Transcript: Urology | Feb 12, 2001

The opening sequence shows a wooden table with a small lit candle as several words fly by: Nutrition, medicine, prevention, treatment, health.
Fast clips show different sets of hands performing activities on a 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.”

Karen appears sitting on a red couch. She is in her thirties, has short black hair, and is wearing a blue blazer over a black blouse.

Karen says HELLO, I'M KAREN
HORSMAN, SITTING IN FOR
MAUREEN TAYLOR.
WELCOME TO “MORE TO LIFE.”
WELL WITH VALENTINE'S DAY
JUST AROUND THE CORNER, YOU
MAY BE IN THE MOOD FOR LOVE,
BUT UNFORTUNATELY MANY
CANADIANS STRIKEOUT BEFORE
THEY EVEN STEP UP TO THE
PLATE.
SEXUAL DYSFUNCTION IS COMMON
AMONG MEN AND WOMEN.
VIAGARA MAY NOT BE THE
ANSWER FOR ALL MEN BUT
OPENING UP SOME DOORS FOR
WOMEN.
HERE TO TALK ABOUT SEXUAL
DYSFUNCTION AND THE LATEST
IN TERMS OF TREATMENT AND
RESEARCH IS OUR RESIDENT
UROLOGIST, Dr. RICHARD CASEY
AND HE'S HERE TO TAKE YOUR
QUESTIONS ABOUT SEXUAL
DYSFUNCTION AND ALSO ISSUES
LIKE INCONTINENCE.

A caption appears on screen showing two phone numbers.

Karen continues AND GIVE US A CALL HERE
IN TORONTO 416-484-2727
LONG DISTANCE IS
1-888-411-1234 THAT’S TOLL FREE
OR YOU CAN E-MAIL US
AT MORETOLIFE AT TVO.COM
AS WE TALK SEXUAL DYSFUNCTION
WELCOME, RICHARD,
GOOD TO SEE YOU AGAIN.

Dr. Richard Casey is in his forties, clean-shaven, with short brown hair. He is wearing a black suit, brown shirt, and brown tie.

Dr. Richard Casey says GOOD
TO BE HERE.

Karen says VIAGRA SEEMS TO
HAVE BROUGHT THE ISSUE OF
MALE DYSFUNCTION OUT IN THE
OPEN.
HOW ABOUT FEMALE SEXUAL
DYSFUNCTION?
WHERE ARE WE AT WITH THAT?

A caption reads “Dr. Richard Casey. Urologist.”

Richard says WELL,
ABOUT 20 YEARS BEHIND THAN
WE ARE WITH MEN.
THERE'S A RECENT POLL
PUBLISHED IN THE JOURNAL OF
THE AMERICAN MEDICAL
ASSOCIATION THAT SUGGESTED
THAT WOMEN HAVE A HIGHER
INSTANCE OF SEXUAL
DYSFUNCTION THAN MEN,
SOMETHING AS A MAN WE'VE
ALREADY, WE'VE KNOWN FOR
YEARS.
BUT THERE ARE PROBLEMS.
THE PROBLEMS WITH FEMALES IS
THAT WE DON'T UNDERSTAND
THEIR SEXUAL FUNCTION THE
SAME AS WE DO WITH MEN.
WITH MEN IT'S FAIRLY
STRAIGHT FORWARD.
THERE'S AN ERECTION, NOT AN
ERECTION AND VIAGARA ATTACKS
THAT BUT WITH WOMEN IT'S
MORE COMPLEX THAN THAT.

Karen says WHEN YOU SAID AS A
MAN YOU'VE KNOWN FOR YEARS,
DO YOU MEAN AS A MAN OR A
UROLOGIST YOU'VE KNOWN
SEXUAL DYSFUNCTION IN WOMEN
IS HIGHER.

Richard says NO, AS
A UROLOGIST.
THERE'S NOTHING PERSONAL
HERE.
WE'VE KNOWN FOR A LOT OF
YEARS A LOT OF THE SURGERY
WE'VE DONE WITH WOMEN CAUSED
SEXUAL DYSFUNCTION AND OFTEN
IGNORED IT.
FOR YEARS AFTER A
HYSTERECTOMY WOMEN
COMPLAINED SEX WASN'T THE
SAME AND WE THOUGHT EITHER
BECAUSE THEY SHORTENED THEIR
VAGINA OR THEY FEEL
DIFFERENT NOW THAT THEY
CAN'T HAVE CHILDREN BUT WE
KNOW THERE ARE NERVES AND
BLOOD VESSELS WE DO
INTERRUPT AND THAT MAY
IMPACT ON THEIR AROUSAL AND
RESPONSE.

Karen says WHY I GOT THERE
DEFENSIVE IMMEDIATELY I
GUESS IS BECAUSE THE I'DY
THIS IS ALL ABOUT -- I
FIND -- PSYCHOLOGY BETWEEN
MEN AND WOMEN AND SEX AND
THE BLAME GAME CAN GO ON.
WELL YOU'RE NOT INTERESTED.
YOU'RE NOT INTO IT.
AND THAT'S WHAT WOMEN CAN
OFTEN HEAR WHEN IT COULD BE
THE REALITY IS A REAL SEXUAL
DYSFUNCTION.
SOMETHING PHYSICALLY IS
WRONG.

Richard says BUT I
THINK MOST OF IT IS
EMOTIONAL AND PSYCHOLOGICAL.

Karen says FOR WOMEN.

Richard says FOR
WOMEN.
AND MOST OF IT FOR MEN, TOO.
I DON'T THINK MOST OF THE
SEXUAL DYSFUNCTION WE SEE IN
MEN CAN BE BLAMED ON SMOKING
OR OBESITY ALTHOUGH THOSE
ARE THE MAJOR CONTRIBUTORS
BUT MOST OF THE MEN WE SEE
IN PRACTICE STILL HAVE
SIGNIFICANT PSYCHOLOGICAL
PROBLEMS AND RELATIONSHIP
ISSUES.
MOST PSYCHOLOGISTS WORK ON
THE MARITAL PROBLEMS FIRST
AND THE PHYSICAL SEC.

Karen says SO DEALING WITH
THE PHYSICAL SIDE OF THINGS
WHEN IT COMES TO SEX EYE
DYSFUNCTION WHAT CAN CAUSE
IT INSIDE THE BODY.

Richard says AS A
SURGEON I'M VERY
PENO-CENTRIC AND WE DEAL
MOSTLY WITH BLOOD FLOW
ISSUES.
SO WE KNOW IN A SMALL GROUP
OF WOMEN THERE ARE PROBLEMS
WITH BLOOD FLOW TO THE VAGINA
THE MOST COMMON THING
THAT WOULD IMPACT THAT WOULD
BE MENOPAUSE.
WHEN ESTROGEN LEVELS DRAW --
DROP, THE VAGINA IS DRIER,
DON'T LUBRICATE AS EASY AND
THE SEXUAL SONS IS
DIFFERENT.
WE USE ESTROGENS, TOPICAL OR
ORAL TO TREAT THAT THE SAME
DISEASES THAT AFFECT MEN AND
THE SAME MEDICATIONS THAT
CAN IMPACT MEN WILL IMPACT
WOMEN AS WELL.
FOR EXAMPLE, ANTIDEPRESSANTS
WILL IMPACT ON THE ABILITY
TO HAVE AN ORGASM, SOMETHING
WE'VE IGNORED FOR WOMEN FOR
A LONG TIME.
WE GIVE THEM A PRESCRIPTION
FOR AN ANTIDEPRESSANT AND
THEY FEEL BETTER BUT THEIR
SEX LIFE WILL BE THE PITS.

Karen says IN TERMS OF THE
REACTION TO THE MEDICATION,
YOU HEAR A FAIR BIT AND
HOPEFULLY YOUR DOCTOR WILL
GO THROUGH THAT WITH YOU
WHEN THEY PRESCRIBE AN
ANTIDEPRESSANT.

Richard says THEY
USUALLY DON'T THOUGH.

Karen asks THEY DON'T?

Richard says NOT
WITH WOMEN.
YOU DON'T FEEL WELL,
DEPRESSED, DON'T HAVE AN
INTERESTING IN SEX, HERE'S A
DRUG THAT WILL MAKE YOU FEEL
BETTER BUT MAKE IT DIFFICULT
FOR YOU TO HAVE AN ORGASM
AND WOMEN ARE EMBARRASSED TO
GO BACK TO THE DOCTOR AND
SAY I CAN'T HAVE AN ORGASM
NOW BUT I FEEL BETTER.

Karen says THIS IS HOW TOUGH
THIS DISCUSSION CAN BE --

Richard says AND
IT'S TOUGH FOR A MAN, TOO.
WOMEN -- I FEEL FEMALE
SEXUAL DYSFUNCTION WILL
BECOME MORE POPULAR WHEN
WOMEN START TO TREAT OTHER
WOMEN.
IT'S DIFFICULT FOR ME AS A
MALE UROLOGIST TO HAVE THIS
DISCUSSION WITH WOMEN,
ALTHOUGH WE DO ALL THE TIME.
THEY WOULD FEEL MUCH MORE
COMFORTABLE WITH
FEMALE PSYCHOLOGIST OR
SURGEON.

Karen asks IF IT'S A BIT OF
BOTH HOW DO YOU TREAT WHAT?

Richard says MOST
OF THE TIME WE ASSUME IT'S
PSYCHOLOGICAL AND LOOK FOR
CONTRIBUTING PHYSICAL CAUSES
THAT CONTRIBUTE TO IT.
WE KNOW FOR EXAMPLE
TESTOSTERONE IS A MAJOR
PLAYER IN FEMALE SEXUAL
DYSFUNCTION, WOMEN MAY
RESPOND, LIBIDO IMPROVE WHEN
YOU GIVE THEM A BIT OF
TESTOSTERONE.
WE HAVE TO BE CAREFUL.
YOU DON'T WANT TO GIVE TOO
MUCH, IT WILL CAUSE FACIAL
HAIR.
MOST WOMEN WOULD RATHER NOT
HAVE SEX THAN HAVE A BEARD.

Karen says NO, THAT
COMPLETELY ADDS TO A
DIFFERENT PROBLEM ON THE
FRONT OF BODY IMAGE.

Richard continues BUT AS
SURGEONS OR PHYSICIANS WE
LOOK FOR MEDICAL CAUSES BUT
95 percent OF WOMEN NEED COUPLE
THERAPY AND NEED TO SEE A
THERAPIST AS WELL.

A caption appears on screen. It reads “Today’s topic: Sexual Dysfunction.”

Karen says YOU TALKED ABOUT
MENOPAUSE.
LET'S GO BACK TO THAT A BIT.
IN TERMS -- IS IT GUARANTEED
THAT A WOMAN, WHEN SHE GOES
THROUGH MENOPAUSE IS GOING
TO HAVE SOME DRYING UP OF
THE VAGINA?

Richard says
GUARANTEED, IF SHE'S NOT ON
ESTROGEN REPLACEMENT.
THERE ARE A NUMBER OF WOMEN
WHO TAKE NATURAL PHYTO
ESTROGENS, PLANT PRODUCTS
AND CAN MAINTAIN FAIRLY GOOD
SKIN IN THE VAGINAL AREA BUT
MOST WOMEN HAVE DRYING AND
SOME DIFFICULTY.
THEY DON'T ALL HAVE TROUBLE
WITH SEX BECAUSE IF THEY
LUBRICATE APPROPRIATELY IT
DOESN'T MATTER IF THEIR
VAGINA'S A BIT DRY.

Karen says WE'RE TAKING
QUESTIONS ON SEXUAL
DYSFUNCTION.
OUR GUEST IS Dr. RICHARD
CASEY, OUR RESIDENT
UROLOGIST HERE ON “MORE TO
LIFE” AND WE CAN ALSO TALK
ABOUT INCONTINENCE, WHETHER
IT BE THE BLADDER, THAT'S
OUR DISCUSSION TODAY.

A caption appears on screen showing two phone numbers.

Karen continues IN TORONTO 416-484-2727
LONG DISTANCE IS
1-888-411-1234
OUR E-MAIL ADDRESS
IS MORETOLIFE AT TVO.COM
LET'S START OFF
WITH JOANNE WHO'S CALLING IN
FROM BEAT ON.
HI JOANNE.

Joanne says HI.

Richard says HI
JOANNE.

Joanne says I'M PRE
MENOPAUSAL AND I'M FINDING
BETWEEN MY FRIENDS AND I
THAT WE'RE TALKING ABOUT
URINARY INFECTIONS WHICH I
NEVER, EVER HAD.
SEXUALLY IS WONDERFUL.
I'M NOT TAKING ANY KIND OF
THERAPY OR NATURAL, JUST
GARLIC AND VITAMIN E.
I'VE NEVER HAD SO MANY OF MY
FRIENDS AND SAY HOW COME
WE'RE GETTING SO MANY
INFECTIONS?
AND WE HAVEN'T CHANGED
ANYTHING.
MY DETERGENT, I'VE GONE
THROUGH EVERYTHING.
SO I'M THINKING IT HAS TO DO
WITH MY AGE?

Richard says WELL,
SOME OF IT'S PROBABLY YOUR
AGE.
WE DON'T UNDERSTAND WHY
WOMEN GET BLADDER
INFECTIONS.
MOST WOMEN HAVE NOTHING
WRONG WITH THEM AND IF WE DO
TESTING AND INVESTIGATIONS
WE RARELY FIND ANYTHING
AMISS.
BUT IT MAY BE JUST THAT
YOU'RE NOT CLEARING THE
INITIAL INFECTION.
SO YOU MAY NOT BE GETTING A
LOT OF NEW INFECTIONS IT MAY
BE ONE INFECTION YOU HAVEN'T
GOTTEN RID OF.
DO YOU FIND THERE'S CERTAIN
ACTIVITIES THAT WILL CAUSE
YOU TO GET AN INFECTION?
LIKE AFTER INTERCOURSE, FOR
EXAMPLE?
ARE YOU MORE LIKELY --

Joanne says NO.
NO.
I WENT WITH ALL THE NATURAL
TRIGGERS, WHEN YOU'RE
YOUNGER AND IF YOU'RE ON THE
PILL AND YEAST INFECTIONS
AND I VERY MUCH -- I KNOW
WHAT'S GOING ON WITH MY
BODY.
I MEAN, YOU KNOW --

Karen asks AND YOU HAVEN'T
TRACKED IT TO TIE IN WITH
ANY TIME THE MONTH OR
PARTICULAR ACTIVITY?

Joanne says NO, MY PERIOD IS
STILL NORMAL AND IT JUST
SEEMS ALL OF A SUDDEN YOU
START GETTING IRRITATION.

Richard says IF YOU'RE NOT GETTING
SICK WITH IT, NOT HAVING
CHILLS AND FEVER AND IT'S
UNCOMPLICATED, PROBABLY A
LONG COURSE OF ANTIBIOTICS,
FOR EXAMPLE SIX WEEKS TO
THREE MONTHS OF A LOW DOSE
OF ANTIBIOTICS WILL PROBABLY
GET RID OF IT.
IN MORE THAN 50 percent OF CASES
THAT'LL BE THE LAST
INFECTION YOU'LL SEE FOR
QUITE SOMETIME.

Karen says SO YOU WOULD BE ON
IT --

Richard says SIX
WEEKS TO THREE MONTHS, VERY
LOW DOSES.

Karen says JUST TO WARD OFF
ANY OTHER ONES IF THERE'S A
CONSISTENT PROBLEM?

Richard says WE OFTEN RELATE BLADDER
INFECTIONS TO SEXUAL
ACTIVITY, ALTHOUGH NOT
NECESSARILY.
YOUNG WOMEN TELL YOU AFTER
SEX IF THEY DON'T GET UP AND
VOID AND EMPTY THE BLADDER
THEY'RE MORE LIKELY TO HAVE
A BLADDER INFECTION.

Karen asks IS THAT A SIGN OF
A WEAK OR SMALL BLADDER?

Richard says IT'S A
SIGN OF A GOOD SEX LIFE, I
THINK.
NO, I'M JOKING.
THE WAY WOMEN WERE BUILT,
THERE'S A DESIGN FLAW.
THEY HAVE A SHORT URETHRA,
THERE'S BACTERIA IN THE
VAGINA THAT SHOULD BE THERE
AND IT GETS INTO THE
BLADDER.
IT'S NATURAL.

Karen says I JUST ALWAYS HEAR
SOME WOMEN ARE MORE LIKELY
TO GET THEM THAN OTHERS --

Richard says MOST
WOMEN, IF YOU DRINK A LOTS
OF WATER AND STAY HOME FROM
THE DOCTOR YOU'LL BE BETTER
BEFORE YOU GET AN
APPOINTMENT.

Karen says OH, OKAY.
IN TERMS OF INCONTINENCE,
LET'S TALK ABOUT THAT.
A GROWING ISSUE WITH OUR
AGING POPULATION.
CAUSES?
TREATMENTS?

Richard says IT'S
TOO BAD.
WE MAKE A FULL CIRCLE, WE
START OUT INCONTINENT AND
END UP INCONTINENT AND
SURGELY URINARY INCONTINENCE
IN WOMEN IS A SIGNIFICANT
HEALTH PROBLEM, ELDERLY
WOMEN.
OLDER MEN DON'T HAVE THE
SAME TYPES OF PROBLEMS.
THEY HAVE A DIFFERENT
PROBLEM WITH THEIR PROSTATE.
BUT AS WOMEN AGE, THEIR
VAGINA BECOMES THINNER, AS
WE MENTIONED EARLIER.
THEIR BLADDER REQUIRES
ESTROGEN TO WORK PROPERLY
AND SO THEIR BLADDER DOESN'T
WORK AS WELL.
AND MANY ELDERLY WOMEN HAVE
DIFFICULTY WITH URGENCY
AND FREQUENCY AND KNOW
WHERE EVERY WASHROOM IS IN
EVERY PLACE THEY GO AND IF
YOU'RE A LITTLE SLOW MOVING
YOU'RE LESS LIKE TOW GO GET
TO THE BATHROOM IN TIME AND
THEY'LL HAVE AN ISSUE CALLED
URGENCY INCONTINENCE, WET
THEMSELVES FIVE, SIX TIMES A
DAY.
IT'S A REAL PROBLEM.

Karen says AND THE MARKETING
WITH THE DEPENDS, IT BECOMES
AN OLD ISSUE IT'S ABOUT AN
ELDERLY WOMAN WHO NEEDS TO
WEAR ALMOST A DIAPER.
BUT CAN IT NOT ALSO STRIKE
YOUNGER PEOPLE?

Richard says IT CAN,
BUT THE THING ABOUT DIAPER
THAT REALLY EFFECTS THEIR
SELF-ESTEEM AS WELL.
IMAGINE.
SO THERE'S LOTS OF
MEDICATIONS AND TREATMENTS
AVAILABLE FOR ELDERLY WOMEN
THAT CAN HELP THEM WITH
INCONTINENCE BUT IT CAN
EFFECT YOUNGER PEOPLE.
STRESS INCOULDN'T JENS, --
INCONTINENCE, DUE TO PELVIC
FLOOR LAXITY AFFECTS WOMEN
IN THEIR 30s, 40s, 50s
USUALLY AFTER CHILD BIRTH
WHERE AS THE ELDERLY
POPULATION HAS URGENT
INCONTINENCE, DUE TO
ESTROGEN AND AGING.

Karen says AND SNEEZING OR
COUGH OGG ARE A LAUGHING FIT
CAN BRING ALL THIS ON.

Richard says
TRADITIONALLY SNEEZING AND
LAUGHING IS THE TRIG-FOR-FOR
STRESS INCONTINENCE, WETNESS
YOU DON'T EXPECT TO HAPPEN
AND ALL OF A SUDDEN IT
HAPPENS AND ELDERLY WOMEN
KNOW THEY HAVE TO PEE AND
CAN'T HOLD BACK AND THERE'S
SOME NEW TREATMENTS FOR
STRESS INCONTINENCE.
THE TENSION FREE VAGINAL
TAPE?

Karen says YEAH, THIS TAPE.
TELL ME ABOUT THAT.

Richard says IT'S
ONE OF THE NEW TREATMENTS TO
PROMOTE SUPPORT OF THE
PELVIC ORGANS AND IT'S A
SMALL TAPE THAT'S PLACED
THROUGH THE VAJ NACHLT LOOKS
LIKE A PIECE OF TAPE.
IT'S ABOUT THAT LONG AND
GOES UP EITHER SIDE OF THE
VAGINAL WALL AND STAYS THERE
AND STICKS TO TISSUE AND
KEEPS THE BLADDER FROM
FALLING DOWN.

Karen asks SO IT'S LIKE A
MESH?

Richard says NOT
QUITE A MESH, BUT IT'S
LIKE -- I WOULD DESCRIBE IT
LIKE THE CLEAR TAPE THAT YOU
SEE, THAT YOU USE AT HOME.
AND IT GOES UP THROUGH THE
VAJ NACHLT IT'S HIDDEN AND
IT HEELS INTO THE SKIN AND
KEEPS --

Karen asks KEEPS THE BLADDER
UP?

Richard says KEEPS IT UP.

Karen says YOU HEAR OF WOMAN
WHO HAVE HAD A LOT OF
CHILDREN, SIX, SEVEN --
SOMETIMES IT CAN BE FOUR OR
FIVE THAT EVERYTHING STARTS
IT FALL.
THE BLADDER IN PARTICULAR
AND THEY GO IN FOR A TIP AND
TUCK TO LIFT IT.
WOULD THIS BE A WAY TO AVOID
SURGERY?

Richard says WELL IT IS SURGERY IT'S
JUST MINOR SURGERY.
WITH BLADDER SURGERY THERE
MUST BE TEN DIFFERENT WAYS
TO FIX IT AND ANY CONDITION
THAT HAS MORE THAN ONE OR
TWO SPRAGUES TO FIX IT TELL
YOU THAT NONE OF THEM REALLY
WORK FOR EVERYBODY.
AND THIS TVT IS JUST ANOTHER
APPROACH FOR WOMEN WHO HAVE
INCOULDN'T NENS WHERE THEY
CAN HAVE IT DONE AS AN OUT
PATIENT WITH MINIMAL SURGE
SCOMPREE TO DATE SEEMS VERY
EFFECTIVE.
IT HAS TO WITH STAND THE
TESTS OF TIME.
I THINK WE'VE BEEN DOING
THEM THREE TO FOUR YEARS,
LET'S TALK ABOUT IT IN TEN
YEARS WHEN WE KNOW.
THERE ARE OPERATIONS NOW WE
KNOW ARE NOT WORKING WE
THOUGHT WERE THE ANSWER TO
THE PROBLEM FIVIERS AGO.

Karen says BUT IT IS ANOTHER
OPTION.
MONICA FROM PETERBOROUGH?
HI MONICA?

Monica says HI.
I HAVE A FRIEND WHO HAS
PARKINSONS AND HE HAS A
SEXUAL DYSFUNCTION.
HIS MEDICAL DOCTOR SUGGESTED
VIAGRA AND IT HASN'T WORKED
IS THIS NORMAL THAT VIAGRA
WOULDN'T WORK FOR SOMEONE
WITH PARKINSONS?

Richard says NO,
AND IT DEPENDS WHY -- WHAT
IS HIS SEXUAL DYSFUNCTION.

Monica says UH, HE'S
IMPOTENT.

Richard says
BECAUSE MEN WITH PARKINSONS
MAY HAVE OTHER SEXUAL
DYSFUNCTIONS DENGD ON THE
MEDICATION HE'S ON BUT IF
HE'S IMPOTENT THEN IT SHOULD
WORK, BUT HE MAY NOT BE
TAKING IT PROPERLY.
YOU HAVE TO TRY IT FIVE OR
SIX TIMES BEFORE YOU REALLY
CAN SAY THE DRUG HAS WORKED
AND NEED A WILLING PARTNER
AS WELL.
BUT PARKINSONS IS NOT A
REASON NOT TO TAKE IT.

Karen asks IS IT 100 percent
GUARANTEED.

Richard says
NOTHING IS, BUT VIAGRA WORKS
IN 70 percent OF THE POPULATION WE
USE IT IN.

Karen asks BUT COULD MONICA'S
FRIEND BE ONE OF THOSE
STATISTICS WHERE IT DOESN'T
WORK?

Richard says HE MAY
BE A HEAVY SMOKE ARE, BAD
VASCULAR DISEASE OR TAKING
IT INAPPROPRIATE.
PARKINSONS PATIENTS OFTEN
TAKE OTHER MEDICATIONS THAT
WILL INTERFERE WITH THE
SEXUAL RESPONSE.

Karen asks DOES VIAGRA WORK
FOR WOMEN?

Richard says WELL,
YES AND NO IS THE ANSWER TO
THAT CERTAINLY IN POST
MENOPAUSAL WOMEN, WOMEN WHO
HAVE PROBLEMS WITH BLOOD
FLOW TO THE VAGINA, VIAGRA
HASN'T SHOWN TO BE VERY
SUCCESSFUL YET, AND IT CAUSE
HEAD ACHE, AS WELL.
LAST THING YOU WANT BEFORE
YOU WANT YOUR WIFE TO HAVE
SEX WITH YOU IS GIVE HER
SOMETHING TO GIVE HER A
HEADACHE.
IN PRE MENOPAUSAL WOMEN IT
MAY WORK BECAUSE IT IMPROVES
BLOOD FLOW AND IN ANIMAL
MODELS, IN RABBITS, AND
THERE'S A RESEARCHER AT
McGILL WHO'S LOOKED AT THIS,
IT IMPROVES VAGINAL BLOOD
FLOW IN PRE MENOPAUSAL WOMEN,
IT MAY BE --

Karen says THE SAME BLUE PILL
THAT THE MEN ARE TAKING?

Richard says BUT
THIS IS ALL CONJECTURE AND
ANECDOTE TAL.
WE THEY A LOT OF WOMEN TAKE
IT AND COME BACK AND SAY
IT'S GREAT.

Karen says A PLACEBO EFFECT,
PERHAPS?

Richard says THE
FUNNY THING, ABOUT 30 percent OF
PEOPLE WHO TAKE VIAGRA HAVE
A PLACEBO RESPONSE.
SO FOR SEXUAL PROBLEM
THERE'S A VERY HIGH PLACEBO
RESPONSE RATE.
IT MIGHT BE.

Karen says THE PHARMACEUTICAL
COMPANIES, THEY LOOK AT A
POTENTIAL TO MAKE THE
GAZILLION DOLLARS THEY'RE
MAKING ON THE MALE VIAGRA SO
I KNOW THERE'S RESEARCH
BEING DONE FOR A FEMALE
PILL --

Richard says I
THINK WE'LL SEE PILLS THAT
IMPROVE FEMALE SEXUAL RESPONSE
BUT WE HAVE TO UNDERSTAND
THERE'S SO MANY DIFFERENT
PHASES OF THE FEMALE SEXUAL
RESPONSE WE HAVE TO TARGET
THE FILL PILLS FOR THE
APPROPRIATE PHASE.

Karen says JOHN FROM OTTAWA
WITH OUR NEXT QUESTION.
HELLO, JOHN.

John says HELLO.
I'M A 50-YEAR-OLD CEREBRAL
PALSY PERSON.
AND I'VE HAD, I'VE HAD
URGENCY PROBLEMS WITH MY
BLADDER FOR A NUMBER OF
YEARS NOW.
AND I'M JUST WONDERING, I'VE
BEEN TAKING -- I'VE BEEN
RECOMMENDED BY MY DOCTOR TO
TAKE DIGOPAN BUT I'M WONDER
PHYSICAL THERE'S ANYTHING
ELSE ON THE MARKET RIGHT NOW
WHICH'LL BE EFFECTIVE.
IT TENDS TO MAKE ME DROWSY,
SLEEPY AND NOT ABLE TO
CONCENTRATE AS WELL AS I
SHOULD BE ABLE TO.

Richard says WELL
CERTAINLY, IF IT WORKS THERE
ARE OTHER MEDICATIONS THAT
WORK AS WELL AS DIGOPAN
WITHOUT THE SIDE EFFECTS.
THERE'S A NEW DRUG CALLED
DETROL JUST RELEASED THAT
WAS VERY EFFECTIVE, AND
THERE'S A NUMBER OF DRUGS
WE'RE WORKING ON IN CLINICAL
TRIALS THAT WILL BE AS
EFFECTIVE WITHOUT THE SIDE
EFFECTS.
SO IF IT WORKS GO BACK TO
YOUR DOCTOR AND ASK YOUR
DOCTOR IF YOU CAN TRY SOME
DETROL AND THAT MAY BE JUST
AS GOOD.

Karen says WE WERE TALKING
ABOUT INCONTINENCE BEFORE
AND LET'S MOVE BACK TO SOME
OF THE TREATMENTS.
I'M GLAD JOHN ASKED THAT
QUESTION IN TERMS OF THE
DRUGS AVAILABLE.
YOU MENTIONED TAPE?
THERE'S ALSO TALK ABOUT A
MAGNETIC CHAIR BEING USED IN
EUROPE AND THE U.S.
HOW EFFECTIVE IS THAT?

Richard says NOT VERY EFFECTIVE.
THESE ARE TREATMENTS THAT
ARE DIRECTED TOWARDS
STIMULATING THE PELVIC FLOOR
MUSCLES WITH THE HOPE THAT
IF YOU STIMULATE THE PELVIC
FLOOR MUSCLES YOU'LL TIGHTEN
THINGS UP AND THE BLADDER
WILL RIDE HIGHER AND IS LESS
LIKELY TO FALL.
AND THERE IS SOME EVIDENCE
MAGNETIC CHAIRS IMPROVE
INCONTINENCE SEE RATES.
SO DOES BY YES FEEDBACK.
SO DO SEVERAL PATIENTS WHO
BUY INTO THE DISEASE AND
SPEND SOMETIME ON THEMSELVES
CAN OFTEN FIX THE PROBLEM
THEMSELVES.
I DON'T THINK THE CHAIR'S
GOING TO BE THE ANSWER TO
THE PROBLEM --

Karen says THE WHOLE CONCEPT
OF SITTING IN A CARE THAT'S
MAGNETIC AND YOU CAN READ --
FULLY CLOTHED.

Richard says BUT
IT'S MUCH LIKE THE KEIGEL
EXERCISES WE'RE SUPPOSED TO
DO --

Karen says THAT YOU DO
YOURSELF, YEAH.

Richard says IT
DOESN'T HAVE A GREAT SUCCESS
RATE BUT IN A MOTIVATED
PAINT IT'S VERY SUCCESSFUL.

Karen says OH, THOSE KIEGELS
THAT'S WHAT YOU'RE TALKING
ABOUT?
THE KIEGELS TO PRACTICE AND
THEY TELL YOU IT'S GOING TO
MAKE CHILD BIRTH EASIER.

Richard says
NOTHING MAKES CHILDBIRTH
EASIER, OTHER THAN EPIDURAL.
BUT THE MAGNETIC CHAIR, WE
HAVE BIOFEEDBACKS, YOU PUT
AN INSTRUMENT INTO THE
VAGINA AND HAVE THE PATIENT
CONTRACT AND RELAX THE
MUSCLES, TO IDENTIFY WHICH
MUSCLES KEEP THE VAGINA
CONTRACTING, THESE ALL WORK
IN MOTIVATED PATIENTS.

Karen says THESE PATIENTS
DON'T WANT TO GO UNDER THE
KNIFE.

Richard says LET'S
TALK ABOUT WEIGHT LOSS AND
QUITTING SMOKING.
IF YOU TACK ALL THE PEOPLE
WE SAW THAT WERE WET, OVER
WEIGHT, AND AGAIN, IF YOU'RE
REALLY OVERWEIGHT, YOUR
OBESE, IT WILL PUSH DOWN ON
YOUR BLADDER, HAVE THEM LOSE
WEIGHT, EXERCISE AND QUIT
SMOKING YOU'D CURE A LOT OF
THE PATIENTS.
THAT'S EVEN HARDER THAN A
MAGNETIC CHAIR.

Karen says YES, YOU'RE RIGHT.
LET'S GO TO KATHY, CALLING
IN FROM OAKVILLE NEXT.
HI KATHY.

Kathy says HI MAUREEN OH,
SORRY, NOT MAUREEN.
BUT I HAVE M.S. AND I HAVE A
BAD PROBLEM WITH URGE
INCOULDN'T JENS, AND --
INCOULDN'T NENS AND QUITE BY
ACCIDENT I DISCOVERED IF I
TAKE TWO 222s OR TAIL UNTIL
WITH CODEINE, IT'S THE
CODEINE IT HELPS THAT
IMMENSELY.
I DON'T HAVE TO RUN FOR THE
BATHROOM AS OFTEN AS I USED
TO, AND IT DOESN'T HAVE THE
SIDE EFFECTS THAT THE DETROPAN
HAS.

Karen asks HAVE YOU HEARD
THIS?

Richard says NO,
I'VE HAD PATIENTS THAT TOLD
ME CODEINE WORKS.
IT IS A SMOOTH MUSCLE
RELAXANT SO CODEINE WILL
RELAX YOUR MUSCLES.
IT ALSO MIGHT MAKE YOU
CONSTIPATED AS WELL BUT SO
LONG AS YOU HAVE NO
WITHDRAWAL SYMPTOMS OR SIDE
EFFECTS FROM TAKING IT ON A
REGULAR BASIS, IT IS AN
OPTION.
ALTHOUGH DIGROPAN HAS
SIGNIFICANT SIDE EFFECTS,
YOU MIGHT WANT TO TRY ONE OF
THESE NEWER MEDICATIONS BUT
IF A LITTLE CODEINE WORKS
WHY NOT TAKE IT.

Karen asks WHAT WOULD BE THE
WITHDRAWAL EFFECT --

Richard says IF YOU'VE EVER TAKEN
TYLENOL TWO OR THREE FOR A
FEW DAYS IN A ROW, WHEN YOU
STOP TAKING IT YOU GET A BIT
SHAKY AND SWEATY.

Karen says OH, REALLY?

Richard says WELL,
IT'S NARCOTIC SO AS
PHYSICIANS WE'RE RELUCTANT
TO PRESCRIBE LONG-TERM
NARCOTICS THAT HAVE OTHER
SOLUTIONS.

Karen asks ARE YOU TALKING
ABOUT THE OVER THE COUNTER?

Richard says WELL, PLAIN TYLENOL
DOESN'T HAVE CODEINE.
TYLENOL TWO AND THREE ARE
PRESCRIPTION DRUGS.
IN THE UNITED STATES YOU CAN
BUY CODEINE OVER THE COUNTER
BUT IN CANADA YOU CAN'T.

Karen says I SEE, SO THIS IS
THE STUFF --

Richard says AND
IT'S A NARCOTIC, AND WE'RE
RELUCTANT TO HAVE PATIENTS
TAKE NARCOTICS FOR THESE
REASONS.

Karen says JUST MOVING BACK
TO SEXUAL DYSFUNCTION FOR A
MOMENT IN TERMS OF WE'VE
BEEN TALKING A LOT ABOUT
WHAT'S BEING DONE FOR WOMEN,
I WANT TO MOVE TO THE MEN'S
SIDE OF THINGS AND TALK
ABOUT PENILE IMPLANTS AND
WHERE WE ARE WITH THAT AS A
SOCIETY, IF MEN ARE STILL
LOOKING AT THAT AS AN OPTION
OR THAT SEEMS TO BE ARCAIC.

Richard says NO,
CERTAINLY VIAGRA HAS
INCREASED THE PATIENTS
SUCCESS WHO COME TO OUR
OFFICE WITH PROBLEMS, AND
CERTAINLY THERE ARE PATIENTS
THAT IT DOESN'T WORK.
WITH THESE PATIENTS ONCE
THEY START DOWN THE ROAD
THEY WANT TO GET IT FIXED.
PLUS THERE'S CONSIDERABLE
PRESSURE IN THE MEDIA TO BE
SEXUALLY ACTIVE.
THERE'S ENOUGH RESEARCH,
THREE OR FOUR NEW DRUGS IN
THE NEXT YEAR OR SO THAT ARE
LIKE VIAGRA THAT WILL GIVE
YOU AN ERECTION.
SOON IT'LL BE AGAINST THE
LAW TO NOT PRODUCE AN
ERECTION ON DEMAND, THERE'LL
BE SO MUCH AVAILABLE.

Karen says DO YOU THINK THE
MEDIA IS PROMOTING VIBRANCY
IN TERMS OF SEXUALLY HEALTHY
LIVES --

Richard says WELL
IF YOU READ THE NEWSPAPER
AND YOU KNOW THERE'S A SOLUTION
TO A PROBLEM YOU'VE IGNORED
FOR YEARS YOU'LL GO TO YOUR
DOCTOR TO WE QUESTIONED SOME
PATIENTS IN GENERAL
PRACTITIONERS' OFFICES WHO
HAVE SEXUAL PROBLEMS.
HALF OF THOSE MEN ARE HAPPY
THE WAY THEY ARE AND DON'T
WANT TO DO ANYTHING ABOUT IT
AND DON'T WANT TO TAKE
VIAGRA.
SO THERE'S A BIT OF PUSHING
AND PRESSURE TO GET THEM TO
SEE THEIR DOCTOR.

Karen says IS A PENILE
IMPLANT LOOKED AS A RADICAL
SOLUTION.

Richard says WELL,
USUALLY THEY'RE THERE AS A
SOLUTION WHEN ALL ELSE
FAILS.
PATIENTS WILL TRY INJECTION
THERAPY.
FIRST THEY'LL TRY ORAL
THERAPY, LIKE VIAGRA, THEN
INJECTION THERAPY WHERE YOU
INJECT A NEEDLE IN THE SIDE
OF YOUR PENIS THAT'LL BIVE
YOU AN ERECTION, THEN A
VACUUM PUMP WHICH IS A
MECHANICAL DEVICE AND IF ALL
ELSE FAILS THEY GO ON TO
MEAN PENILE IMPLANT.

Karen says DO YOU HAVE TO DO
THAT INJECTION AN HOUR
BEFORE --

Richard says USUALLY TEN OR 15 MINUTES
BEFORE, AND VACUUM
IMMEDIATELY BEFORE.
THERE IS SOME PLANNING AND
INTERFERES WITH THE
SPONTANEITY BUT MOST OF
THESE PATIENTS HAVE BEEN
MARRIED FOR 20 OR 30 YEARS
SO IT'S NOT AS SPONTANEOUS
AS IT USED TO BE.
BUT IMPLANTS ARE GOOD FOR
YOUNGER MEN AS WELL WHERE
VIAGRA HASN'T WORKED OR
BRITTLE DIABETIC, WHERE
INJECTIONS DON'T WORK AS
WELL AND IMPLANTS CAN
RESTORE A NORMAL FUNCTIONING
PENIS AND BE COSMETICLY
QUITE ACCEPTABLE.
THE NUMBER OF IMPLANTS WE DO
IS DOWN SIGNIFICANTLY THAN
WHAT IT WAS FIVIERS AGO.

Karen says BECAUSE THERE'S
OTHER OPTIONS.
LET'S GO TO KATHY FROM
LONDON.

Kathy says HI, HOW ARE YOU?

Karen says FINE THANKS.

Kathy says I JUST HAD A
QUESTION.
I WAS WONDERING IF A
CIRCUMCISED OR UNCIRCUMCISED
PENIS HAD ANY EFFECT ON
SEXUAL FUNCTION EITHER FOR
THE MAN OR WOMAN HE'S WITH.

Karen says GOOD QUESTION.

Richard says A GOOD
QUESTION AND THE ANSWER IS
NO, IT DOESN'T.
A CIRCUMCISED PENIS IS NO
LESS SENSITIVE THAN AN
UNCIRCUMCISED PENIS AND THIS
IS FROM THOUSANDS AND
THOUSANDS OF MEN THAT HAD
BOTH.

Karen says A BIG DEBATE.

Richard says THAT'S
A POLITICAL ISSUE.
AS FOR FEMALES, CERTAINLY
IF HES HYGIENE ISN'T VERY
GOOD, AND WE'RE GOING TO
ASSUME THAT THIS GUY LOOKS
AFTER HIMSELF CLEANS
UNDERNEATH HIS FORESKIN, IT
SHOULD HAVE NO IMPACT ON THE
FEMALE SEXUAL PART OF IT AS
WELL.
SO IT'S A POLITICAL ISSUE,
NOT A MEDICAL ISSUE.

Karen says I HAVE TWO BOYS,
JUST HAD A BABY BOY, AND
DISCUSSION AROUND
CIRCUMCISION AND THAT WHOLE
DEBATE ON SEXUAL PERFORMANCE
IS A LOT OF PRESSURE FOR THE
PARENTS WHO ARE MAKING THE
DECISION IF YOU ARE IN SORT
OF THAT MIDDLE OF DECIDING
YES/NO, YES/NO.
AM I GOING TO MAKE THIS
DECISION AND EFFECT HIS
SEXUAL LIFE DOWN THE ROAD?

Richard says I
DON'T KNOW WHERE THAT COMES
FROM BECAUSE THE LAST THING
I'M TO THINK OF MY
THREE-YEAR-OLD -- THREE-WEEK-OLD
BOY WHO IT'S GOING TO AFFECT
HIS SEXUAL PERFORMANCE.
BUT DON'T HAVE HIM
CIRCUMCISED BECAUSE UNLESS
IT'S A RELIGIOUS QUESTION.

Karen says I’M GLAD YOU BROUGHT
THAT UP IN TERMS OF OUR
CONTEXT OF SEXUAL DYSFUNCTION

Richard says WE HAVE FATHERS WHO BRING
IN THEIR SONS AND SAY I WANT
MY SON TO LOOK JUST LIKE ME.
AND LIKE THE SON CARES.
HE LOOKS AT HIS DAD'S PENIS
WHICH IS SO BIG AND
GROTESQUE LOOKING, HE
DOESN'T WANT TO LOOK LIKE
HIS DAD.

Karen says SUZANNE FROM
SUDBURY.
HI SUZANNE.

Suzanne says HI.

Karen says HI.

Suzanne says MY QUESTION IS
I'M A 45-YEAR-OLD WOMAN, AND
BASICALLY MY SEXUAL FUNCTION
USED TO BE GREAT, AND NOW
IT'S ALMOST TO NIL.
I HAVE NO SEXUAL DESIRES
WHATSOEVER.
BUT ALTHOUGH FOR THE LAST
YEAR AND A HALF I'VE BEEN
GOING THROUGH A SERIES OF
TESTS AND THEY'RE NOT SURE
WHAT THEY'RE DEALING WITH.
MY DOCTOR SENT ME AGAIN THIS
MORNING FOR SOME MORE BLOOD
WORK BECAUSE HE WASN'T SURE
OF THE -- HE WASN'T HAPPY
WITH THE LEVELS OF -- HOW
WE SAY IT?
I'M A LITTLE BIT NERVOUS
HERE.

Karen says THAT'S OKAY IS IT
YOUR OVER ALL HEALTH THEY'RE
TESTING FOR OR
SPECIFICALLY --

Suzanne says WELL THEY'RE NOT
SURE IF IT'S MUSCULAR DISFEE
OR PAULIOMYECITIS.
I'M NOT SURE IF I'M SAYING
IT RIGHT.
BUT I'VE NOTICE MYSELF
IN THE LAST YEAR,
YEAR AND A HALF.
I WAS 35 WHEN I HAD MY
DAUGHTER AND 37 WHEN I HAD
MY OTHER DAUGHTER, AND AFTER
I HAD THE BABIES, WELL THAT
DECREASED A BIT BUT THEN IT
PICKED UP AGAIN.
BUT NOW I'M NOT SURE IF IT'S
BECAUSE OF THE MUSCLE
DYSFUNCTION THAT I'M GETTING.
BUT I MEAN, I'M REALLY
CONCERNED.

Richard asks YOU'RE
NOT INTERESTED IN SEX
ANYMORE?

Suzanne says AT ALL.
I'M TIRED.
AND MY LIBIDO'S NIL.
COMPLETELY.
SO I'M NOT SURE IF IT'S
BECAUSE OF THE MUSCLES, THE
FUNCTIONS THAT I'M GETTING
RIGHT NOW.
AND THEN I'M FINDING THAT I
ALWAYS HAVE TO WEAR LIKE A
MINI PAD.
I CAN'T -- IF I HAVE TO GO
TO THE WASHROOM IT'S LIKE
NOW BECAUSE OTHERWISE THANK
GOD THAT I HAVE A MINI PAD.
I HAVE NO CONTROL.

Richard says IT'S
UNFORTUNATE THAT AS WE GET
OLDER IT IMPACTS OUR SEX
LIFE AND ALL OUR HEALTH
IMPACTS OUR SEX LIFE.
I THINK YOU DEMONSTRATE A
PATIENT THAT HAS OTHER
THINGS GOING ON IN HER LIFE
THAT ARE PROBABLY MORE
IMPORTANT AND INTERFERING
WITH ENJOYMENT OF SEX.
DO YOU HAVE A WILLING
PARTNER OR A HUSBAND THAT'S
INTERESTED IN HAVING SEX?

Suzanne says YES I DO.
BUT BECAUSE OF EVERYTHING
THAT'S BEEN GOING ON, I
THINK HE'S MORE AFRAID
BECAUSE I DO GET SO MANY
MUSCLE SPASMS.
I THINK HE'S AFRAID TO
APPROACH ME.

Karen says YEAH, IT SOUNDS
LIKE WITH ALL THE HEALTH
ISSUES AND THE STRESSES
PSYCHOLOGICALLY AND THEN
ALSO SOME LEAKING FROM THE
BLADDER THERE'S A LOT GOING
ON.

Richard says AND
SEX IS ALWAYS DOWN AT THE
BOTTOM OF THE LIST.
LOOK AFTER YOUR KIDS, LOOK
AFTER YOUR HEALTH AND DO THE
SHOPPING OR WHATEVER AND
UNFORTUNATELY THERE'S NOT
ENOUGH TIME IN THE DAY.
AND IF YOUR HEALTH STARTS TO
FAIL, OFTEN YOUR SEX LIFE
SUFFERS.
AND I MEAN, THIS IS THE TYPE
OF PROBLEM WHERE YOU GO TO
YOUR FAMILY DOCTOR AND YOU
DEAL WITH EACH THING AT A
TIME AND DON'T BE TOO
CONCERNED.
UNLIKELY TO FIND ANY
HORMONAL REASON FOR SEXUAL
DYSFUNCTION IN THIS PATIENT
AND MORE LIKELY AN EMOTIONAL
PROBLEM.

Karen says NOT TOO MUCH
PRESSURE ON ONESELF THEN TO
PUSH.

Richard says DON'T
PUSH.
NO.

Karen says I'VE GOT AN E-MAIL
FOR YOU FROM RUTH.
HI.
I AM HERE FROM NZ AND HAVE
ANOTHER DAUGHTER WITH SPINA
BIFIDA.
SHE WAS PUT ON A DRUG,
DETRETOL FOR BLADDER
CONTROL.
ARE THERE OTHER DRUGS
AVAILABLE HERE WHICH DO THE
SAME THING?
COULD YOU ALSO TELL ME THE
SURGICAL TECHNIQUES YOU ARE
USING IN CANADA NOW TO HELP
WITH INCONTINENCE IN
CHILDREN CAN WITH SPINA
BIFIDA IN PARTICULAR WITH A
SMALL CAPACITY BLADDER WITH
A LOW LEAKAGE POINT.

Richard says WELL
THAT'S A WHOLE SHOW TO
ANSWER THAT QUESTION.
I'LL ADDRESS THE DETROL
ISSUE AND THEN THE ISSUE
WITH CHILDREN.
DETROL IS A NEW DRUG AND IT
WAS INVENTED BECAUSE IT HAS
LESS SIDE EFFECTS THAN DIGROPAN.
THERE ARE NOT MANY OTHER
MEDICATIONS THAN THE DETROL
RIGHT NOW AND IT WORKS,
DON'T BE CONCERNED ABOUT
TAKING IT LONG-TERM.
SPINA BIFIDA, THESE ARE
CHILDREN THAT ARE BORN WITH
DEFECTS IN THEIR LOWER
SPINAL CORD, WHERE THE
NERVES THAT SUPPLY THE
BLADDER AND THE LOWER LIMBS
PROTRUDE AND ARE DAMAGED.
SO SOME OF THESE PATIENTS
HAVE -- THEY CAN'T MOVE
THEIR LEG, THEY'RE
PARALYSED.
SOME PATIENTS HAVE VARYING
DISABILITY.
BUT ALMOST ALL OF THEM HAVE
BLADDER PROBLEMS WHERE THE
BLADDER DOESN'T WORK.
IT DOESN'T EMPTY PROPERLY,
AND MOST OF THESE PROBLEMS
HAVE TO BE DEALT WITH AT A
PAEDIATRIC INSTITUTION WHERE
THERE'S A MULTIDISCIPLINED
APPROACH WITH A NEUROSURGEON
AND NEUROLOGIST.
SO I CAN'T ANSWER THAT
QUESTION IN A SHORT PERIOD
OF TIME.

Karen says BUT RUTH DID
MENTION SOMETHING ABOUT A
LOW LEAKAGE POINT IS THAT --

Richard says THESE
ARE PATIENTS THAT HAVE SMALL
BLADDERS THAT ANY KIND OF
PRESSURE, THE BLADDER WILL
DRAIN AND THEY'LL BE WET.
AND IN SOME INSTANCES YOU
CAN PUT AN ARTIFICIAL
URINARY SPHINCTER, A
SILICONE CUFF AROUND THE
BASE OF THE BLADDER THAT A
PATIENT WITH A PUMP IN THE
LABIA, THE PATIENT CAN PUSH
IT AND DRAIN IT AND IT
CLOSES ON ITS OWN.
SO THERE ARE SURGICAL
TECHNIQUES TO MAKE THE
BLADDER LARGER BY USING BOWL
AND TO MAKE THE LEAK POINT
HIGHER BY PUTTING A CUFF
AROUND THE BASE OF THE
BLADDER.

Karen says WHEN TALKING ABOUT
CHILDREN, RUTH OBVIOUSLY HAS
A UNIQUE SITUATION, A MORE
CHALLENGING ONE WITH HER
CHILD.
BUT IN TERMS OF YOUNG GIRLS
AND BOYS AROUND THE AGE OF
LET'S SAY SIX OR SEVEN, ARE
GIRLS -- DO YOU HAVE TO BE
MORE CAREFUL IN TERMS OF
INFECTIONS AND BECAUSE OF
THEIR VAGINAS VERSUS PENIS?

Richard says NO.
WE SEE MORE BLADDER
INFECTION AFFECTIONS IN
YOUNG GIRLS THAT WE DO IN
BOYS.
AND AGAIN I'M NOT QUITE
CERTAIN WHY THAT'S NOT THE
CASE -- WHY THAT'S THE CASE
BUT NO, YOU DON'T HAVE TO BE
ANYMORE CAREFUL.
IT'S NOT NECESSARY TO
INSTRUCT YOUR DAUGHTER TO
WIPE HERSELF FRONTOR TO BACK
OR BACK TO FRONT.
IT'S GENERAL HYGIENE.
BUT CHILDREN ARE MORE
WORRIED ABOUT THEIR PLAY
TIME AND TELEVISION TIME SO,
OFTEN WHAT'LL HAPPEN IS
THEY'LL KEEP THEIR BLADDER
FULL NUMBER THERE'S A BREAK.
THERE'S A COMMERCIAL BREAK,
THEN THEY'LL GO VOID.
THEY'LL GO ENOUGH TO EMPTY
THE BLADDER AND GO RIGHT
BACK TO WATCHING TELEVISION
SO INFREQUENT VOIDING IS A
PROBLEM IN CHILDREN WHERE
THEY MAY GET BLADDER
INFECTIONS.

Karen says ARE YOU SUPPOSED
TO TREAT YOUR BLADDER VERY
MUCH LIKE A MUSCLE AND WORK
IT, SO THAT NOT JUST WITH
CHILDREN BUT TEENAGER, THAT
WAS STUDY IN THE PAPER A FEW
WEEKS A AGO ABOUT UNIVERSITY
AND COLLEGE STUDENTS NOT
VOIDING REGULARLY BECAUSE
THEY WERE SO BUSY CLASS AND
SAYING THAT THAT COULD
DAMAGE THE BLADDER DOWN THE
ROAD.

Richard says IT'S NOT GOING TO DAMAGE
THE BLADDER DOWN THE ROAD
BUT IT MAY MAKE THEM MORE
LIKELY TO HAVE BLADDER
INFECTIONS.
JUST IGNORE YOUR BLADDER.
EVERY ONCE IN A WHILE IT
WILL TELL YOU WHAT TO DO AND
YOU GO DOWN IT.

Karen asks SO YOU DON'T HAVE
TO WORK IT?
LIKE THEY TELL TO YOU STOP
START, STOP START, AND THAT
WILL ACTUALLY WORK THE
MUSCLE?

Richard says NOT UNLESS YOU HAVE A LOT
OF TIME ON YOUR HAND.
JUST FORGET ABOUT YOUR
BLADDER IT.
WILL LOOK AFTER ITSELF.

Karen says OKAY.
AND I ALSO HEAR WITH BUBBLE
BATH YOU HAVE TO WATCH THAT
WITH YOUNG KIDS AND BLADDER
INFECTIONS AND ALSO HOT
TABS.
NOT THE HOT TUB BUT THE
JACCUZZI TUBS.

Richard says WELL SOMETIMES THE
CHLORINE WILL IRRITATE THE
SKIN AND IN YOUNG GIRLS IT
MIGHT BE IRRITATING BUT THIS
IS ALL ANECDOTAL STORIES.
NONE OF IT HAS BEEN PROVEN
TO INDUCE INFECTIONS.
BUBBLE BATHS, CAN BE
IRRITATING, BUT I DON'T
THINK IT'S A MAJOR ISSUE.
I WOULDN'T WORRY ABOUT IT.

Karen says ANNETTE IS NEXT.
SHE'S GOT OUR NEXT QUESTION
HEAR ON “MORE TO LIFE” AS WE
TALK ABOUT SEXUAL
DYSFUNCTION AND ISSUES TO DO
WITH INCONTINENCE AND OUR
BLADDER, Dr. RICHARD CASEY
IS OUR GUEST.
HI ANNETTE?

Annette says HI.

Karen says HI.

Annette says I HAVE PROBLEM
WHERE OCCASIONALLY I JUST
CANNOT URINATE AT ALL, AND
IT GETS TO THE POINT WHERE
IT FEELS LIKE MY BLADDER'S
ACTUALLY GOING TO EXPLODE.
AND IT WILL EVENTUALLY COME
OUT, BUT IT'LL ONLY TRICKLE
OUT AND IT TAKES ABOUT FOUR
OR FIVE HOURS TO ACTUALLY
EMPTY MY BLADDER.

Karen says SOUNDS PAINFUL.

Annette says YEAH, IT IS.
I'M JUST WONDERING IF IT'S
ANYTHING TO BE CONCERNED
ABOUT.

Richard says SURE
IT'S SOMETHING TO BE
CONCERNED ABOUT PARTICULARLY
IF IT TAKES YOU FOUR TO FIVE
HOURS TO EMPTY YOUR BLADDER.
DO YOU HAVE DIFFICULTY
PEAING IN PUBLISH WASHROOMS?

Annette says NO, IT JUST
HAPPENS OCCASIONALLY.

Richard asks HAVE YOU HAD ANY KIND OF
PELVIC SURGE SFLEE.

Annette says I HAD MY TUBES
TIED.

Richard says WELL,
WHAT YOU SAY, WHAT YOU
COMPLAIN ABOUT IS NOT VERY
COMMON.
WE DON'T SEE MANY WOMEN WHO
HAVE DIFFICULTY EVERY ONCE
IN A WHILE EMPTYING THEIR
BLADDER.
CERTAINLY SHE SHOULD SEE HER
FAMILY DOCTOR AND TALK ABOUT
IT AND IT WOULD BE A
CONCERN.
IT MAY BE RELATED TO HER
CYCLE.
MANY WOMEN SAY IN MID-CYCLE
I FEEL I HAVE TO VOID MORE
FREQUENTLY BUT IT'S THE
WEIGHT OF THE UTERUS PUSHING
ON THE BLADDER BUT SOMEONE
WHO TAKES FOUR TO FIVE HOURS
TO EMPTY A BLADDER SHOULD
SEE A DOCTOR ABOUT IT.

Karen says YEAH.
LET'S GO TO KAREN IN YORK
REGION.
HI KAREN.

Karen says HI.
I WAS JUST WONDERING, I'VE
HAD TWO CHILDREN.
THE FIRST ONE, AFTERWARDS,
INTERCOURSE WAS NO PROBLEM.
THE SECOND ONE WHO I JUST
HAD ABOUT EIGHT MONTHS AGO I
HAD AN EPISIOTOMY, I DON'T
KNOW, IT JUST DOESN'T FEEL
RIGHT, I'M NOT LUBRICATED,
MORE TENDER AND IT'S MAKING
INTERCOURSE BEING PUT ON THE
BACK BURNER.

Karen asks DOES IT STILL HURT AFTER
EIGHT MONTHS?

She replies IT JUST DOESN'T FEEL
RIGHT.
LIKE IT'S WEIRD.
LIKE I JUST -- I ALMOST
TENSE UP AND I DON'T FEEL
LIKE -- I JUST, I CAN'T
RELAX.
I KNOW IT'S GOING TO HURT.
IT DOESN'T FEEL LIKE I'M THE
SAME AFTER MY EPISIOTOMY.

Richard says IT MAY
BE THE EPISIOTOMY AND
OBVIOUSLY IT MAY BE YOUR
FAMILY DOCTOR AND GO TO YOUR
GYNECOLOGIST, BUT IT'S MORE
LIKELY THE FACT THAT YOU NOW
HAVE TWO CHILDREN INSTEAD OF
ONE CHILD AND THE DEMANDS ON
YOU DURING THE DAY AND THE
EVENING NEVER END AND YOU
CAN'T GET RELAXED AT NIGHT.
WHY DON'T GO AWAY FOR A
COUPLE WEEKENDS AND I THINK
YOUR EPISIOTOMY WOULD BE
LESS THAN A PROBLEM.
GO SEE YOUR DOCTOR ABOUT IT.
IT'S NOT LIKELY SERIOUS.
IT WILL GO AWAY WITH TIME IF
YOU JUST RELAX.

Karen says MY BABY'S JUST A
COUPLE MONTHS OLDER KAREN
AND THERE IS SOMETHING ABOUT
THAT, WHAT YOU'RE SAYING.
EVERYONE TELLS YOU TO GO
AWAY FOR A COUPLE WEEKENDS
LIKE THAT'S THE MAGIC BULLET
BUT WHEN YOU COME HOME THE
STRESS IS GOING TO BE THERE
TOO.

Richard says BUT AT
LEAST YOU HAVE A COUPLE GOOD
WEEKENDS.

Karen says YOU'RE RIGHT.
BUT PHYSICALLY, YOU'D THINK
ONCE YOU'VE BEEN TORN THERE
AND YOU'VE BEEN HURT THERE
IS SOMETHING ABOUT
PSYCHOLOGICALLY YOU JUST
FEEL LIKE YOU'RE NOT THE
SAME.
I MEAN, IS IT WORTH TALKING
TO A DOCTOR ABOUT OR READING
OR --

Richard says I
DON'T MEAN TO BE FLIPPANT
ABOUT A WEEKEND AWAY.

Karen says NO, I KNOW, IT'S
JUST I'VE HEARD THAT A LOT.

Richard says WHAT
DO MEN SAY?
RELAX.
YOU'LL BE FINE.

Karen says I KNOW, JUST
ENJOY.

Richard continues THE
VAGINA'S A VERY FLEXIBLE
ORGAN AND EPISIOTOMYS CAN BE
PUT TOGETHER INAPPROPRIATE
AND YOU MAY HAVE A BIT OF AN
AREA THAT NEEDS ATTENDING
TO.
ASSUME ASSUMING THERE'S NO
PROLAPS OF YOUR RECTUM AND
OTHER PROBLEMS MOST OF THESE
PROBLEM ALSO HEAL AND GET
LESS NOTICEABLE THE FARTHER
AWAY YOU ARE FROM YOUR
PREGNANCY.
IS IT WORTH TALKING TO THE
DOCTOR?
SURE, THERE MAY BE SOME
LOCAL PROBLEMS OR SOMETHING
IRRITATING OR FLAPS OF SKIN
BUT MOST OF THE TIME IT'S
JUST A MATTER OF GETTING
BACK ON TRACK --.

Karen says AND GETTING USE
TO.
I HAVE A C-SECTION AND TO
HAVE AN INCISION AND FEEL SO
DIFFERENT, THERE'S SOMETHING
ABOUT GROWING WITH IT AND
LIVING WITH IT AND IT
BECOMING A PARTS OF YOUR
BODY --

Richard says BUT A
LOT ELSE HAS HAPPENED WITH
ANOTHER CHILD AT HOME AND
THERE'S A LOT OF DEMANDS.

Karen says YEAH, THAT'S FOR
SURE.
NANCY FROM THORNHILL.
HI NANCY?

Nancy says HI.
ACTUALLY I HAVE QUESTION
REGARDING THE CONDITIONS
CALLED HYPOSPADEUS AND I WAS
WONDERING HOW SERIOUS IT IS
AND WHETHER SURGERY WILL
TAKE CARE OF THE PROBLEM.

Richard says
HYPOSPADEUS IS A CONDITION
WHERE YOUR SON'S -- THE
OPENING OF YOUR SON'S PENIS
IN IS NOT AT THE VERY END
AND IT'S VERY COMMON.
IT OCCURS IN ABOUT ONE IN
300 MALE BIRTHS.
AND IT'S MORE OF A COSMETIC
DEFORMITY IN THE MILD FORMS.
SO IF THE OPENING OF YOUR
PENIS IS A LITTLE BIT DOWN
THE SHAFT IT LOOKS FUNNY BUT
THE PENIS WORKS FINE AND YOU
CAN EMPTY YOUR BLADDER.
IT CAN BE CORRECTED AND
SURGEONS CAN MOVE THE END
OF YOUR PENIS FROM THE
MIDDLE OF YOUR PENIS TO THE
END QUITE SUCCESSFULLY.
THE MORE SEVERE FORMS
WHERE THE URETHRA IS
ACTUALLY IN THE PERONEUM,
WHERE IT WOULD BE IN A
FEMALE BABY ARE SERIOUS AND
CAN CAUSE PROBLEMS.
BUT THE BOTTOM LINE IS IT'S
MORE OF A COSMETIC PROBLEM
IN THE MILD CASES AND CAN BE
FIXED.
AND IN MOST CASES IT'S VERY
SUCCESSFUL.

Karen says OKAY, I WANT TO
SHIFT GEARS HERE A LITTLE
BIT TO TALK ABOUT PROSTATE
CANCER AND FOCUS IN ON THAT.
AND THERE'S BEEN A LOT OF
DISCUSSION, OF COURSE, IN
THE LAST COUPLE OF WEEK,
PARTICULARLY ABOUT GENES AND
MAPPING THE HUMAN BODY.
BUT THERE WAS THE
DISCOVERARY OF THE GENE,
APPARENTLY, FOR PROSTATE
CANCER.
WHAT DOES THIS MEAN FOR THE
FUTURE?

Richard says WE'VE
ALL -- THOSE OF US WHO WORK
WITH PROSTATE CANCER KNOW
THERE'S A SIGNIFICANT
HEREDITARY COMPONENT AND
THAT YOU HAVE ONE -- IF YOUR
FATHER HAS PROSTATE CANCER,
YOU HAVE TWICE THE RISK OF
HAVING PROSTATE CANCER AND
IF YOUR FATHER AND BROTHER
HAVE PROSTATE CANCER YOU
HAVE FOUR TIMES THE RISK OF
HAVING IT.
SO WE KNOW THERE'S A
FAMILIAL COMPONENT.
RECOGNIZING THE GENE IS
IMPORTANT.
THAT WE KNOW THAT THERE'S A
GENE THAT'S ATTACHED TO IT.
WHETHER OR NOT IT'S GOING TO
BECOME CLINICALLY IMPORTANT,
WHETHER OR NOT WE CAN USE IT
AS A TEST TO SAY “YOU'RE AT
HIGH RISK OF HAVING PROSTATE
CANCER.”
THAT'S FINE.
BUT UNLESS WE CAN SUGGEST
SOMETHING, NOW WE SHOULD
CHANGE YOUR DIET OR YOU
SHOULDN'T HAVE CHILDREN,
THAT'S YET TO BE SEEN.
BUT IT'S IMPORTANT.
WE'VE KNOWN FOR YEARS
THERE'S IS A SIGNIFICANT
GENETIC COMPONENT AND ABOUT
A THIRD TO HALF OF ALL
PROSTATE CANCER HAS A
GENETIC COMPONENT TO IT.

Karen says WE WANT TO TAKE A
CLOSER LOOK NOW AT
TREATMENTS WHEN IT COMES TO
PROSTATE CANCER BECAUSE
PROSTATE CANCER IS THE
SECOND LEADING CANCER FOR
MEN IN CANADA.
IT IS A DISEASE WITH NO
PERFECT TREATMENT AND YET
THERE ARE MANY OPTIONS.

Several clips show men walking on the streets.

Maureen narrates says PROSTATE CANCER
IS THE MOST COMMON CANCER IN
MEN.
APPROXIMATELY 16,000
CANADIAN MEN WILL BE
DIAGNOSED WITH PROSTATE
CANCER THIS YEAR.
ABOUT 4,000 WILL DIE FROM
IT.
BUT IT'S A SLOW-GROWING
DISEASE, AND MANY MEN CAN
LIVE WITH PROSTATE CANCER
FOR YEARS WITHOUT UNDERGOING
TREATMENT.

A clip shows a man in a white coat walking into an office. He is clean-shaven, has short wavy dark brown hair, and is wearing a black suit, pale blue shirt, black tie, and glasses.

Maureen continues Dr. NEIL FLESHNER IS AN
ONCOLOGIST, UROLOGIST AND
SURGEON AT TORONTO'S
SUNNYBROOK REGIONAL CANCER
CENTRE.

A caption reads “Dr. Neil Fleshner. Uro-Oncologist.”

Neil says ABOUT 80 percent OF MEN, IF THEY
LIVE LONG ENOUGH, WILL
ULTIMATELY DEVELOP PROSTATE
CANCER.
SO IT'S SORT OF LIKE GREY
HAIR AND WRINKLES.
NOW, HAVING SAID THAT, ONLY
ABOUT 15 percent OF MEN WILL BE
DIAGNOSED WITH A PROSTATE
CANCER?
THEIR LIFETIME, AND OVERALL,
ABOUT 4 percent OF MEN WILL DIE
FROM PROSTATE CANCER, WHICH
MAKES IT THE SECOND MOST
COMMON CAUSE OF
CANCER-RELATED DEATHS AMONG
MEN.

A clip shows a nurse taking blood from a man.

Maureen continues A BLOOD TEST
CALLED P.S.A. FOR PROSTATE
SPECIFIC ANTIGEN DETECTIVES
THE CANCER AT AN EARLY STAGE
LONG BEFORE SYMPTOMS CAN BE
FELT BY PATIENT OR DOCTOR.

A clip shows a man lying on a stretcher, and a doctor beside him.

The doctor says OKAY SO, WE JUST DO A
RECTAL EXAMINATION NOW --

Maureen continues BUT A POSITIVE DIAGNOSIS
PRESENTS A DILEMMA.
WHETHER TO TREAT OR LEAVE IT
ALONE.
Dr. GERARD MORTON IS A
RADIATION ONCOLOGIST AT
SUNNYBROOK.
HE SPECIALIZES IN TREATING
CANCER WITH RADIATION.

A clip shows a man in a doctor’s office. He is bald with short brown hair on the sides, has a trimmed full beard, and is wearing a gray shirt under a white coat.
A caption reads “Dr. Gerard Morton. Radiation Oncologist.”

Gerard says THE DILEMMA IS THAT THE
CANCER CAN BE CURED WHEN IT
IS AT ITS EARLIER --
EARLIEST STAGE.
ONCE IT HAS SPREAD OUTSIDE
OF THE PROSTATE, THE CHANCE
OF CURING IT DECREASES.
SO WE ARE PICKING IT UP AT
AN EARLIER STAGE IN YOUNGER
MEN.
WE CAN CURE IT IN A HIGH
PROPORTION, BUT YES, THESE
MEN DO HAVE TO LIVE WITH THE
SIDE EFFECTS.

Several clips show men walking on the streets.

Maureen continues AND THE POSSIBLE SIDE
EFFECTS, IMPOTENCE AND
INCOULDN'T JENS --
INCONTINENCE ARE DREADED BY
ALL MEN.
THAT, COMBINED WITH THE
KNOWLEDGE THAT THE CANCER
MAY NOT KILL THEM, MAKES THE
DECISION WHETHER TO TREAT
AND HOW A PARTICULARLY
DIFFICULT ONE.

Neil says WHEN ONE CONSIDERS
TREATMENT FOR PROSTATE
CANCER ONE HAS TO CONSIDER
TWO FACTORS.
THE DISEASE AND THE PATIENT.
SO THE DISEASE-RELATED FACT
TO THE MAJOR FACTOR IS THE
STAGE.
HOW EARLY HAVE WE CAUGHT IT?
AND OF COURSE THE NEXT
IMPORTANT FACTOR IS THE LIFE
EXPECTANCY OF THE PATIENT
AND THEIR GENERAL HEALTH.
SO OPTION ONE IS WATCHFUL
WAITING, WHICH IMPLIES JUST
DOING NOTHING, BUT
MONITORING THE CANCER
CLOSELY.

Gerard says IF SOMEBODY IS YOUNGER,
OR IF THEY'VE GOT HIGHER
GRADE CANCER, THERE'S QUITE
A HIGH CHANCE THAT THE
CANCER WILL ACTUALLY
PROGRESS IN THEIR LIFETIME
AND CAUSE EITHER LOCAL
PROBLEMS OR SPREAD ELSEWHERE
IN THE BODY AND RESULT IN
PROBLEMS WITH QUALITY OF
LIFE, PAIN, AND THEIR
EVENTUAL DEATH.

A clip shows a man in surgery.

Neil says SECOND OPTION WOULD BE
SURGICAL REMOVAL OF THE
PROSTATE.
CALLED A RADICAL
PROSTATECTOMY FOR YOUNG MEN
WITH EARLY STAGE PROSTATE
CANCER THAT WE THINK IS
CONFINED TO THE PROSTATE AND
HAVE ABOUT A 15-YEAR LIFE
EXPECTANCY.
THAT THAT TENDS TO BE
GENERALLY MEN UNDER 70 YEARS
OF AGE.
WE GENERALLY DO NOT DO THE
OPERATION IN MEN OVER 70.

Maureen narrates says IF THE CANCER IS
CONFINED TO THE PROSTATE
THIS IS USUALLY SUCESSFUL IN
REMOVING THE CANCER, BUT
INCONTINENCE OCCURRED IN 5 percent
TO 7 percent OF MEN.
THE OTHER MAJOR RISK FACT TO
SEXUAL DYSFUNCTION HAPPENS
MORE OFTEN.

Several clips show surgeons operating in a surgery room.

Neil says THE NERVES THAT CONTROL
SEXUAL FUNCTION RUN
MILLIMETRES AWAY FROM THE
PROSTATE.
AND ONE OF THE TRICKS
SURGICALLY IS TO REMOVE THE
PROSTATE WITHOUT DISTURBING
THOSE NERVES.
AND IF ONE PERFORMS A
NERVE-SPARING OPERATION,
DEPENDING ON THE AGE GROUP
OF THE PATIENT, ABOUT 50 percent OF
MEN CAN HAVE SATISFY
ERECTION, SUFFICIENT FOR
PENETRATION AND INTERCOURSE
AFTER THE OPERATION.
SO IT'S ABOUT 50/50.

Gerard says IF THE CANCER HAS SPREAD
OUTSIDE THE GLAND, IF IT IS
AN AGGRESSIVE CANCER,
SURGELY IS NOT A GOOD
OPTION.
BECAUSE THERE IS A VERY HIGH
CHANCE OF LEAVING SOME
CANCER BEHIND.
AND SURGERY REALLY IS BEST
WHEN THE CANCER IS CONFINED
WITHIN THE PROSTATE.

A clip shows a man in radiation therapy.

A nurse says MOVING THE MACHINE AROUND
YOU NOW.

Maureen continues FOR MORE
AGGRESSIVE OR WIDESPREAD
CANCER, EXTERNAL BEAM
RADIATION WITH HORMONE
TREATMENT IS RECOMMENDED.

Neil says A CHRONIC URINARY PROBLEM
IS QUITE RARE AFTER
RADIATION THIRP.
PERHAPS ONLY ABOUT 2 percent OF
PATIENTS.
SEXUAL DYSFUNCTION THOUGH
CAN ALSO OCCUR IN RADIATION
THIRP AGAIN UPWARDS OF ABOUT
40 percent TO 50 percent OF MEN BUT TENDS
TO BE A SLOWER ONSET OF
ERECT TILE DYSFUNCTION,
UNLIKE THE PROSTATECTOMY
WHERE IT'S THE DAY OF THE
OPERATION THIS IS A SHER AND
MORE INSIDIOUS PROCESS THAT
GENERALLY OCCURS OVER
THREE YEARS BECAUSE
IT NARROWS THE BLOOD
VESSELS.

Maureen continues ANOTHER TREATMENT OPTION
CALLED BRACHYTHERAPY IS
SHOWING GOOD RESULTS IF THE
CANCER IS DETECTED EARLY AND
CONFINED WITHIN THE
PROSTATE.

Gerard says BRACHYTHERAPY REFERS TO
CHOOSING CANCER BY PLACING A
RADIO ACTIVE SOURCE IN OR
CLOSE TO THE TUMOR.
IT HAS THE ADVANTAGE OF
GIVING A VERY HIGH DOSE TO
THE TUMOR, A HIGHER DOSE
THAT CAN BE ADMINISTERED
USING EXTERNAL BEAM
TREATMENT AND ALSO GIVING
LESS DOSE TO SURROUNDING
NORMALTISSUES.
SO THERE ARE LESS SIDE
EFFECTS AND GREATER DOSE TO
TUMOR.

A clip shows Gerard at a computer. The screen shows a picture with several numbered green dots.

Gerard says SO THIS IS A PICTURE
THROUGH THE PROSTATE IN THE
CENTRE.
AND THE GREEN DOTS REPRESENT
THE LOCATION OF THE RADIO
ACTIVE SEEDS.

Maureen narrates says BRACHYTHERAPY HAS BEEN
AROUND FOR DECADES.
RECENTLY THERE HAVE BEEN
SIGNIFICANT IMPROVEMENTS.

Gerard says THE GREATEST CHANGES HAVE
OCCURRED OVER THE LAST FIVE
TO TEN YEARS.
WHEN THE DEVELOPMENT OF
ULTRASOUNDS TO IMAGE THE
PROSTATE, BETTER TECHNIQUES,
AND COMPUTERS IT ALLOW US TO
ACCURATELY PLAN AND WORK OUT
IN ADVANCE WHERE THE SEEDS
NEED TO BE PLACED ENABLES US
TO DO VERY GOOD IMPLANTS.
THESE PICTURES CAN THEN BE
SENT TO A PLANNING COMPUTER,
WHICH GIVES US A THREE
DIMENSIONAL PICTURE OF THE
PROSTATE.
AND WE USE THIS INFORMATION
TO WORK OUT EXACTLY WHERE
AND HOW MANY SEEDS WE NEED
TO USE.

A clip shows a group of surgeons operating on a man.

Maureen narrates says THE PATIENT IS
ANAESTHETIZED BELOW THE
WAIST, SO THE PROCEDURE IS
PAINLESS.
THE SEEDS NO, BIGGER THAN A
GRAIN OF RICE, ARE LOADED
INTO A NEEDLE.
GUIDED BY AN ULTRASOUND
IMAGE OF THE PROSTATE, THE
DOCTOR INSERTS THE NEEDLE
THROUGH THE SKIN, UNDER THE
SCROTUM.
BETWEEN 80 AND 100 RADIO
ACTIVE SEEDS ARE DEPOSITED
DIRECTLY INTO THE PROSTATE.
THE SEEDSESLY THEIR POTENCY
WITHIN SIX MONTHS BUT THEY
STAY IN THE PROSTATE
FOREVER.

Gerard says WHEN THAT IS DONE, THE
PATIENT LEAVES THE ROOM AND
MOST CASES THE MAN CAN
ACTUALLY WALK OUT OF THE
OPERATING ROOM.
AND USUALLY HE GOES HOME ONE
OR TWO HOURS LATER.

Maureen continues THE PROCEDURE IS HE'D YER
AND RECOVERY QUICKER -- IS
EASIER AND RECOVERY QUICKER,
BUT THERE ARE STILL SIDE
EFFECTS TO GRAPPLE WITH.

Gerard says WITH BRACHY IS THERAPY,
THE RISK OF INCONTINENCE IS
LESS THAN 1 percent.
IMPOTENCE DOES OCCUR.
INITIAL REPORTS SUGGESTED
THAT IT WAS ACTUALLY QUITE
UNCOMMON.
WITH INITIAL REPORTS OF 5 percent
TO 10 percent OF IMPOTENCE.
MORE RECENTLY, THERE WAS
EVIDENCE THAT THE RISK OF
IMPOTENCE IS A BIT HIGHER,
PROBABLY CLOSER TO 30 TO
40 percent.
BUT IT'S STILL LESS THAN
THAT WITH SURGERY.

Neil says THE REAL ADVANTAGE OF THE
BRACHYTHERAPY IS IT'S A ONE
DAY TREATMENT, IN AND OUT
THE SAME DAY.
THE RADIATION TREATMENT YOU
HAVE TO COME DAILY FOR SEVEN
WEEKS AND OF COURSE THE CON
VALENS SENSE OF THE SURGERY,
WHICH IS ABOUT THREE IT FIVE
WEEKS.

Gerard says THE PROBLEM IS THERE'S NO
PERFECT TREATMENT FOR CANADA
SEMPLT THE PERFECT TREE.
OF A 100 percent CURATE WITH ZERO
PERCENT CHANCE OF
COMPLICATIONS AND WE DON'T
HAVE THAT TREATMENT.

Karen reappears in the studio.

Karen says WE'VE BEEN TALKING
ABOUT SEXUAL DYSFUNCTION
HERE ON “MORE TO LIFE” WITH
OUR RESIDENT UROLOGIST
Dr. RICHARD CASEY AND NOW
WE'RE SHIFTING OUR FOCUS
SOMEWHAT TO PROSTATE CANCER
AND TAKING YOUR QUESTIONS
ABOUT IT.
THE TREATMENTS AVAILABLE AND
DETAILS ON PROSTATE CANCER.
SO OUR NUMBERS HERE IN TORONTO

A caption appears on screen showing two phone numbers.

Karen continues 416-484-2727
LONG DISTANCE IS
1-888-411-1234
AND OUR E-MAIL ADDRESS IS
MORETOLIFE AT TVO.COM
AND Dr. RICHARD CASEY CAN TAKE
QUESTIONS ON PROSTATE
CANCER.
THAT LOOKED AT A VARIETY OF
DIFFERENT TREATMENTS BUT TO
STAY WITH OUR THEME ABOUT
SEXUAL DYSFUNCTION AND ITS
ROLE IN PROSTATE CANCER, IS
IT GUARANTEED A MAN WILL BE
IMPOTENT AFTER SURGERY?

Richard says NO,
NOT AT ALL.
IN FACT MOST ARE NOT
IMPOTENT.
THE DATA IS OLDER DATA WHEN
WE DID THE OPERATION A BIT
DIFFERENTLY, BUT WE HAVE TO
REALIZE ABOUT 40 percent OF MEN ARE
IMPOTENT BEFORE THE SURGERY.
THEY HAVE PROBLEMS BECAUSE
THERE'S SUCH A HIGH INSTANCE
OF SEXUAL DYSFUNCTION.
ABOUT 60 percent OF MEN WHO HAVE A
RADICAL PROSTATECTOMY WILL
MAINTAIN THEIR POTENCY IF
POTENT BEFORE SURGE SCOMPREE
A GOOD PORTION OF THOSE CAN
BE RECOVERED BY USING DRUGS
LIKE VIAGRA OR INJECTION
THERAPY.
I WOULDN'T LET THE FEAR OF
SEXUAL DYSFUNCTION INTERFERE
WITH MY DECISION TO HAVE
SURGERY BECAUSE IT CAN BE
FIXED MOST OF THE TIME.

Karen asks AND WHAT'S ITS
FUNCTION?

Richard says IT HAS
ANTIBACTERIAL FUNCTIONS,
PROVIDES FLUID FOR SEMEN.
IT HAS VERY LITTLE FUNCTION
AFTER YOUR CHILD BEARING
YEARS ARE OVER SO IT'S
BETTER JUST TO HAVE IT
REMOVED IF YOU DON'T NEED IT
ANYMORE.

Karen asks IS IT LOCATED
BEHIND THE PENIS?

Richard says IT'S
BETWEEN THE BLADDER AND THE
TESTICLES.
YOU'RE URETHRA GOES RIGHT
THROUGH THE MIDDLE OF YOUR
PROSTATE WHICH IS THE SIZE
OF A WALNUT OR CHESTNUTGETS
BIGGER AS YOU GET OLDER.
AND I DIDN'T MEAN THAT WE
SHOULD TAKE IT OUT ON
EVERYBODY AS THEY GET OLDER
BUT IT HAS NO USEFUL
FUNCTION AFTER THE AGE OF
SAY 45 AFTER YOU FINISH WITH
YOUR CHILDREN.

Karen says BUT WHAT ABOUT THE
DOCTOR WHO SAYS IT'S JUST
LIKE GETTING GREY HAIR AND
WRINKLES --

Richard says IT
GETS BIGGER AS YOU GET OLDER
AND THE COMMON DISEASE OF
THE PROSTATE IS B.P.H.,
BENIGN PROSTETIC HYPOPLAYSIA
THAT INTERFERES WITH AURN
NATION AND GO TO THE
BATHROOM AND SLOWS THE
STREAM DOWN.
THERE IS TREATMENT FOR THAT.
CANCERS ARE COMMON AND AS
THE DOCTOR SAID IF YOU LIVE
LONG ENOUGH YOU'LL GET
PROSTATE CANCER, BUT MANY OF
THESE MEN IN THEIR 70s AND
80s WHO HAVE IT DON'T NEED
TREATMENT.
YOU CAN WAIT AND WATCH
YOU’LL DIE FROM SOMETHING
ELSE.

Karen says YOU'LL DIE FROM
SOMETHING ELSE.
WHICH IS TO THINK YOU'VE GOT
THE CANCER IN YOUR BODY BUT
IT'S NOT GOING TO KILL YOU
BECAUSE IT'S IN YOUR
PROSTATE.
LOOKING AT SOME OF THE
TREATMENTS, BRACHYTHERAPY
HOW NEW IS IT?

Richard says IT'S
NOT VERY NEW, BECAUSE WHEN I
WAS A RESIDENT IN 1978
BRACHYTHERAPY WAS BIG AT
THAT TIME.
BRACHYTHERAPY IS WHERE WE
INSERT LITTLE RADIO ACTIVE
SEEDS INTO THE GLAND AND THE
RADIATION SLOWLY KILLS THE
PROSTATE CANCER.
NOW WHEN I FIRST WAS
FAMILIAR WITH IT IN THE LATE
'70s OR EARLY '80s, WE USED
A DIFFERENT TYPE OF RADIO
ACTIVE MATERIAL BUT THE
PATIENTS WERE DIFFERENT AS
WELL.
WE DIDN'T HAVE P.S.A., FIND
THE PATIENTS WITH THE
DISEASE VERY EARLY AND THE
RESULTS WEREN'T GOOD SO
AFTER FIVE OR TEN YEARS OF
BRACHYTHERAPY, IT FELL BY
THE WAYSIDE.
IT'S BACK NOW BECAUSE P.S.A.
IS FINDING EARLIER, PROSTATE
CANCER PATIENTS, WE FIND
MORE PROSTATENCER
PATIENTS AND YOUNGER
PATIENTS.

Karen asks AND P.S.A. IS THE
TEST?

Richard says P.S.A. IS THE TEST THAT
HELPS US FIND IT EARLIER.

Karen asks LIKE A MAMMOGRAM
FOR A WOMAN?

Richard says A BLOOD TEST
FAIRLY SENSITIVE IN FINDING
PROSTATE CANCER.
YOU HAVE TO DO A BIOPSY AS
WELL AS A P.S.A. BLOOD TEST
BUT MEN ARE NOW GOING TO A
DOCTOR AND ASKING FOR P.S.A.,
GETTING A RECTAL EXAMINATION
AND WE'RE FINDING CANCER
EARLIER.

Karen asks ISN'T THERE SOME
CONTROVERSY SURROUNDING THE
P.S.A. SUGGESTING IT MAY NOT
BE AS EFFECTIVE AS WE
EARLIER HAUTE?

Richard says THE
TEST IS ONLY AS GOOD AS THE
SITUATION YOU USE IT IN IF
YOU RELY ON P.S.A. BY ITSELF
TO FIND PROSTATE CANCER
YOU'LL ONLY BE ACCURATE
ABOUT 60 percent OF THE TIME BUT IF
YOU INCLUDE REGULAR
FOLLOW-UPS WITH YOUR DOCTOR,
SO THE DOCTOR CAN MONITOR
THE CHANGE IN YOUR P.S.A.
FROM YEAR TO YEAR AND HE CAN
DETERMINE WHAT P.S.A. YOU
SHOULD HAVE, DEPENDING ON
THE SIZE OF YOUR PROSTATE --
BECAUSE EVERYBODY HAS A
DIFFERENT P.S.A..

Karen asks AND NOT TO ORDER
THE BIOPSY RIGHT AWAY IF
IT'S ELEVATED?

Richard says NOT
NECESSARILY IT.
CAN BE ELEVATED BECAUSE YOU
HAVE INFECTION, BECAUSE OFF
BIG PROSTATE GLAND.
AND IT'S REALLY --

Karen says OR BECAUSE YOU
HAVE A LONG BIKE RIDE AND
STIMULATED THE BIKE RIDE.

Richard says SURE,
OR INTERCOURSE THE NIGHT
BEFORE.
BUT THE TREND IS IMPORTANT
SO REGULAR FOLLOW-UP WITH
THE DOCTOR HELPS MAKE IT
MORE VALUABLE.
BUT BACK TO THE BRACHYTHERAPY,
THIS SEEMS TO BE A GOOD
TREATMENT.
I'M GOING TO WITHHOLD
JUDGMENT FOR ANOTHER 15
YEARS UNTIL WE HAVE DATA.
BECAUSE WITH PROSTATE CANCER,
ALL TREATMENTS ARE GOOD FOR
THE FIRST FIVE OR SIX YEARS
BECAUSE PROSTATE CANCER
GROWS SO SLOWLY.
SO BRACYYTHERAPY HAS GOOD
NUMBERS UP TO ABOUT EIGHT
YEARS, SO WE KNOW IN EIGHT
YEARS OUT IN COMPARABLE
PATIENTS IT'S ABOUT AS GOOD
AS SURGERY BUT AGAIN, I'M
BIASED.
I'M FOR A SURGEON.
FOR THOSE PATIENTS GOOD
CANDIDATES FOR BRACHYTHERAPY
AND ARE LESS THAN 70
YEARS OF AGE, SURGERY
PROBABLY GIVES THEM A BETTER
QUALITY OF LIFE.

Karen says OKAY, RITA FROM
THORNHILL.
HI RITA?

Rita says HI.
I'M WONDERING IF THE DOCTOR
COULD DISCUSS HORMONAL
MANIPULATION.
MY 79-YEAR-OLD FATHER HAS
PROSTATE CANCER AND THIS IS
HOW HE'S BEING TREATED.

Karen asks HOW ABOUT HORMONES
VERSUS SURGERY?

Richard says WELL, IT'S NOT -- YOU
CAN'T SAY HORMONES VERSUS
SURGERY BECAUSE HORMONES ARE
NOT CURATIVE.
WHEREAS THE SURGERY IS AN
ATEMPT CURE THE DISEASE AND
MAKE IT GO AWAY FOREVER.

Karen asks HORMONE IS
TREATMENT?

Richard says
PROSTATE CANCER, BECAUSE
IT'S A MALE CANCER, IT NEEDS
TESTOSTERONE TO GROW.
SO IF YOU REMOVE
TESTOSTERONE, AND THE
TREATMENT USED TO BE
CASTATION AND STILL IS, IF
YOU REMOVE THE MALE HORMONE
THE CANCER STOPS GROWING AND
WILL STOP GROWING FOR MONTHS
AND MONTHS, UP TO FIVE YEARS
SOMETIMES IT.
WILL ALWAYS START GROWING
AGAIN, IF YOU LIVE LONG
ENOUGH.
BUT IF YOU TAKE THE FUEL
AWAY FROM THE FIRE, THE FIRE
WILL GO OUT FOR A WHILE.
SO HORMONE MANIPULATION IS
GENERALLY RESERVED FOR OLDER
MEN, MEN WHO HAVE LESS THAN
A 15-YEAR LIFE EXPECTANCY
MAY HAVE DISEASE OUTSIDE THE
PROSTATE GLAND SO IT CANNOT
BE CURED AND THIS IS A WAY
TO CONTROL THE DISEASE AND
KEEP IT FROM CAUSING
PROBLEMS.
SO YOU REMOVE TESTOSTERONE
FROM THE BODY FOREVER, OR
SIX MONTHS AT A TIME AND
RESTART, STOP THE DRUGS SO
THE HORMONE LEVELS COME BACK
UP.
IT'S A WAY TO CONTROL THE
PROSTATE CANCER BY
CONTROLLING THE FOOD THAT IT
NEEDS TO GROW.

Karen asks HOW EFFECTIVE IS
IT?

Richard says IT'S
VERY EFFECTIVE.
IT'S DRAMATIC.
MEN WHO COME TO OUR OFFICE
WHO HAVE METASTATIC PROSTATE
CANCER, CANCER SPREAD
THROUGH OUT THEIR BODY, BACK
PAIN, MAYBE DIFFICULTY VOIDING,
ONCE YOU START HORMONE
TREATMENT WITHIN DAYS
THEY'RE BETTER.
IT'S REMARKABLE.

Karen says REALLY?
HOW OFTEN IS CASTRATION
DONE?
YOU MENTIONED --

Richard says WE DO
MEDICAL CASTRATION NOW,
BECAUSE IT'S THE '90s AND
THE NEW MILLENNIUM.
UP UNTIL 15 YEARS AGO, WE
USED TO ROUTINELY REMOVE THE
TESTICLES FROM MEN THAT HAD
CANCER THAT SPREAD INSIDE
THEIR BODY.

Karen asks AND NOW
CHEMICALLY?

Richard says IT'S
PROBABLY TEN TIMES MORE
EXPENSIVE, BUT THE RESULT IS
MEN RETAIN THEIR TESTICLES.

Karen says ANNA FROM TORONTO
NEXT.
HI ANNA?

Anna says HI.
MY DAD PASSED AWAY WITH
PROSTATE CANCER ABOUT FOUR
MONTHS AGO AND HE SUFFERED
QUITE A BIT.
BUT I WANT TO KNOW HOW COME
HE WASN'T ABLE TO HAVE
SURGERY?
IS IT BECAUSE HE HAD A TUMOR
ALSO ON HIS SPINE?

Karen says HE WAS NOT ABLE TO
HAVE SURGERY.

Anna says YEAH, THEY SAID
THAT THERE WAS NO REASON TO
HAVE SURGERY.

Richard says
PROBABLY BECAUSE WHEN YOUR
DAD'S PROSTATE CANCER WAS
DISCOVERED IT WAS ALREADY
OUTSIDE THE PROSTATE, AND
SURGERY IS ONLY USEFUL IF
YOU CAN REMOVE ALL OF THE
PROSTATE CANCER CELLS IN THE
BODY AND IF THERE'S ALREADY
CANCER IN THE SPINE, TAKING
OUT THE PROSTATE CANCER
WOULD HAVE CAUSED HIM A LOT
OF GRIEF, TIME IN HOSPITAL
AND WOULDN'T HAVE MADE HIM
LIVE ANY LONGER.

Karen says IT SOUNDS SHOCKING
WHEN YOU SAY YOU'RE GOING TO
DIE FROM SOMETHING ELSE WHEN
YOU HAVE PROSTATE CANCER IN
YOUR BODY --

Richard says BUT
MOST MEN WHO HAVE PROSTATE
CANCER DIE FROM PROSTATE
CANCER NOW BECAUSE THEY LIVE
A LOT LONGER.
WE USED TO SAY YOU'RE NOT
GOING TO DIE FROM IT, YOU'LL
DIE WITH IT.
NOW CANADIAN MEN LIVE TO
THEIR 80s, WE'RE A LITTLE
MORE AGGRESSIVE.

Karen says WITH HIGH PROFILE
EXAMPLES, PRESTON MANNING
WHOS A JUST RECENTLY BEEN
TREATED FOR PROSTATE CANCER,
AND NEW YORK, THE MAYOR,
GUILIANI THERE, WHEN YOU GET
EXAMPLES THAT HIT THE NEWS
LIKE THAT AND HEADLINES, DO
YOU THINK THAT'S GOOD IN
TERMS OF THE SQUEAMISH --
LOTS OF THEM DON'T GO TO A
DOCTOR AT ALL, NEVER MIND
GET THEIR --

Richard says MEN
LIKE TO PUT OUT FIRES, DON'T
DO PREVENTION AT ALL.
BUT CERTAINLY WHEN SOMEONE
LIKE MAYOR GUILIANI HAS
PROSTATE CANCER, PEOPLE COME
IN AND SAY “HE'S ONLY 54
YEARS OLD.”
I'VE SEEN MEN IN MY PRACTICE
IN THEIR LATE 40s WITH
PROSTATE CANCER.
THAT TYPE OF PUBLICITY IS
VERY GOOD.
BAD PUBLICITY IS TALKING
ABOUT CURES.
THIS IS A NEW CURE FOR A
DISEASE AND IT REALLY ISN'T
BECAUSE IT CAN GIVE PEOPLE
FALSE HOME.
MEN ARE MUCH BETTER NOW.
THEY COME SEE THEIR DOCTOR,
GET THEIR P.S.A.s DONE.
IT'S BETTER THAN IT WAS 10
YEARS AGO.

Karen says DO YOU THINK
THAT'S BASED ON FEAR OR MEN
NOT WANTING BODIES INVADED
OR TOUCHED --.

Richard says IT'S
BASED ON THEIR WIFE TELLING
THEM YOU BETTER GET YOUR
BUTT IN THERE.
I HAVE A MAMMOGRAM, SOMEONE
SQUEEZES MY BREAST, YOU'RE
GOING TO GET A FINGER IN
YOUR REAR END.
MEN HATE HAVING RECOLLECTAL
EXAMINATIONS.
NOT THAT THEY SHOULD ENJOY
IT.
IT'S AN EASY TEST AND IT CAN
AIVE THEIR LIFE.

Karen says IN TERMS OF HOW
MUCH YOU CAN CONTROL IN
ONE'S LIFE IN TERMS OF DIET
WHEN IT COMES TO PROSTATE
CANCER, HOW MUCH CAN YOU DO?

Richard says YOU
CAN DO QUITE A BIT AND NEIL
FLESHNER HAS AN INTEREST
THIS THAT FROM SUNNYBROOK.
THERE IS EVIDENCE THE NORTH
AMERICAN DIET INCREASES OUR
RISK OF GETTING PROSTATE
CANCER AND IF YOU LOOK AT
JAPANESE MEN, WITH A LOWER
INSTANCE, AND THE DIETARY
DIFFERENCE, A DIET LOW IN
ANIMAL FAT, HIGH IN VITAMIN
E AND HIGH IN LYCOPINES AND
YOU CAN HAVE AN IMPACT ON
YOUR CANCER -- I'VE SEEN
PATIENTS WHO HAVE BEEN ABLE
TO CHANGE THEIR P.S.A. FOR
WHAT THAT'S WORTH, THEY CAN
LOWER THEIR P.S.A. BY
CHANGING THEIR DIET.
WE ROUTINELY ADVISE PATIENTS
TO LOOK AT THEIR DIET AND IF
THEY HAVE A HIGH ANIMAL FAT
DIET TO CHANGE IT AND TAKE
AS A RESULT MINUTE E.

Karen says WE'RE SEEING AN
INCREASE OF THE NUMBERS TO
SAY THERE'S MORE AND MORE
CASES OF PROSTATE CANCER IN
THIS COUNTRY.
IS IT BECAUSE OF AWARENESS
OR WHAT IS THE ANSWER?

Richard says
BECAUSE OF AWARENESS AND
CHANGES IN TECHNOLOGY.
P.S.A. IS ONE EXAMPLE AND
THE WAY WE BIOPSY PROSTATES.
IT'S A LOT EASIER TO BIOPSY
A PROSTATE NOW --

Karen says I HEAR IT'S AWFUL.

Richard says IT'S NOT SO BAD NOW.
WE USE A TRANS RECOLLECTAL
ULTRASOUND GUN WE USE AND
IT'S NOT VERY PAINFUL.
IMPROVEMENTS IN DIAGNOSTIC
TECHNIQUES ALWAYS RAISE THE
INCIDENTS OF THE DISEASE
BECAUSE WE LOOK AT IT IN
MORE PEOPLE.
MEN ARE COMING AND GETTING
TESTED EARLIER.

Karen says AND AN AGING
POPULATION AS WELL.

Richard says AND
GOOD HEALTHCARE SO PEOPLE
HAVE ACCESS.

Karen says BUT IT'S NEVER
BEEN BETTER IN TERMS OF
OPTIONS FOR TREATMENT.

Richard says
THERE'S A LOT OF OPTIONS NOW,
BRACCHYALTHERAPY.
A RADICAL -- LAP SCOOPIC
RADICAL PROSTATECTOMY,
THERE'S A DOCTOR IN BRAMPTON,
DOING QUITE A BIT OF THOSE,
AND WE'RE DOING THEM IN
OAKVILLE AS WELL.
WE THINK IF YOU MAKE MORE
OPTIONS AVAILABLE TO MEN FOR
TREATMENT THEY'RE MORE
LIKELY TO GO TO THEIR DOCTOR
SO THEY CAN MAKE A DECISION
BECAUSE MEN LOVE TO BE IN
CONTROL.

Karen says OH, YEAH.
AND THAT'S COMING FROM YOU.
IS THERE A SET AGE?
55 OR 50 WHERE YOU'D LIKE TO
SEE REGULAR TESTS?

Richard says
CERTAINLY AT 50 I THINK YOU
SHOULD GO TO YOUR DOCTOR AND
HAVE A RECTAL AND P.S.A. ON
A YEARLY BASIS UNTIL YOU'RE
70 BUT AFTER THAT IT'S UP
TO YOU AND YOUR GENERAL
HEALTH STATUS.
IF YOU HAVE A FAMILY HISTORY
OF PROSTATE CANCER, MAKE IT
45.
IF YOUR DAD HAD PROSTATE
CANCER AND IF YOUR BROTHER
HAD IT, BE SURE YOU GO TO
YOUR DOCTOR ON A REGULAR
BASIS.

Karen says THAT SOUNDS FAIR.
BOTH SEXES ARE TAKING CARE
OF THEMSELVES.
ALL RIGHT, RICHARD, IT'S
GREAT TO SEE YOU.
THANKS FOR COMING IN.
Dr. RICHARD CASEY, OUR
RESIDENT UROLOGIST HERE ON
“MORE TO LIFE” AND HE'S THE
DIRECTOR OF THE MALE HEALTH
CENTRES IN OAKVILLE.
IF YOU'D LIKE TO REACH HIM

A slate appears on screen. It reads “Dr. Richard Casey. 905-338-3130. www.malehealth.com.”

Karen continues HERE’S HIS PHONE NUMBER
905-338-3130, OR VISIT HIS WEBSITE
WWW.MALEHEALTH.COM.
THAT’S IT FOR TODAY SHOW.
I’M KAREN HORSMAN, JOIN US
MONDAY TO FRIDAY FOR MORE TO LIFE.

A closing slate reads “The advice given in the preceding program is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances.”

Watch: Urology