOW.

Chris says NO T DOESN'T REALLY DO
MUCH FOR THE DESIRE FOR
IT.
BUT IT JUST MAKES IT A LOT
MORE COMFORTABLE AND MORE
ENJOYABLE FOR ME

Maureen says AND
THIS IS YOUR POINT ABOUT VIAGRA
IS NOT THERE TO RAISE
YOUR LIBIDO.

Richard says NO T WON'T AFFECT YOUR
LIBIDO.
WHAT IT WILL DO IN A FEMALE
PATIENT IF IT WORKS IS
IMPROVE PELVIC BLOOD FLOW,
LUBRICATION, AND MAKE IT
MORE COMFORTABLE.
IT HAS NO EFFECT ON LIBIDO
ONLY THAT IT MIGHT MAKE IT
MORE ENJOYABLE SO YOU LOOK
FORWARD TO HAVING SEX MORE.

Maureen says WHAT DO YOU DO FOR
WOMEN WHO COME TO YOU SAYING
THEY HAVE NO DESIRE TO HAVE
SEX.

Richard says GET THEM A BABY-SITTER.
WELL, I MEAN THERE ARE SO
MANY REASONS FOR WOMEN.
AND MOST OF THE TIME IT IS
RELATIONSHIP ISSUES AND THE
BURDEN OF HAVING CHILDREN
AND WORKING.
WE DO HORMONE TESTS AND
OCCASIONALLY IT IS HORMONALLY
RELATED OR RELATED TO PELVIC
SURGERY.
WE HAVE TO DO A FULL
EVALUATION AND SEE.
SOMETIMES TAKING
TESTOSTERONE, A LOW DOSE CAN
BE VERY HELPFUL, A DRUG THAT
MEN TAKE FOR PROBLEMS CAN BE
VERY HELPFUL.

Maureen says BUT IS THIS ANDRO THE
SAME FOR WOMEN AS THE -- IS
IT AS SUCCESSFUL IN ALL
WOMEN?

Richard says NO IT IS NOT.
THERE ARE A LOT OF WOMEN
THAT HAVE DIFFICULTIES WITH
LIBIDO WHO HAVE HORMONAL
PROBLEMS WILL TELL THEM IF
THEY GIVE THEM A BIT OF
TESTOSTERONE WILL MAKE THEM
FEEL BETTER.

Maureen says YOU CAN'T GIVE
TOO MUCH THOUGH RIGHT.

Richard says NO, BECAUSE THEY DON'T
LIKE SHAVING.

Maureen says I DON'T KNOW WHY.
HE SAYS I'M 42 YEARS OLD,
FOR THE LAST FEW MONTHS HE
FEELS I SELDOM GET AN
ERECTION AND IF I DO IT IS
NOT HARD AND LONG ENOUGH IS
IT NORMAL AT THIS AGE.
WHEN SHOULD I BE THINKING
ABOUT SEEKING MEDICAL HELP.

Richard says WELL, IT IS NORMAL TO
HAVE A REDUCTION IN
FREQUENCY IN SPONTANEOUS
ERECTIONS.
WHEN ARE YOU 18 YEARS OLD A
DIFFICULT WIND WILL GIVE YOU
ONE.
BUT WHEN YOU ARE 50 YOU NEED
TO BE IN THE RIGHT MOODS
AND CONDITIONS NEED TO BE
APPROPRIATE.
I WOULD ONLY SEEK ATTENTION
IT INTERFERES WITH YOUR SEX
LIFE OR ENJOYMENT OF SEX.
SO IF YOU DON'T GET AN
ERECTION WHEN ARE YOU TRYING
TO ENGAGE IN
SEXUAL ACTIVITY MAYBE IT IS
TIME TO SEE A DOCTOR.
BUT I WOULD MAKE NOTHING OF
THE SPONTANEOUS ERECTIONS
OR THE ONES YOU ARE SUPPOSED
TO GET IN THE MORNING
BECAUSE THEY ARE VARIABLE.

Maureen says HAVE YOU HAD
FAIRLY YOUNG MEN COME ASKING
FOR VIAGRA.

Richard says I HAVE HAD MEN AS YOUNG
AS 14.
AND I COUPLE THEM TO SAY ARE
YOU 14, YOU ARE A MINOR, YOU
SHOULDN'T BE HAVING SEX T IS
AGAINST THE LAW.
HE SAID IT IS OKAY, MY
GIRLFRIEND IS 14 AS WELL.
I DIDN'T GIVE HIM THE VIAGRA
WE HAVE HAD MEN AS YOUNG AS
14 AND OLD AS 90.

Maureen says COMING FOR IT.

Richard says YEAH.

Maureen says BUT THE AVERAGE
IS.

Richard says ABOUT 55.

Maureen says RITA IS IN
SCARBOROUGH, HELLO.

Rita says HIGH, MAUREEN, THANKS FOR
TAKING MY CALL.
MY QUESTION IS I HAVE A
19-YEAR-OLD DAUGHTER WHO HAS
RECENTLY BEEN DIAGNOSED WITH
INTERSTITIAL CYSTITIS
SOMETHING I NEVER HEARD OF
BEFORE.
SHE EXPERIENCING A LOT OF
PAIN DURING HER PERIOD TIME.
LAST MONTH SHE HAD A
CYSTOSCOPY DONE AND SHE WAS
TOLD THIS IS WHAT SHE HAS.
AND THAT IS IT.
WE HAVE NOT HAD ANY FOLLOW-UP
VISIT, NO MEDICATIONS OR
NOTHING.
MY QUESTION IS AT THIS STAGE
SHOULD SHE NOT BE ANY
MEDICATIONS BECAUSE CAN IT
GET WORSE IF SHE DOESN'T
TAKE -- SHE IS ONLY 19.

Richard says IT IS A HORRIBLE PROBLEM
BECAUSE IT IS VERY DIFFICULT
TO TREATS YOU HAVE ALREADY
EXPERIENCED.
YOU PROBABLY SHOULD GO BACK
TO THE UROLOGIST THOUGH
THERE ARE A NUMBER OF
TREATMENTS AVAILABLE FOR
THIS DISEASE.
WHAT IT IS AN INFLAMMATION
OF THE LINING OF THE
BLADDER.
AND WE THINK IT MAY BE DUE
TO A LOSS OF THE MUCOUS
LINING THAT THE BLADDER
NORMALLY PRODUCES TO PROTECT
THE MUCOSA WHICH IS THE
INNER LINING OF THE BLADDER
AGAINST THE URINE, PATIENTS
HAVE HORRIBLE SYMPTOMS WITH
URGENCY, FREQUENCY, LIKE
FROM A URINARY TRACT
INFECTION BUT IT DOESN'T
HELP.
THERE ARE A NUMBER OF
TOPICAL TREATMENTS YOU CAN
TAKE THAT CAN GIVE YOU
COMFORT AND YOU SHOULD SEEK
TREATMENT AND SPEAK TO THE
DOCTOR ABOUT IT.

Maureen says IS THIS GOING
TOSH A LIFELONG PROBE.

Richard says IF SHE TRULY HAS HAD, AND
IF THAT IS SOMETHING WE HAVE
TO QUESTION BECAUSE IT IS A
DIFFICULT DIAGNOSIS TO MAKE
IS A DISEASE YOU HAVE FOR
LIFE BUT IT MAY NOT GET
WORSE, PROGRESSIVELY WORSE.
SO SHE MIGHT HAVE THE SAME
SYMPTOM FORCE A NUMBER OF
YEARS.

Maureen says SO NOW WHAT IS THE
CYSTOSCOPY SHE SAID HER
DAUGHTERS HAD.

Richard says IT IS SOMETHING
UROLOGISTS DO, WE TAKE A
SMALL CAMERA ON THE END OF A
SMALL PROBE AND PUT IT INTO
THE BLADDER.
IT TAKES ABOUT FIVE MINUTES
AND WE CAN LOOK AT THE
LINING OF THE BLADDER AND
SEE WHAT IT LOOKS LIKE.
IT IS NOT VERY PAINFUL.

Maureen says WHEN PEOPLE ARE
EXPERIENCING FREQUENT
BLADDER INFECTIONS, YOU
MIGHT DO A CYSTOSCOPY THEN
TOO.

Richard says WELL RARELY, CYSTOSCOPIES
ARE SOMETHING WE DO WHEN WE
SUSPECT THERE MAY BE
PATHOLOGY OR SOMETHING WRONG
WITH THE BLADDER.
MOST PEOPLE WITH URINARY
TRACK INFECTIONS HAVE A
NORMAL BLADDER.

Maureen says WE ARE TALKING ABOUT THE
BLADDER AND OTHER THINGS
THIS AFTERNOON, THE PROSTATE,
SEXUAL DYSFUNCTION WITH
DOCTOR RICHARD CASEY.
HE IS A UROLOGIST AND HE IS
ALSO DIRECTOR OF THE MAYO
HEALTH CENTRES IN OAKVILLE
SO IF YOU HAVE A QUESTION
CALL US, IN TORONTO
416-484-2727.
CALL TOLL-FREE
1-888-411-1234 OR E-MAIL
YOUR QUESTIONS TO
MORETOLIFE@TVO.ORG.
AND RICHARD IS CALLING FROM
PUCKERING.
HELLO, RICHARD.

The caller says HI.

Maureen says HI.

The caller says IS DOCTOR CASEY THERE.

Maureen says YEAH, HE IS.

The caller says DOCTOR CASEY, I HAD A
RADICAL PROSTATECTOMY TWO WEEKS
AGO AND HAD THE CATHETER OUT
TWO DAYS AGO.
I'M HAVING A LOT OF TROUBLE
WITH INCONTINENCE.
I HAVE A LITTLE BIT OF
CONTROL AT NIGHT WHEN I HAVE
MY LEGS STRAIGHT UP IN THE
AIR TYPE OF THING.
BUT I AM DOING MY KEGEL.
THEY DON'T SEEM TO BE
HELPING.
BUT I WAS WONDERING IF THERE
IS A PILL TO GET A REACTION
OUT OF THE PENIS.
I'M NOT GETTING ANY REACTION
T JUST SITS THERE.
I TRY TO STIMULATE IT A
LITTLE BIT.
IF I GOT MUSCLE CONTROL, I
THINK I MIGHT BE ABLE TO GET
BLADDER CONTROL.

Richard says FIRST OF ALL, RELAX.
DON'T WORRY ABOUT IT.
IT IS VERY EARLY AND MOST
PATIENTS ARE NOT CONTINENT
TWO WEEKS AFTER A RADICAL
PROSTATECTOMY.
IF YOU HAVE SOME CONTROL,
ODDS ARE IT WILL GET BETTER
AND IT WILL TAKE MAYBE UP TO
A MONTH OR SIX MONTHS.
THERE IS NOTHING THAT YOU
CAN DO OTHER THAN STAY
ACTIVE AND TO DO YOUR KEGEL
EXERCISES THAT ARE GOING TO
SPEED IT UP.
THERE ARE NO PILLS THAT YOU
NEED TO TAKE.
JUST RELAX IT IS VERY, VERY
EARLY AND I WON'T WORRY
ABOUT IT.
I ALSO WOULDN'T EXPECT TO
YOU HAVE ERECTIONS SO EARLY.
I'M SURE YOU HAVE AN
APPOINTMENT TO SEE AN
UROLOGIST SOON.
THEY WILL TELL YOU WHETHER
OR NOT HE DID A NERVE
SPARING OPERATION AND HOW
THINGS WENT.
BUT IT TAKES MONTHS BEFORE
YOU HAVE COMPLETE REIT
SOUNDS LIKE ARE YOU DOING
PRETTY GOOD SO FAR, THOUGH.

Maureen says TELL ME ABOUT
THIS NERVE-SPARING
OPERATION.
IS THAT THE -- CABBERMAT.

Richard says THAT IS A TOOL THAT WAS
DEVELOPED BY A DOCTOR AT
SUNNYBROOK T IS A
PROGRESSIVE UROLOGY
DEPARTMENT.
WE DID SOME WORK, NERVE
SPARING IS A NAME FOR THE
OPERATION WE DO NOW THAT REX
THE NERVES THAT SUPPLY THE
PENIS IN ERECTIONS AND
SEPARATES THEM AWAY FROM THE
PROSTATE WHEN WE REMOVE IT.
MOST PATIENTS CAN HAVE A
NERVE SPARING OPERATION AND
MAINTAIN SEXUAL FUNCTION
AFTER A RADICAL PROSTATECTOMY.
IT WAS A WAY TO STIMULATE
THE NERVES BECAUSE IT IS
TOUGH TO SEE IN SURGERY.

Maureen says THIS ONE OF THE
THINGS MEN WERE LEFT
IMPOTENT BECAUSE YOU GOT THE
NERVES.

Richard says WE TOOK EVERYTHING OUT.
BUT STILL 50 PERCENT OF THE MEN ARE
STILL LEFT PESSIMISM TENT
WITH NERVE SPARING SO IT IS
NOT ALL IT IS CRACKED UP
ABOUT.

Maureen says I HAVE ALSO READ
THAT IT IS REALLY IMPORTANT
TO HAVE A SKILLED SURGEON DO
THIS.
NOT ALL SURGEON DOES THIS
EQUALLY.

Richard says NO, A LOT OF UROLOGISTS
DON'T LIKE DOING THEM
BECAUSE IT DOES REQUIRE A
CERTAIN AMOUNT OF SKILL BUT
MOST OF US DO IT.
IT IS AN OPERATION THAT
DEFINES THE UROLOGIST.
YOU SHOULD ASK YOUR SURGEON
HOW MANY HE DOES A YEAR AND
WHAT HIS SUCCESS RATE IS.
AND ASK IF YOU CAN SPEAK TO
ONE OF HIS PATIENTS THAT HAS
HAD ONE OR GO TO A SUPPORT
GROUP IN YOUR AREA AND THEY
WILL TELL YOU THE DOPE ON
THE LOCAL SURGEON.

Maureen says WHAT IS
CONSIDERED A SUCCESS THEN.

Richard says THE SUCCESS IS DESIGNED
DIFFERENTLY FROM A SURGEON
AND FROM A PATIENT'S POINT
OF VIEW.
AND I WOULD CONSIDER IT A
PATIENT'S SUCCESS IF YOU
WERE CONTINENT AFTER THE
SURGERY, IF YOU WERE POTENT
AND YOUR PSA WAS ZERO AT
FIVE YEARS THAT WOULD BE A
REAL SUCCESS.

Maureen says OKAY, RICHARD,
GOODING LUCK, THANKS FOR
YOUR CULL.
CHRIS SAYS I SUFFER FROM
FREQUENT URGES TO URINATE.
WHERE CAN I GET A BOOK OR
PAM FLEET THAT OUTLINES THE
EXERCISES.
I BELIEVE THERE IS A
SPECIAL NAME FOR THESE, IT
IS PROBABLY THE KEGEL.

Richard says THERE IS A GOOD BOOK
CALLED YOU DON'T HAVE TO
LIVE WITH CYSTITIS, IT TALKS
ABOUT THAT AND THE EXERCISES
AND DIFFERENT THINGS THAT YOU CAN DO.
THERE IS ALSO A PLACE CALLED
THE UROLOGY RESOURCE CENTRE
IN BURLINGTON THAT HAS A
LIBRARY OF A NUMBER OF BOOKS
THAT YOU CAN USE AND
EXERCISES AND A NURSE ON
CALL THERE THAT WILL HELP
YOU WITH THOSE EXERCISES AS
WELL.

Maureen says IS THIS SOMETHING
CHRIS SHOULD ASK FOR A
REFERRAL TO A UROLOGIST
ABOUT.

Richard says IT DEPENDS.
I DON'T KNOW ENOUGH ABOUT
HIS HISTORY TO KNOW.
I WOULD SPEAK TO HIS FAMILY
DOCTOR FIRST IT IS NOT
NECESSARY TO GO TO A
UROLOGIST.

Maureen says CATHY IN
OAKVILLE.

Cathy says I HAVE MULTIPLE SCLEROSIS
AND SOME PEOPLE THAT -- IN
FACT ALL THE PEOPLE WITH MS
THAT I HAVE SUGGESTED TAKING
222s OR TYLENOL WITH CODEINE TO
HELP WITH
THEIR URINARY INCONTINENCE
BUT THE PEOPLE THAT DON'T
HAVE MS IT DOESN'T HELP.
SO IS THAT ONE WAY TO
DIAGNOSE WHETHER A PERSON'S
PROBLEM IS COMING FROM A
NEUROLOGICAL PROBLEM.

Richard says NO I DON'T THINK IT SAND
I'M NOT GOING TO ARGUMENT
WITH THE FACT THAT THE
TYLENOL MAY HELP THE
INCONTINENCE.
THERE COULD BE THERE IS A
MUSCLE RELAXANT AFFECT OF
THE CODEINE IN THE TYLENOL
NUMBER 2s O 3s BECAUSE
THERE IS CODEINE IN THAT BUT
IT IS NOT A WAY TO DIAGNOSE
MULTIPLE SCLEROSIS, NO.

Maureen says IS THERE ANY
EVIDENCE THAT PEOPLE WITH MS
HAVE URINARY INCONTINENCE AT
A HIGHER RATE.

Richard says THEY DO, CERTAINLY.
ONE OF THE MOST TROUBLING
SYMPTOMS IN PATIENTS WITH MS
IS THE URINARY FREQUENCY.
ABOUT TWO-THIRDS OF THEM
WILL HAVE URGENCY AND THAT
IS QUITE DISABLING.
A LARGE POPULATION THAT I
SEE HAVE MS.
THERE ARE GOOD DRUGS LIKE
THE BLADDER RELAXANTS WE
TALKED ABOUT EARLIER AND WE
ARE INVOLVED IN CLINICAL
TRIALS THAT ARE LOOKING AT
DRUGS FOR PEOPLE WITH
MULTIPLE SCLEROSIS OR NON --
OR WHO DON'T HAVE IT WHO
HAVE URGENCY AND FREQUENCY.
IT DOES HELP.

Maureen says THOSE DRUGS YOU
TALKED ABOUT THAT WILL RELAX
THE BLADDER, ANY SIDE
AFFECTS TO THOSE?

Richard says IN GENERAL THE SIDE
EFFECTS ARE DRY MOUTH,
CONSTIPATION, THAT IS ABOUT
IT, REALLY.
NOT MANY SIDE EFFECTS.

Maureen says OKAYS.
STU IN NIAGARA.
HI, STU.

Stu says YES, DOCTOR, I HAVE A
QUESTION REGARDING DELAYED
ORGASMS AND PROBLEM WITH
EVEN GETTING ORGASMS.
I HAVE BEEN TRYING THE
VIAGRA AND IT TENDS TO HELP
MY PARTNER GREATLY BUT IT
TENDS TO MAKE THE ORGASMS
DELAYED OR NOT EVEN COME
SOMETIMES.
I WONDER IF -- I'M CALLING
IT SEX DRIVE.

Richard says WELL, VIAGRA SHOULDN'T
HAVE ANY IMPACT ON YOUR
ABILITY TO REACH AN ORGASM.
ARE YOU TAKING ANY
MEDICATIONS.

Stu says NO, NO, I'M NOT.

Richard says THE COMMONEST CAUSE OF
DIFFICULTY WITH ORGASMS
WOULD BE MEDICATIONS, SOME
OF THE ANTI-DEPRESSANTS WILL
INTERFERE WITH YOUR ABILITY
TO HAVE AN ORGASM.
OTHER THAN THAT, AS WE GET
OLDER OUR ABILITY TO HAVE AN
ORGASM GETS HARDER AND
HARDER.
BUT MOST PEOPLE HAVE
DIFFICULTY WITH ORGASMS HAVE
AN ANXIETY PROBLEM.
THEY WORRY TOO MUCH AND THEY
ARE TRYING TO EJACULATE AND
CAN'T AND THEN THEY JUST
NEVER GET THERE.
SO BEHAVIOUR MODIFICATION
THERAPY, SEEING A COUNSELLOR
CAN BE HELPFUL.

Maureen says SO A SEX THERAPIST.

Richard says YEAH SO.

Maureen says SO THIS DOESN'T
SOUND LIKE SEX DRIVE.

Richard says NOT DRIVE.
THEY ARE ALL RELATED.
IF EVERY TIME YOU HAVE SEX
YOU CAN'T HAVE AN ORGASM YOU
ARE NOT GOING TO HAVE IT
VERY OFTEN.
IT IS NOTHING TO DO WITH
DRIVE, PROBABLY NOTHING TO
DO WITH TESTOSTERONE.
IF YOU HAVE A FEW BAD
EXPERIENCES YOU BECOME A
SELF-FULFILLING PROPHECY.
YOU DON'T LOOK FORWARD TO T
ARE YOU ANXIOUS, YOU HAVE A
POOR ERECTION, YOU HAVE
DIFFICULTY EJACULATING.

Maureen says IS STU THE KIND
OF GUY ON VAGUE RA IN THE
FIRST PLACE.

Richard says I WOULDN'T PUT SOMEONE ON
VIAGRA IF THE DIFFICULTY WAS
WITH THE ORGASM ONLY.
BUT OFTEN THEY ARE TOGETHER,
YOU HAVE A WEAK ERECTION T
IS DIFFICULT TO AMERICAN
TAKEN AND EJACULATING AS
WELL.
SO MAYBE STU IS
APPROPRIATELY ON VIAGRA BUT
CERTAINLY THERE IS NO
RELATIONSHIP BETWEEN VIAGRA
AND THE ABILITY TO
EJACULATE.

Maureen says YOU RUN MALE
HEALTH -- MAYO HEALTH CENTRE,
DO YOU HAVE COUNSELLORS AND
SEX THERAPISTS ON STAFF.

Richard says MOST OF THE WORK WE DO IS
COUNSELLING.
WE HAVE NURSES THAT TO THAT
AND THERAPISTS.
CERTAINLY IN THE OAKVILLE
BRANCH, THERAPISTS,
EVERYBODY WITH SEXUAL
DIFFICULTIES FOR A PROLONGED
PERIOD WOULD BENEFIT FROM A
SEXUAL COUNSELLOR, GET OUT OF
BAD HABITS.

Maureen says THANKS, STU,
DONNA IS NEXT, HI, DONNA.

Donna says HI.

Maureen says HOW ARE YOU.

Donna says WE ARE GOOD.
THANKS FOR MY CALL.
I HAVE A QUESTION TORE
DOCTOR CASEY.
DOCTOR CASEY, MY SON IS EIGHT
YEARS OLD.
AND HE JUST ONLY FROM THE
HOSPITAL.
HE HAD A KIDNEY STONE WHICH
WAS THE TEN MILLIMETRE STONE.

Richard says OUCH.

Donna says I'M NOT GETTING THE
QUESTIONS THAT I'M ASKING
HERE. IS THIS GOING TO BE A
REOCCURRENCE FOR THIS LITTLE
GUY.

Richard says IT IS UNUSUAL FOR YOUNG
CHURN TO HAVE KIDNEY STONES
BUT THEY DO.
AND TO ANSWER YOUR QUESTION
I DON'T KNOW.
BUT HE SHOULD SEE A
NEPHROLOGIST AND HAVE A
METABOLIC EVALUATION.
YOUNG CHILDREN HAVE A DIFFERENT
TYPE OF KIDNEY STONE THAN
ADULTS AND THEY CAN BE BORN
WITH METABOLIC ABNORMALITIES
SO ABOUT 70 PERCENT IN PEOPLE
IN GENERAL THAT HAVE ONE
STONE WOULD NOT BE ANOTHER.
BUT I WOULD BE CONCERNED
ABOUT MY TEN-YEAR-OLD AND
MAKE SURE HE SEES A
NEPHROLOGIST AND GET AN
EVALUATION.
UROLOGISTS, WE ARE
PLUMBERS AND THEY ARE
ARCHITECTS.
THEY ARE INTERNAL MEDICINE
DOCTORS THAT LOOK AT THE
BLOOD TEST AND THE SURGEONS,
UROLOGISTS ARE PRIMARILY
SURGEONS.

Maureen says SO WHO DOES
GALLBLADDER.

Richard says GENERAL SURGEONS DO
GALLBLADDERS.

Maureen says AND KIDNEY
STONES.

Richard says UROLOGISTS BUT WHEN IT
COMES TO THE EVALUATION OF
YOUR METABOLISM TO KNOW
WHY YOU PRODUCE THEM THAT IS
NEPHROLOGIST.

Maureen says WHAT ARE THE
KIDNEY STONES?

Richard says I HAVE HAD A KIDNEY STONE
IT IS HORRIBLE.
A LOT OF WOMEN WHO HAVE BOTH
TELL KNEE IS WORSE THAN
LABOUR.

Maureen says WORSE THAN
CHILDBIRTH.

Richard says YEAH T CAN BE UP TO THREE
TO FOUR MILLIMETRES AS IT
PASSES DOWN YOUR URINARY
TRACT IS BLOCKS YOUR KIDNEY
AND CAUSES HORRIBLE PAIN.

Maureen says IS IT EASIER FOR
WOMEN TO PASS THAN MEN.

Richard says NO.
ALTHOUGH WOMEN CAN HAVE A
BETTER PAIN TOLERANCE THAN
MEN.

Maureen says I WONDER WHY.
WE WERE BUILT THAT WAY.

Richard says VERY PAINFUL.

Maureen says I HOPE THAT HE
NEVER HAS ANOTHER ONE.
THANK YOU FOR THE CALL.
RICK IS IN OSHAWA.
HELLO, RICK.

Rick says HI, HOW ARE YOU.

Maureen says GOOD, THANKS.

Rick says THANKS FOR GETTING MY
CALL IN.

Maureen says YOU ARE WELCOME.

Rick says I AM A 37-YEAR-OLD
MALE AND I HAVE HAD CHRONIC
TIGHT IS SINCE I WAS 29.
I HAVE HAD TWO BIOPSIES, THE
FIRST ONE WAS QUESTIONABLE.
THE SECOND ONE WAS
NEGATIVE. I HAVE HAD A THIRD ONE IN
THE LAST WEEK.
AND I'M AWAITING AS A
RESULTS ON THAT.
BASICALLY FOR THIS CONDITION
I HAVE BEEN TO THE KINGS
HEALTH CENTRE PROSTATE CLINIC IN TORONTO
AND THEY'VE
TRIED A NUMBER OF HERBAL
THINGS.
IT IS THERE ANYTHING ELSE I
CAN BE DOING HERE.

Maureen says YOU COULD START
WITH AN EXPLANATION OF WHAT
PROSTATIS IS?

Richard says IT IS PROSTATITIS AND
THAT IS AN INFLAMMATION OF
THE PROSTATE GLAND.
AND THERE ARE A NUMBER OF
DUMP TYPES OF PROSTATITIS.
THERE IS BACTERIAL
PROSTATITIS WHICH ARE DUE TO
BACTERIA LIKE E. COLI.
THEY ARE OFTEN ASSOCIATED
WITH URGENCY, FREQUENCY,
BACK PAIN, CHILLS AND FEVER
OR URINARY TRACT INFECTION.
THEN THERE IS A BACTERIAL
PROSTATITIS.
WE DON'T KNOW WHAT CAUSES IT,
IT COULD BE A VIRUS OR LOCAL
INFLAMMATION FOR NO REASON
AND IT HAS A LOT OF THE
SYMPTOMS BUT YOU DON'T HAVE
CHILLS, FEVER OR POSITIVE
YOU RECENT CULTURES.
THEN CHRONIC BACTERIAL AND
A-BACTERIAL PROSTATITIS IT IS
A DIFFICULT CONDITION TO
TREAT.
THE HISTORY HERE IS UNUSUAL.
MOST PEN WITH PROSTATITIS
DON'T HAVE PROSTATE BIOPSIES.
AND CERTAINLY NOT THREE
PROSTATE BIOPSIES SO I WOULD
HAVE TO BE CONCERNED WHAT
KIND OF ADVICE THIS YOUNG MAN IS
GETTING FOR HIS PROSTATE.
A LARGE NUMBER OF PATIENTS THAT
HAVE PROSTATITIS DON'T HAVE PROSTATITIS.
IS EASY FOR
PHYSICIANS WHEN THEY COME IN
WITH PAIN IN THEIR REAR END
AND A BIT OF FREQUENCY AND
SAY YOU HAVE PROSTATITIS AND
TAKE THIS FOR THE NEXT FIVE
YEARS AND WILL YOU GET
BETTER.
MANY PATIENTS DON'T.
THAT’S WHY HERBAL REMEDIES
OTHER METHODS SUCH AS ACUPUNCTURE HAVE
BEEN SUCCESSFUL BECAUSE MANY
HAVE PELVIC FLOOR MUSCLE
SPASMS OR WHAT WE CALL PELVIC FLOOR
MIGRAINE WHERE THEY JUST HAVE
SPASMS OF THE PERI-
PROSTATIC MUSCLES AND HAVE
ALL THE SYMPTOMS BUT IT IS
REALLY MUSCULAR.
SO I CAN'T RECOMMEND ANY
HERBAL REMEDIES BUT I WOULD
RECOMMEND THIS MAN STOP FROM
SCRATCH, STOP THE
ANTIBIOTICS, STOP THE
REMEDIES, SEE ANOTHER
UROLOGIST WHO IS NOT GOING
TO BIOPSY HIM AND HAVE A
PROPER EVALUATION.

Maureen says BECAUSE A BIOPSY
IS USUALLY TO SEE IF THERE
IS CANCER.

Richard says TO SEE IF THERE IS CANCER

Maureen says NOW HAVING
PROSTATITIS DOES NOT MEAN
WILL YOU GET PROSTATE
CANCER.

Richard says THERE IS NO RELATIONSHIP.
IF YOU HAVE PROSTATITIS THE
LAST THING YOU WANT TO DO IS
STICK A NEEDLE THROUGH THE RECTUM
INTO THE PROSTATE.

Maureen says WHY.

Richard says IT CAN STIR THINGS UP.
WHY PUT A NEEDLE INTO A
HORNET'S NEST.
SO A BIOPSY IS USUALLY NOT
PART OF THE WORKUP FOR
PROSTATITIS, CERTAINLY IN A YOUNG
MAN IT WOULDN'T BE.
IN AN OLDER MAN WHERE YOU
SUSPECT THERE MIGHT BE
PROSTATE CANCER, THERE ARE
SOME TYPES OF PROSTATITIS,
ONE CALLED GRANULOMA THAT
CAN FEEL LIKE PROSTATE CANCER
BUT REALLY BE
DUE TO AN INFECTION AND THEN
YOU MIGHT WANT TO DO A
BIOPSY.

Maureen says BACK TO PROSTATE
CANCER FOR A MINUTE.
WHAT IS NEW IN THE SURGERY
THERE.
WE TALKED ABOUT SAVING THE
NERVES BUT IS THERE LAPAROSCOPIC
SURGERY YOU DO.

Richard says THERE WAS AN ARGUMENT
ABOUT A ROBOT ASSISTED PROSTATECTOMY,
IT JUST HOLDS
THE CAMERA THAT LOOKS INTO
THE PELVIS BUT IN EUROPE,
THE FRENCH HAVE BEEN VERY
INSTRUMENTAL IN POPULARIZING
LAPAROSCOPIC RADICAL
PROSTATECTOMY. IT’S AN OPERATION
THAT TAKES US ABOUT TWO
HOURS BUT IT TAKES A
LAPAROSCOPIC SURGEONS ABOUT 6
TO 8 HOURS TO DO.
THERE’S RECENTLY ONE DONE THAT TOOK
MORE THAN 7 HOURS, THE FIRST
ONE DONE THERE I THINK I CAN
HAVE THE BEFORE THE SURGEON
IS FINISH MOOD

Maureen says IS THAT
BETTER THAN IF IT TAKES
LONGER.

Richard says IT IS HARD TO KNOW.
I'M INTERESTED IN DOING AND
I THINK I WILL GO LEARN IT
BECAUSE IT SOUNDS LUKE
SOMETHING WHERE SOMEPLACE
WHERE SURGERY IS GOING.
IS IT BETTER, I DON'T KNOW.

Maureen says BECAUSE YOU DON'T
HAVE TO OPEN THEM UP.

Richard says THE ADVANTAGE IS THAT THE
PATIENT ISN'T AS
UNCOMFORTABLE AFTER THE
SURGERY.
NOT AS MUCH BLOOD LOSS AND
POSSIBLY YOU CAN SEE THE
NERVES BETTER AND THE
PATIENT WILL GET HOME
EARLIER AND BE BACK TO WORK
EARLIER.
BUT RIGHT NOW MOST SURGEONS
GET THEIR PATIENTS HOME IN
THREE TO FOUR DAYS AND MOST
PATIENTS ARE BACK AT WORK IN
SAY THREE MONTHS.
BUT LAPAROSCOPIC SURGERY
HAS SOME ADVANTAGES AND WE
THOUGHT THE SAME THING WHEN
WE HEARD ABOUT GAL BLADDER.
THE SURGERY TALKS FOUR HOURS,
I CAN DO AN OPEN ONE IN 20
MINUTES WHY BOTHER GOING LAPAROSCOPIC.
I THINK LAPAROSCOPIC PROSTATECTOMY IS A WAY A LOT
OF SURGEONS WILL DO IT.

Maureen says INTERESTING.
LORI IS NEXT, SHE IS IN
WELLAND.

Lori says I LIKE YOUR SHOW A LOT.

Maureen says THANKS.

Lori says MY QUESTION TO THE DOCTOR
IS I LIVE WITH INTERSTITIAL
CYSTITIS.
I GO FOR THESE BLADDER
SUSPENSIONS FROM TIME TO
TIME AND THEY REALLY HELP.
AND WAS WONDERING, MY
QUESTION IS WHAT HAPPENS IF
THEY PUT TOO MUCH WATER IN
THE BLADDER, LUKE DID THAT
EVER HAPPEN OR -- BECAUSE
THAT IS WHAT I'M REALLY
WORRIED ABOUT WHEN I GO.

Richard says DON'T WORRY ABOUT THAT I
MEAN THEORETICALLY IF THEY
PUT TOO MUCH WATER IN YOUR
BLADDER YOUR BLADDER WOULD
RUPTURE AND YOUR BLADDER
WOULD LEAK OUT.
ALTHOUGH THIS IS DONE BY A
SURGEON IN CONTROLLED
CIRCUMSTANCES AND HE IS
MEASURING HOW MUCH HE IS
PUTTING IN.
AND HE KNOWS HOW MUCH HE
PUTS IN EACH TIME SO DON'T
WORRY ABOUT THAT.
IT IS A GENTLE STRETCHING.
THEY USUALLY PUT 500 TO 750
MILLIMETRES IN
YOUR BLADDER WHICH IS ABOUT
TWICE THE CAPACITY.
HAS IT EVER HAPPENED BEFORE.
PROBABLY BUT I'M NOT AWARE
OF IT HAPPENING IN ANY OF
THE SURGEONS THAT I KNOW.

Lori says I SEE.
AND THE LADY WHO CALLED AND
HER DAUGHTER WAS DIAGNOSED
WITH IT.
THERE IS A BOOK AND IT IS
CALLED OVERCOMING BLADDER
DISORDERS AND IT IS LIKE A
BIBLE FOR ME.
IF SHE WANTS SHE SHOULD GET
THAT BOOK.

Richard says IS IT IN THE LABOUR
RATHER.

Lori says IT IS EVERYWHERE, BOOK
STORES.
IT IS CHRISTINE WHITMORE IS
THE DOCK TO A REALLY GOOD
BOOK.

Maureen says THANK YOU.

Richard says SEE I LEARN SOMETHING.

Maureen says OVERCOMING BLADDER
DISORDERS.
GREAT, THANKS, LORI.
AN E-MAIL FROM ANOTHER CHRIS,
FOR THE PAST TWO MONTHS I
HAVE HAD DAILY LOWER
ABDOMINAL PAIN AND PAWN AT
THE END OF YOU ARE NATION IT
IS NOT SEVERE BUT VERY A
ANYTHING.
I HAVE HAD MANY YOU ARE IAN
TESTS AND NO INFECTION.
I HAD ULTRASOUND WITH A
SMALL CYST ON AN OVARY WHICH
THEY SAY IS NOT THE CAUSE
AND A MILDLY ENLARGED UTERUS,
I HAVE ALSO HAD SOME
PROBLEMS WITH EMPTYING MY
BLADDER COMPLETELY BUT THAT
SEEMS TO HAVE STOPPED.
COULD YOU OFFER DIRECTION ON
WHAT I SHOULD BE HAVING
DONE.

Richard says NO.
YOU KNOW THERE ARE THINGS
THAT MIMIC BLADDER
INFECTIONS THAT WE NEED TO
LOOK THE.
MANY PATIENTS WHO HAVE LOWER
ABDOMINAL PAIN OR PAIN AT
THE END OF URINATION MAY
HAVE A KID FEE STONE.
AN ULTRASOUND IS NOT BEST
TEST FOR A KIDNEY STONE.
I WOULD SUGGEST SHE GO BA
STOCK -- BACK TO HER DOCTOR
TO HAVE AN X-RAY TO SEE IF
IT IS A KIDNEY STONE.
FANNED IT CONTINUES HAVE HER
DOCTOR REFER HER TO A
UROLOGIST.

Maureen says HOW DO YOU KNOW WHEN IS A
BLADDER INFECTION IT HAS TO
BE THE FEVER.

Richard says YOU DON'T GET ONE WITH A
BLADDER INFECTION.

Maureen says I'M SICK.

Richard says YOU PROBABLY HAVE KIDNEY
INFECTION.
BLADDER INFECTION USUALLY
CAUSES URGENCY AND FREQUENCY
AND SMELLY URINE AND PAIN
WHEN YOU PEE.
USUALLY YOU CAN GET A
CULTURE AND SEE THE
INFECTION IN THE URINE.

Maureen says AND CRANBERRY JUICE IS
ONE WAY TO PREVENT OR TREAT
IT.

Richard says I THINK SO.
AGAIN THERE IS NO SCIENCE
THERE BUT A LOT OF ANECDOTAL
EVIDENCE TO SUPPORT DRINKING
VITAMIN C JUICES AND
CRANBERRY JUICE CAN BE
HELPFUL.

Maureen says BUT NORMALLY YOU WOULD SEE A DOCTOR
AND GET ANTIBIOTICS TO CLEAR
IT UP.

Richard says MOST INFECTIONS WILL GO O
WAY ON THEIR OWN.
IF YOU GET A BLADDER
INFECTION AND YOU DON'T HAVE
FEVER AND CHILLS JUST A LOT
OF FREQUENCY, YOU DRINK A
LOT YOU WILL GET BETTER IN A
COUPLE DAYS WITHOUT AN
ANTIBIOTIC IN MOST CASE.
MOST WILL GO AWAY IN TWO,
THREE DAYS.

Maureen says OKAY.
HERBERT IS CALLING FROM
WATERLOO.
HELLO.

Herbert says YES.
HELLO.

Maureen says GO AHEAD.

Herbert says DOCTOR, YEAH, I WAS --
I'M HAD AN ENLARGED PROSTATE
AND I HAVE BEEN GOING TO THE
DOCTOR FOR ABOUT EIGHT YEARS
AND THEN FINALLY HE DONE MY
PSA TEST WENT UP TO 5
SOMETHING.
AND THEY HE DONE A BIOPSY
AND THEN IT SHOWED SOME
CANCER THERE.
AND THEN I HAD TO HAVE THE
OPERATION BEFORE ME ANY
RADIATION SO I HAD THE
PROSTATE REAMED OUT.
AND HE SAID HE NEVER SEEN NO
CANCER UP THERE.
BUT ANYWAYS I HAD ONE DOSE
OF RADIATION ABOUT A YEAR
AGO.
AND THEN THE LAST I HAD
TROUBLE WITH THE BLEEDING
WITH THE BOWEL ALL THE TIME,
WITH BOWEL MOVEMENTS AND FOR
ABOUT A WHOLE YEAR I WAS
BLEEDING AND STUFF.
AND SO HE DONE, TWICE HE WENT UP THERE
AND LOOK UP THERE AND SAID
HE NEVER SEEN NOTHING.
BUT THERE’S A RED SPOT
UP IN THERE.

Richard says HOW OLD ARE YOU.

Herbert says 74.

Richard says AND YOU ARE FEELING OKAY
NOW THAT YOU HAVE HAD YOUR
TREATMENT.

Herbert says WELL, SOME DAYS I'M NOT
TOO BAD AND SOME DAYS I'M
NOT TOO GOOD.
I HAVE THE TROUBLE WITH THE
BLEEDING.
BUT HE DONE A BIOPSY ABOUT A
MONTH AGO.

Richard says I WOULDN'T WORRY TOO MUCH
THIS IS A COMMON TYPE OF
STORY YOU HEAR A MAN WHO HAS
PROSTATE CANCER AND THEN
DIFFICULTY EMPTYING HIS
BLADDER AND HAS AN
OPERATION.
THE PROSTATE CANCER IS ON
THE OUTSIDE OF THE PROSTATE
A GLAND SO IT IS NOT USUAL
TO HAVE A -- TO NOT FIND IT
ON THE INSIDE.
RADIATION IS A GOOD
TREATMENT FOR AN OLDER MAN,
A GOOD WAY TO TREAT IT IF IT
IS LOCALIZED BUT HE IS
DESCRIBING SO SIDE AFFECTS
OF RADIATION WHICH ARE
RECTAL BLEEDING, URINARY
TRACT BLEEDING IT IS BECAUSE
THE PROSTATE IS SO CLOSE TO
THE RECTUM IN THE BLADDER
THAT YOU CAN'T ISOLATE THOSE
TWO ORGANS SO THEY GET
RADIATED AS WELL.
MANY OF THE AFFECT GOES ON
FOR YEARS AND YEARS BUT ARE
EASILY CONTROLLED, NOT THAT
TROUBLESOME.

Maureen says WHAT IS THE SEED TYPE OF RADIATION?

Richard says CALLED BRACHYTHERAPY THEY
HAVE BEEN AROUND FOR A LONG
ACTUAL IT WAS HOT WHEN I WAS
A RESIDENT 20 YEARS AGO AND
HOT AGAIN NOW IS WAY TO
DELIVER A HIGHER DOSE OF
RADIATION TO THE PROSTATE
GLAND AND IT HAS SHOWN
PRETTY GOOD RESULTS IN
TREATING PROSTATE CANCER.
THE LONG-TERM RESULTS ARE
NOT BACK YET AND I STILL
WOULD BE RELUCTANT TO
EMBRACE IT AS A WAY TO TREAT
PROSTATE CANCER IN GENERAL.
I THINK IT IS PART OF THE
DUMP TOOLS WE USE TO TREAT
CANCER IT IS EXPENSIVE, MORE
THAN SURGERY.

Maureen says I SEE.
AND IT IS SOMETHING EMBEDDED
IN THERE RIGHT, INSTEAD OF
YOU GETTING --

Richard says A SURGEON PUTS ABOUT A
HUNDRED SEEDS IN YOUR
PROSTATE, LIKE LITTLE GRAINS
OF RISE AND IT IS NOT
WITHOUT SIDE EFFECT BUS IT
IS FAIRLY SUCCESSFUL IN
TREATING EARLY STAGE CANCER
AND PROBABLY EQUIVALENT TO
SURGERY IN SELECTED CASES.

Maureen says THANK YOU, HERBERT FOR
YOUR CALL.
SANDRA IS IN NEWMARKET.
HI, SANDRA.

Sandra says HI THERE.
I HAVE A QUESTION FOR
DOCTOR CASEY.
I HAVE A 21-YEAR-OLD
DEVELOPMENTALLY DELAYED
DAUGHTER WHO FROM
PRACTICALLY BIRTH HAS HAD
MILD INCONTINENCE DURING THE
DAY AND ALSO BEDWETTING WITH
PRACTICALLY EVERY NIGHT
OTHER THAN THE FACT THAT SHE
TAKES -- TWO THINGS TOGETHER
ON A REGULAR BASIS AND HAS
FOR ABOUT EIGHT YEARS.
WE HAVE HER TESTED TO MAKE
SURE THERE IS NO PHYSICAL
PROBLEMS WHICH THEY DON'T
FEEL THERE IS.
WE'VE TRIED KEGEL EXERCISES
BUT SO FAR WE ARE STILL ON
THE DDAVP AND THE DITROPAN
AND WE WONDERED IF THERE IS
ANY NEW TYPE OF MEDICATIONS
FOR THIS TYPE OF PROBLEM.

Richard says THE SHORT ANSWER IS NO.
FROM WHAT IT SOUNDS IT IS
PROBABLY NO MEDICATIONS
BECAUSE IT MAY NOT BE AN
ACTUAL PHYSICAL PROBLEM T
MAY JUST BE PART OF HER
DEVELOPMENTAL DELAY AND YOU
KNOW, IF YOU TAKE A YOUNGER
CHILD, A BOYS, FOR EXAMPLE,
THEY WILL HAVE TROUBLE WITH
DAYTIME INCONTINENCE BECAUSE
THEY WOULD RATHER WATCH OR
PLAY THAN GET TO THE
BATHROOM IN TIME.
SHE HAS SEEN A UROLOGIST AND
AN EVALUATION OF HER BLADDER
TO SEE IF SHE HAS ANY
PROBES WITH HER BLADDER.

Sandra says THEY HAVE RULED THAT OUT,
THEY DON'T FEEL IT IS
ANYTHING PHYSICAL.
BUT WE WORRIED MORE ABOUT
THE LENGTH OF TIME THAT SHE
CAN BE ON --
THIS SPRAY WORKS WONDERS.
BUT WE JUST -- AND IF YOU
DON'T TAKE IT IS AMAZING, IF
YOU DON'T TAKE IT AT EXACTLY
THE RIGHT TIME AT NIGHT,
THEY WILL VOID.
BUT I JUST WONDERED IF IT IS
SAFE THAT SHE IS ON IT FOR
SUCH A LONG PERIOD OF TIME.

Richard says WELL, DDAVP IS ANTI-DIURETIC
HORMONE, A
SYNTHETIC ANTI-DIURETIC
HORMONE, ALL BODIES PRODUCE
IT WHEN WE GO TO SLEEP AT
NIGHT.
PART OF TURNING THE
THERMOSTAT DOWN SO WHEN YOU
GO TO BED YOU DON'T PRODUCE
AS MUCH URINE SO YOU DON'T
HAVE TO GET UP TO PEE

Maureen says I
LIKE LUKE THAT.

Richard says AND WE USE IT FOR YOUNG
CHILDREN IN FOR BEDWETTING.
THERE HAVE BEEN SOME PATIENT
TONS FOR YEARS AND YEARS AND
TO DATE THERE HAVE BEEN NO
LONG-TERM SIDE EFFECTS
SO THE ANSWER IS IT
PROBABLY IS SAFE TO USE FOR
A PROLONGED PERIOD OF TIME.
IN YOUNG CHILDREN THAT TAKE
IT WE GIVE THEM THE CHOICE
BETWEEN HUGGIES OR DDAVP
BECAUSE MOST EVERYBODY
OUTGROWS IT.
UNFORTUNATELY YOUR DAUGHTER
HASN'T.
AND I WOULD GIVE HER DRUG
HOLIDAYS EVERY ONCE IN A
WHILE TO SEE IF SHE HAS
OUTGROWN THE CONDITION BUT
IF SHE HASN'T AND SHE HAS TO
WEAR DIAPERS AT FIGHT THAN
IT IS PROBABLY A GOOD COMPROMISE
SOLUTION.

Maureen says OKAY, THANK YOU,
SANDRA, GOOD LUCK.
LET'S SEE, ABOUT TWO YEARS
AGO MY SEAM PHYSICIAN
DIAGNOSED ME WITH
PROSTATITIS AND IT WAS
TREATED WITH ANTIBIOTICS.
FIRST I FELT LIKE A NEW
PERSON WITH NO PROBLEMS.
THEN THINGS WENT RIGHT BACK
TO EYE USUAL SYMPTOMS MOSTLY
URGENCY AND ERECTILE
DYSFUNCTION.
A SECOND TREATMENT WITH A
DUMP ANTIBIOTIC HAD NO
AFFECT.
I STILL STUFF SUFFER WITH
THE SAME HAVEN'T IMPROVED OR
WORSENED IT IS SOMETHING
THAT IS NOT LIFE CHANGING
BUT MORE OF A NUISANCE.
I'M A MALE IN MY MID 40s.

Richard says THIS IS AN EXAMPLE THAT
PROBABLY DIDN'T HAVE PROS
THAT TIGHT.
WHAT TELLS ME THAT IS THAT
IF I HAD PROSTATITIS AND
TOOK AN ANTIBIOTIC I
WOULDN'T GET BETTER THE NEXT
DAY, IT WOULD TALK AWHILE
BECAUSE IT IS A HORRIBLE
INFECTION IN THE PROSTATE
GLAND.
SO THE FACT HE GOT BETTER
THE NEXT DAY SUGGESTS IT WAS
A PLACEBO EFFECT AND THAT
MAYBE HE HAS A CONDITION
CALLED PROSTATOSIS WHICH
IS THIS PELVIC FLOOR MUSCLE
SPASM, MAYBE HE SHOULD LOOK
AT HIS LIFE ACTUAL,
EXERCISES AND WHAT KIND OF
EXERCISE HE DOES.
AND MAYBE GET SOME OTHER
ISSUES TO DEAL WITH.
PROBABLY ANTIBIOTICS IS NOT
GOING TO BE A SOLUTION.

Maureen says DO YOU THINK
ERECTILE DYSFUNCTION RELATED TO IT.

Richard says PROBABLY RELATED TO THE
ANXIETY.
HE IS PROBABLY A VERY TYPE A
PERSON.
NOT RELATED TO THE
PROSTATITIS, NO.

Maureen says OKAY, PATTY
CALLING FROM BRADFORD, HI,
PATTY.

Patty says HI, I HAVE A QUESTION FOR
THE DOCTOR.
IN 91 I HAD SURGERY ON MY
BLADDER TO CORRECT WHAT THEY
CALLED REFLUX.
SINCE THEN I HAVE HAD THREE
PROCEDURES.
I DON'T KNOW WHAT THE
PROCEDURE WAS CALLED BUT WAS
TO WIDEN THE URETHRA TO
ALLOW ME TO PASS THE URINE --
I HAD IT DONE LAST YEAR AND
THEY SUGGESTED I NEED TO
HAVE IT DONE YEARLY.
I'M STARTING TO EXPERIENCE
LESS URINE PASSING NOW BUT STILL
THE GREAT URGENCY TO GO.
THE FOLLOWING DAY I WILL GO
LIKE CRAZY IN THE FIRST PART
OF THE DAY AND NOT SO IN THE
NEXT.
CAN YOU SHED SOME LIGHT ON
THAT.

Richard says HOW OLD YOU WERE WHEN YOU
HAD THE OPERATION FOR
REFLUX.

Patty says I WAS 25.

Richard says AND WERE YOU HAVING A LOT
OF KIDNEY INFECTIONS PRIOR
TO THE OPERATION.

Patty says I HAD HAD NO
RECOLLECTION.
I HAVE WHITE BLOOD CELLS
THAT ARE FREQUENTLY IN MY
YOU RUN.

Richard says SO WHAT DID THE SURGEON
TELL YOU THE REASON WAS TO
HAVE AN OPERATION FOR REFLUX.

Patty says I HAD A SMALL RIGHT
KIDNEY IT WAS HALF THE SIZE
OF WHAT IT SHOULD HAVE BEEN
IT WAS URINE PASSING BACK UP,
I GUESS, OVER THE NUMBER OF
YEARS.

Richard says GET ANOTHER UROLOGIST.
THE DILATATION IS SOMETHING
REALLY UNUSUAL ON A YOUNG
WOMAN AND TO OPERATE ON
REFLUX FOR A GOOD REASON,
I'M NOT SAYING IT IS WASN'T
HERE BUT THE REASON YOU
WOULD OPERATE ON AN ADULT
WOMAN WITH REFLUX AND THAT
IS A CONDITION WHERE THE
VALVE THAT DRAINS FROM THE
KIDNEY INTO THE BLADDER IS
INCONTINENT AND URINE GOES
BACK AND FORTH.
STERILE REFLUX WHERE YOU
DON'T HAVE BLADDER
INFECTIONS IS USUALLY NOT A
PROBLEM.
IF THE KIDNEY IS ALREADY
SMALL T IS UNLIKELY THAT
OPERATING ON REFLUX IS GOING
TO MAKE A BIG DIFFERENCE.
AND THE DILATATIONS ARE A
BIT UNUSUAL.
SO I CAN'T SHED LIGHT TON
OTHER THAN SUGGEST THAT YOU
PROBABLY GET A SECOND
OPINION.

Maureen says OKAY.
I'M TOLD THAT RITA IN OTTAWA
HAS A REALLY QUICK LAST
QUESTION, HI, RITA.

Rita says HI.

Maureen says WHAT IS IT.

Rita says WELL, I HAVE A URINE
PROBLEM EARLY IN THE MORNING
IT IS VERY YELLOW AND ---,
I DRINK A LOT OF WATER AND
LATE IN DAY IT IS CLEAR AND
WHITE I'M WONDERING IF THAT
IS A BLADDER PROBLEM,
INCONTINENCE OR WHAT.

Maureen says DOES OUR URINE
CHANGE COLOUR DURING THE
DAY.

Richard says IT SOUNDS LUKE WHAT YOU
EAT F IT IS CONCENTRATED IT
WILL BE DARKER AND DILUTE IT
WILL BE LIGHTER, OR IF YOU
EAT BEATS IT WILL BE REDDISH.

Maureen says AFTER FOUR BEERS IF IS
LIGHT BECAUSE YOU HAVE A LOT
OF DILUTED.

Richard says FOUR BEERS, OR VITAMIN
C IT WILL BE YELLOW AS WELL.

Maureen says SO NO PROBLEMS.

Richard says DON'T WORRY ABOUT THAT.

Maureen says ALL RIGHT, WELL,
I THINK THAT IS ABOUT IT.
WHAT IS THE BEST THING WE
CAN ALL DO TO HAVE HEALTHY
BLADDERS, PROSTATES,
EVERYTHING.

Richard says EXERCISE.

Maureen says GENERAL AEROBIC
EXERCISE.

Richard says STAY IN SHAPE.
KEEP YOUR WEIGHT DOWN,
EXERCISE.
DEALS WITH STRESS, BLADDERS,
PROSTATES, EVERYTHING.

Maureen says SOUNDS GOOD.
THANKS FOR BEING HERE.

Richard says MY PLEASURE.

Maureen says DOCTOR RICHARD CASEY IS A
UROLOGIST AND THE DIRECTOR
OF THE MAYO HEALTH CENTRES.
YOU CAN VISIT THE WEB SITE
AT WWW.MALEHEALTH.COM.
THANKS FOR WATCHING “MORE TO LIFE”
TODAY. I’M MAUREEN TAYLOR. WE’RE HERE MONDAY
THROUGH FRIDAY AT O’CLOCK.

Watch: Urololgy