May 12, 2025 • 42 mins
- Listen Saturday mornings at 8 as Dr. Msonthi Levine discusses medical issues and takes your calls on News Talk 560 KLVI. Dr Levine is board certified in Internal Medicine and Geriatrics. His office is located at 3080 Milam in Beaumont, Texas. He can be reached at 409-347-3621.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
All right, Internet ready listeners, Welcome, Welcome, Welcome, Welcome to
Doctor Levine Medical Hour. This is your weekly host, Doctor Levine,
coming to you live from the series of kov I
Hear in Boma, Texas. Thank you for joinings from the
edition of the show. We are here every Saturday typically
to answer your questions about healthcare and medicine as I
(00:23):
see it and as we see it. After having a
two way conversation about the situation, which is what healthcare
is all about now is shared decision between the physician
and their patient, which is a little bit different from
when I first hit the scene. It's more of a
(00:44):
decision between the doctor and the patient so that the
patient can be informed and a lot more information out
there the patients have available to them if they would
like to be more informed. Phone lines are open eight
done six kov I one one hundred three three zero.
Speaker 2 (01:00):
Okayovi.
Speaker 1 (01:02):
We'd love to hear from you, talk with you and
try to answer your questions and get you some information
to help you figure out what is good and what
is not so good.
Speaker 2 (01:11):
For that.
Speaker 1 (01:13):
Haven't heard too much about the measles outbreak. Seems like
that concern has calmed down, but they did issue some
suggestions that just like we mentioned before, if you are
concerned about acquiring measles or your concern that maybe your
protection is not where it needs to be, just go
(01:35):
get a booster. It's that simple. It's that easy. Again,
it's to offer that human body some protection against invasion
of certain micro organisms. In this particular situation, virus. And
there's a bunch of viruses out there. We target a few,
We target the ones that typically cause high percentage of
(01:56):
the infections in the community. And seems like the measles
outbreak has somewhat calmed down. Don't hit too much. But again,
if you're concerned, just go get a vaccine.
Speaker 2 (02:07):
It's that easy.
Speaker 1 (02:08):
It's normally not in doctors' offices. He would have to
probably go to the pharmacy, which again that industry has
pretty much taken over the vaccine issue or providing vaccines
to the local community. You know, very convenient, get your medicines,
(02:30):
pick up some milk and yeah it didn't get your vaccine.
And they normally keep good records and they've done very
well at putting a or should say, providing a service
that was I would say lacking for many years. Again,
(02:50):
most primary care decisions offices. It's difficult to provide vaccines.
There's a lot more logistical issues come up, and you know,
you need a lot of support and a lot of
know how to put that program together and keep it
running on a regular basis. And we have vaccines in
(03:12):
our office in our clinic, but it's provided by a
company that we partner with, so they make it real
easy to perform the giving of or providing a vaccine.
So that's how we do that. But yeah, just go
get a measless vaccine and get yourself some protection against
(03:36):
these organisms. I thought I spent a little time today
on just screening exams, as you know when missus Lavine
is on the air. And by the way, she wanted
us to mention to all the mothers out there, happy
Mother's Day. This is Mother's Day weekend tomorrow Sunday, the
(03:57):
day that restaurants normally are just crazy busy, and I
was a waiter at several different restaurants. I worked at
Crazy Ages when it was here back in the day,
and as as well as worked at Olive Garden there
by Saint Elizabeth Hospital, work there a couple of years
(04:20):
and Mother's Day was always packed I mean super packed
long waiting lines and just bringing mom out and thanking
her for all of the help and the care over
the years. But I don't know, sometimes it's maybe a
little bit too busy, and it's probably better to just
stay at home and do something at home because it's
(04:42):
very stressful coming in and out of the restaurant and
having to wait and being rushed through your meal. Maybe
something more personal and more lovely at home, you know,
for everyone to come together and cook something almost like
things giving. Just everyone brings something and we'll have some
(05:04):
dinner at home and celebrate Mother's Day at home without
all the commotion because restaurants get pretty busy during this
Mother's Day day. But anyway, Happy Mother's Day to all
the mothers out there. But I thought I spent some
time talking about cancer screening. We don't really do a
whole lot of talking about that on the as much
(05:26):
as I promote vaccines. When missus Lavine is on there,
sometimes we do get into talking about that. But yes,
cancer screening. As you know, cardiovast disease is number one
cause of morbidity mortality in our country and then cancer
is numbered two. So either it's heart attack, stroke or
(05:49):
some sort of cancer that tends to cause the morbidity
mortality in Americans. And as you know listen to my show,
a lot of that has to do with our lifestyle, right.
We always have to pay attention to our lifestyle, and
that primarily means what you're putting in your mouth every day.
It really comes down to that what are you putting
(06:11):
in your mouth every day as it pertains to your
food items and your beverage choices. In my opinion, after
over twenty years a doctrine and interviewing thousands of patients
in office in the hospital, to me, it's pretty clear if.
Speaker 2 (06:30):
You want to be healthy, got to eat right. Yes,
you can.
Speaker 1 (06:34):
Always find the one person that defies the odds and
they eat whatever they want and they're then and they
don't go to the doctor, they don't take any medicines,
and they're just doing just fine. But for the majority
of us, it doesn't work like that. We really have
to put some effort into promoting our health and preserving
(06:58):
our health as we get older, just because the aging
process will start to kick in and we have to
make some changes with the way we do things if
we don't want Number one, cardiovasc disease, and number two,
we want to decrease our chance of having a cancer.
But nonetheless we do screen for some cancers, not all
(07:22):
of them. However, we might have colleagues or friends or
family that unfortunately get diagnosed with very advanced cancer, certain
cancers that we don't really have an active screening program
to screen for, and a lot of those of the
(07:43):
intra abdominal cancers like kidney cancer or pancreatic cancer are
even a variant cancer. We do at a certain age
sort of promote gynecological examinations, and as a part of
that examinations, practitioners are throwing in ultrasounds of the intrabdominal area,
(08:06):
again looking for evidence of malignancy in the ovaries. But
again the results of that are mixed, meaning how often
do you do it, how many years, when do you start,
when do you stop? Those recommendations are a little fuzzy
as it pertains to ovarian cancer. So some ladies are
(08:28):
getting caught with very advanced ovarian cancer even though they're going.
Speaker 2 (08:32):
To the doctor. Right.
Speaker 1 (08:35):
We hear that frequently when a person is doing everything
they've been asked to do by their doctor and the
medical community, and they still get caught with a disease
that they have to deal with. And it's just that
normally going to a healthcare professional for routine visit or
(08:56):
going to your primary everything, a lot of times will
not be picked up. It's just only so much we
can try and screen for. It's only so much we
can pick up. And there's still things that can happen
to you that are not frequent but can happen. And
that's sort of where kidney cancer falls into place, and
(09:18):
pancreatic cancer, liver cancer, that's where it's an ovarian cancer,
that's where some of that falls into place. But other cancers, yes,
we are screening for. I think most people are familiar
with mammograms or breast examinations or breast X rays and
(09:39):
our hopes to try and screen for breast cancer. And
for most physicians practitioners that normally starts in the forties
are at forty. Some will say fifty, but for me,
I start at the age of forty or I start sooner.
(10:00):
If there's a lot of breast cancer in the immediate
family what we call first degree relatives, that would be
your mother or your sister. So if your mother, your
sister came down with cancer in their thirties or their twenties,
then that puts normally your patient at super high risk
(10:23):
for maybe developing that same cancer and them because normally
there's a strong genetic predisposition. As we talk about breast cancer,
I mean, there's so much information now out there about
breast cancer, screening, how to treat it. It's become very
sophisticated compared to when I first came out, And unfortunately
(10:47):
I'm not an oncologist and haven't necessarily kept up with
the literature in terms of what is the decision tree
as it pertains to breast cancer if you could die nosed,
But certainly I am a big believer in prevention or
early diagnosis. I'm in primary care, so that's what we
(11:10):
spend our time doing all the time, and breast cancers
no different. We do find breast cancers in thirty year
old patients, unfortunately normally a big shot, and it can
be spontaneous, meaning there's no history of it in their family.
But then they come down with that and again at
(11:31):
the age of forty, that's when I normally start introducing
annual mammograms to my female patients. But if there's a
strong family history, then we do it sooner. Now a
lot of these breast cancer screens are being done by
gynecologists just because a lot of young females don't have
a whole lot of medical issues, so they don't find
(11:53):
a need to go to a physician, but they do
buy into the need to screen for vagin i'm sorry,
cervical cancer and just want women health, female health right
and GANA colleges pretty much tackle that responsibility, and so
they're doing a lot of those first mammograms, first pap smears,
(12:15):
and there is some suggestion that in patients again with
strong family hishuy of early breast cancer, that they do
have some genetic predisposition, and they have promoted doing genetic
testing of genetic screening in those patients, and if they
find that the genetic screening is positive, then they start
(12:36):
those mammograms even before the age of forty, maybe in
their thirties, and just sort of target them and make
sure they're getting proper screening. Certainly, the self breast examination
that they can do once a month themselves is a
good way to screen for that because a lot can
happen within twelve months and what I mean by that is,
(13:02):
ladies can have normal routine mammograms, and then between that
next mammogram, let's say six months later, they may have
a new lump or a new hard lesion that grows,
that grows in that meantime. So it's always good to
(13:23):
double down and do their self breast examination because a
lot of ladies actually find their own breast cancer just
doing their breast exams, you know, once a month, and
there's videos on how to do that. You don't have
to get too fancy with it. Basically, just sort of
want to what we call palpait that area once a month,
(13:45):
looking really for what they call a dominant lesion whereby
you feel a marble or just something that's hard, doesn't
have to be painful, but certainly new, never felt it before,
and only that will promptly come into the office, will
order a repeat mammogram because a lot of times you
(14:07):
may have had one four months ago. Now you feel
a new lump, we'll go ahead and order a new mammogram,
and sometimes we'll throw in an ultrasound of that area
too to look for the lesion that you're palpating. Certainly
fibrocystic breast disease can be sort of an interference with
(14:29):
a lot of ladies. I hear that comment a lot
when I talk about doing a self breast examination and
will sort of say, a, you know, I have a
lot of lumps already and it's kind of confusing. And
I get that, but normally with cancer, it's going to
be what they call a dominant lesions. These this whatever
(14:51):
you feel is going to stand out as something new,
and it tends to get large and larger month by month,
and most ladies can sort of I feel that, but
I would just have Honestly, if I was a female,
if I felt something I was concerned about, I would
just go get a mammogram. I mean, it's a very easy,
(15:13):
simple test. Now, I wouldn't say it was the most
comfortable test. Based on what my patients are telling me.
They sort of have to compress the breast tissue between
these two plates, and that can be very uncomfortable when
they're putting you through that, and I know that that
(15:35):
deters a lot of patients from even getting mammograms. I've
heard patients come back saying I'm never getting another mammogram
again because they didn't have quite the greatest experience with
maybe the technician that actually does the test, maybe there
was some inconsideration of the pain and discomfort and how
(15:56):
it's done, and it's just puts a bad taste in
the mouth, and then they say, I'm not going to
go again, which is unfortunate, because what we're trying to
do with most cancers is detect at an earlier stage. Right,
and most people are familiar with the staging of cancer
and how cancer doctors work. There's normally a one, two, three,
(16:17):
fourth stage right, and one is normally one that's sort
of a focal stage. It hasn't what they call metastasize
or spread. It's just there stage one versus four Stage four,
where normally that means it's left its original site, the
(16:38):
breast in this particular situation, and it's gone to another site,
whether it could be the bones or the liver or
wherever it decides to go. That will be a stage four,
And then there's the stage two and three in between.
And again the staging and the nomenclature of cancer has
(16:59):
again got more fiscate. Sometimes there's an A or B
attached to it, which means there's certain specific characteristics about
this person's cancer that helps make decisions about their treatment plan.
So sometimes you hear a stage four A or stage
three B, which, again, the cancer world is very robust
(17:20):
in terms of its research and its interests. There's a
lot of interest in cancer treatment and cancer discovery and
how to get better and better and better every year,
and so the nomenclature follows that as they get more
knowledge than the way they talk about it and the
way they describe it gets more sophisticated. For me, not
(17:43):
so much again, because I don't do that every day.
We get taught that in medical school, but after you
get out and you start doing your sort of whatever
your career is, you don't get that exposure as much
as you need to stay up with that. You focus
on other things like cholesterol and blood pressure and making
(18:04):
sure people are getting their screening examinations, and you sort
of lose lose focus on that and focus on what's
most important for you. But certainly breast cancer screening is
most people familiar with, but I will be I'll tell
you know, we still have patients that get diagnosed with
stage four and it puzzles me. It boggles my mind
(18:30):
to think that that can still happen in today's America
with all of the conversation about breast cancer and breast
screening and mammograms. And again the expense might be an issue,
but even in someone who has no insurance, the cost
(18:50):
of getting a lot of these routine screening exams is
most generally fairly affordable. You know, it's not out of
reach like it you used to be. You know, thousands
of dollars to get this screening. Even blood work if
you have no insurance, is still doable, and a lot
(19:10):
of times you can get a great panel of screening
blood work, you know, probably for eighty dollars one hundred
dollars at a lot of these freestanding lab businesses which
we have here in the Golden Triangle, such as Acutacs
or lab Core or Quest. Even the bigger hospitals here
(19:33):
Baptists and Elizabeth Mid County, a lot of times their
labs will work with you to get some just routine
basic labs to see how you're doing. And the same
thing with X rays. They now have more freestanding X
ray businesses that sort of cater to the population where
(19:53):
if you don't have insurance, you normally can show up
and pay cash and get that mammograham, get that cat
scan if you want a cat skin of something. Remember
cat scan technology is old now and the prices have
come way down in terms of if you need a
cat scan a lot of times again you can somehow
(20:15):
rustle up some nickels and some pennies in that couch
and gets your cat scan of whatever you're looking for,
or head set of your head, or again a mammogram.
And normally we do it annually or sooner if you
have some sort of concern or a lesion. That's how
we do that. So breast cancer we still see stage four.
(20:38):
God it boggles me some people Again, they're busy, they're distracted.
Time just sort of gets away from them. They have
all these other priorities and it's not something that thinking about.
Maybe they're a caregiver and they have a job and
have kids, have grandkids. I hear that a lot where
mothers are taking care of their grandchildren and for whatever reason,
(21:01):
the mother maybe not available to be a mom, and
maybe there was an early death and they're having to
assume responsibility of being a mother when they're in their
sixties or seventies, and so just their priority shift and
they go year after year without getting proper screening, which
(21:22):
is unfortunate because again we want to catch everything. In
stage one, when it's focal, it's not gone anywhere most
of the time. That means the prognosis is excellent. In
today's arena of cancer treatment, the prognosis is excellent versus
stage four, and even in stage four, man, they're getting
(21:44):
pretty good at prolonging your life and preserving your function.
Because remember that was the big thing back in the
day when I was growing up. But still remember growing
up watching Dallas on TV eight o'clock Friday PM, right
that iconic introductory music and song. I still remember that.
(22:07):
I have it in my brain. But when Miss Ellie
got diagnosed with breast cancer, I just still remember that
as a young kid, and all the things she went through,
having to have surgery and a big what they call
mas sectomy, which is when you remove the breast tissue,
and how they used.
Speaker 2 (22:24):
To do that.
Speaker 1 (22:24):
They would just remove everything and certainly would leave the
patients sort of maimed if you will, physically. But they've
come so far now with even treating a stage four
breast cancer that a lot of times you can preserve
breast function, you can preserve a person's life. But nonetheless,
(22:45):
we're talking about cancer screening today on DOCTORA V.
Speaker 2 (22:52):
Medical.
Speaker 1 (22:52):
If if you have any questions about give us a
call eight nine six kalvy I one hundred and three
to three zero kalvy. I'll be back in two minutes.
All right, welcome back to doctor m Metilour FuMB line
to open eight nine six ko here one hundred.
Speaker 2 (23:09):
And three to three zero. OK.
Speaker 1 (23:10):
Yeah, talking about cancer screening and what most patients are
eligible for when you go to your healthcare professional.
Speaker 2 (23:19):
For a routine visit.
Speaker 1 (23:21):
That is part of our evaluation is what cancer screenings
are you doue for. And we spend some time talking
about breast cancer screening with the mammogram or an ultrasound,
we're not really doing mr Eyes of the breast. Some
ladies come in wanting that that tends to be an
issue with insurance company and paying for that. A lot
of times ladies have maybe had a breast documentation. And again, men,
(23:47):
if you've never had a mammogram. When ladies go in
to get the mammograms, they have to sort of press
down on the breast and flatten it out and sometimes
that can injure or fracture the breast prosthesis that has
been put in for breast augmentation, and they don't want
to go through that, or again they just feel like
it's too painful. They've maybe had several before and they
(24:09):
don't want to do it anymore, and they're just trying
to do their part to get screened, so they'll do
MRIs of the breast. So that's a very infrequent way
to do it, but it can be done. It's just
who's going to pay for it. And as I mentioned,
if insurance companies don't want to pay for it, the
pricing of some of these X rays is coming down
to a point where it is within reach of someone
(24:32):
who has no insurance. So don't be afraid if you
don't have insurance to ask, you know, what is a
cash price for this particular procedure and can I.
Speaker 2 (24:43):
Pay it out?
Speaker 1 (24:43):
And again, these companies want your business. They're trying to
provide a service, and yes they're in business. They want
to get patients in there, so they're more than willing
to work with you, So don't be afraid to do that.
But beyond breast cancer screening, the other more common screenings
that we have is prostate cancer screening for men, and
(25:06):
again that's a pretty easy, straightforward way to do things.
Speaker 2 (25:11):
At this point.
Speaker 1 (25:11):
We normally just do a blood test called a PSA,
which stands a prostate specific eengen. Some doctors old school
typically will include what they call a DRE a DRE
right digital rectal exam. That's digital is digit your finger
rectal examination where in a vary for most people, uncomfortable situation. Yes,
(25:36):
a practitioner healthcare provider inserts their digit in the rectum
and to palpate the prostate which sits right there beyond
the entrance of the anus. It is palpable at that point,
and for many years was a part of prostate cancer screening.
Speaker 2 (25:57):
You had to perform a DRE DR as a part of.
Speaker 1 (26:03):
Prostate cancer screening in addition to the PSA. That was
an annual test when I came out of a residency
and medical training. And fast forward to today and there
are certainly cancer screening regulatory bodies that do not that is,
do not recommend the DRE exam anymore DRE. So guys
(26:27):
can sort of relax and be comfortable because, yeah, when
hitting fifty they would know that. Oh my god, I
got to get that exam. Oh man, they set up
all last night, previous night, worn about it, right, But now,
based on the current literature, it's unnecessary to get the
drag exam. Certainly, if you're practitioner believes in that exam,
(26:51):
you can. It's up to you if you want to
get it done, but you're not missing out in my opinion,
be sure and get the PSA examination. For me, I'm
not a fan of the DRE examination. Always thought it
was an uncomfortable examination to the patient, and a lot
of practitioners don't like doing them as well. It's sort
of a vulnerable position for the patient, and you know,
(27:13):
it's just not a comfortable thing to do. And I
always felt like it was an inadequate exam, and it
is because the prostate is maybe the size of a
walnut with the shell on it, are a little bit
smaller than that, and when you do the DRE examination,
and you do it correctly, you're only able to examine half,
(27:38):
typically only half of the prostate itself, where the other
half goes unexamined. And that's been the limitation of these
rectal examinations. Is doing it does not guarantee that you
don't have cancer, because the cancer could technically be sitting
on the half that you did not palpay, which is
(27:58):
where the PSA comes into play, because typically any significant
prostate cancer will bump the PSA test.
Speaker 2 (28:08):
Above at level four.
Speaker 1 (28:10):
So we a lot of times do PSAs in the office.
We do them annually, and my current understanding of the
recommendations today is African Americans start at forty. All other
nationalities or ethnicity start at the age of fifty. Or
if you have early prostate cancer in your family, your
father brother maybe had prossect cancer less than fifty years old,
(28:33):
then we would start in that patient ten years sooner
to try and catch the cancer sooner. And again we
would just start doing PSA levels, and normally a significant
cancer will cause the PSA number to go four point
zero or above, such that if your prostate cancer test
(28:57):
level is ten, that's on the high side.
Speaker 2 (29:00):
I mean, we do sometimes.
Speaker 1 (29:01):
See thirty forty eighty, which is super duper high. But
some guys get a PSA level in their fifteen twenties,
they go to the eurologists, they get their bopsi's in
it's negative for cancer. It's just at the prostate's enlarge
and there's other factors that cause a PSA level to
be high, which is again it's not a perfect screening test,
(29:23):
but it's the best we have now based on understanding.
A lot of these urologists to do prostate cancer treatment
all the time are utilizing MRII technology to visualize the
prostate and apparently prosta cancer shows up very well on
MRII testing such that they're foregoing the rectal examination the
(29:48):
DRE because it's inadequate. You only get to palpate half
of it and just looking at it with an MRI.
I don't know that every patient is getting an MRI.
If they go into the doctor's office with an elevated PSA,
you know, normally did we send them to the urologist.
These are surgeons of the bladder and genital urinary system
(30:10):
that would be the kidneys, the urders, and the bladder.
They operate, but they also provide medical care as well
for various genital urinary problems. But they normally go through
their process of elimination as it pertains to elevated PSA,
do some urine tesks, some labs, and again depending on
the story, they do sort of various things and haven't
(30:32):
quite pinned it down sort of how they decide what
their decision tree if they're going to monitor, meaning yes,
it's elevated, but we're just going to sit tight and
we're going to have you come back in three months,
six months, and it's going to continue to follow the
PSA or hey, let's do an m r leis to
a bopsey, let's figure out what it is. It's a
(30:55):
little fuzzy to me as a primary care physician. Again,
the screening part has been about the same process. Cancer
screening was kind of controversial there at one time in
terms of whether or not it was needed and just
this whole discussion of it's a non aggressive cancer that
doesn't deserve to be sort of screened for because it
(31:19):
doesn't necessarily advance that much. Most guys who get it
don't necessarily need any treatment, and the treatments were causing
problems like what we call incontinence where you couldn't control
your urine or infections or erectilitis function. So why are
we harming these patients when really the cancer doesn't need
(31:41):
to be messed with. We can just leave it alone
and they can have good function, it's not going to
kill them, why are we screening for it? So that
was just all this controversy for a while, and I
think that has sort of died down and settled down,
and based on my experience with my patients, I think
they want to know anytime they have cancer.
Speaker 2 (32:01):
They just want to know.
Speaker 1 (32:02):
I mean, they really want to try and stay on
top of that and get to the bottom of it
and get treated again. We want to do something in
an early stage versus a later stage. And it's a
simple blood test, right, just go in, get some blood, boom,
you know it, and just sort of stay on top
of that. So it wasn't really a controversial issue for me.
(32:25):
I just started screening again African Americans at the age
of forty it's annual, and then all other ethnicities at
the age of fifty annual until we get up to
about the age of seventy, maybe sixty eight, or if
your life expectancy is less than ten years, then we stop. Personally,
(32:45):
I stopped screening for prostate cancer with the PSA. I
might have some really healthy, high functioning seventy year old
guys coming in. I mean, everything's working really take no medicines,
they're physically active, their life expectancy should or can go
(33:07):
beyond ten years. So yes, I would continue to screen
for project cancer in that population, maybe every other year,
because again as a lot in my experiences, as one
gets older, that the risk of the cancer does sort
of decline. So you unlikely to have clinically significant prosect
cancer cause harm to a male as they get older
(33:31):
if it has not been picked up by the age
of seventy or so. But it still can happen, and
so we still will do it maybe every other year.
And someone who's in their seventies, they're healthy or they're
high functioning, you're expecting them to live another ten years,
and so you continue to screen. It's the same thing
with breast cancer. I think for the average person, we
(33:53):
start or I'm sorry, we stop, or we slowed down.
Let me put it that way, we slow down. Breast
cancer screen at the age sixty five seventy and slow down.
I talk with patients, hey, do you want to get screened?
Speaker 2 (34:03):
Do you not?
Speaker 1 (34:05):
And if they do, then I start going maybe every
other year, but I still encourage them to do their
monthly breast exams again to pick up on anything that
they might feel. And normally those breast cancers in the
later stages of a person's life tend to be less severe.
Same thing with prosect cancer. You get dicnosed in your
seventies maybe eighties, it tends to be less severe than
(34:27):
someone who's in their fifties or forties who gets diagnosedits
that tends to be a more aggressive cancer. So again,
for you guys out there, prosect cancer screening after Americans out,
start at forty. For everybody else, start at fifty annual.
Phone lines are opened eight done, six klvy at one
hundred and three three zero kov. I'll be back in
(34:47):
two minutes. All right, welcome back to TAGRAPH Medical. Our
phone lines open. We have Henry from Baytown. How can
we help you?
Speaker 3 (35:01):
Yeah, just a real quick question, doc, How you're done? Okay,
Whenever you take your medication, like for instance, I do
in the morning, and then uh, and then I take
whenever I eat, et cetera. Sometimes within that hour period
I start doing my bow movements, I have to go
to the bathroom. Does those pills actually get flushed out
(35:23):
when you go to the bathroom?
Speaker 1 (35:25):
You mean the tablets are capsules that you consume the
same morning when you have a bow movement.
Speaker 2 (35:33):
Are they eliminated?
Speaker 3 (35:37):
No, yes, like for instance, blood pressure, I take one, Okay,
so they actually stay in there there?
Speaker 2 (35:43):
Yeah, yeah, they actually.
Speaker 1 (35:45):
I guess everybody is different depending on the health of
their cash intestino system, and may take up to three
or even seven days for the pill to get through
your entire system and then be eliminated.
Speaker 3 (35:58):
Okay, yeah, all right, that's that's one of the questions
I need to ask, and then we have more time.
I need to ask some other question, but I'll do
that at a later date. Thank you, You have a good.
Speaker 2 (36:06):
Day, all right, brother, appreciate it.
Speaker 1 (36:08):
And yeah, you know, you have to remind yourself that
the colon is basically storage for feces, and storage means
it can sit there for a while. And we see
a lot of constipation issues in this country because again
(36:29):
various reasons. Again, most Americans are consuming a low fiber
diet just because we are consuming a lot of processed
foods and beverages every day. It's very convenient, it's cheaper,
and fiber gets stripped a lot of times out of
the process. When you're eating processed food, fiber gets taken
(36:51):
out of it, and so if you're consuming a lot
of these products, your bile function does so down. Number
two sedentary and number three as a result of the
poor diet and being sedentary normally it introduces disease and illness,
which then means medications. Medications and generate more consumpation, so
(37:12):
it slows bowel function down, primarily being sedentary, that's a
big one. And the food, so it might take a
whole week for tablets that you consume to get through
the entire GIS system. So again probably not a big
deal in this particular situation. But talking about cancer screenings,
(37:35):
we talked about mammograms for breast PSA for prostate cancer
screen a couple of other notable cancer screens that we
do as lung cancer. This is primarily designed for heavy smokers,
normally for fifteen twenty years or more. We start screening
at the age of fifty five, typically with a cat
(37:57):
scan of the chest. We normally do that annually. Again,
it can be moved up and moved back depending on
the patient's clinical history. So if you are a smoker,
you've smoked for many years, you still smoke, you should
try and get your screening started and it's normally got
to be a cat scan. Chest X ray is okay,
(38:19):
but tends to miss smaller cancers such that you could
have a normal check that chess X ray and still
have cancers. That's where we're going for these cat scans
because they give us a larger view of your lung
field as it pertains to seeing stage one cancers against
Stage one is normally smaller and maybe a little bit
(38:39):
more hidden. You can't see it on a chest X ray.
So we're doing these cat scans again, starting at the
age of fifty five, and then we do colon cancer screening.
And colon cancer screening has more options now. They just
came out with the blood tests called shield Shi E
l D, which I was introduced to a couple of
(39:01):
about a week ago, two weeks ago, which is a
blood based test. Right, as you know, the colonoscopies have
been sort of the gold standard way to screen for
colon cancer for many years, and then came sort of
the stool kit that came to your house, the colon
Guard you've seen the commercials on TV again trying to
make it more convenient. Now they have a blood test
(39:22):
that came out where you can get your colon cancer
screening through the blood isn't America wonderful? Phone lines are
open eight and nine six Kalvy I wanted hundred through
through zero o kov I had last break. All right,
doctor Lavine Medical our last segment. Phone lines are open,
(39:45):
but we sort of at the end of the show,
hour goes by so rapidly. Again, just trying to remind
patients to get your cancer screening. Most of the time,
when you go to healthcare provider's office, they will at
your profile and determine what you are eligible for. But
all of this stuff in terms of cancer screening is
(40:06):
available to you, and if you want to know what
you're due for normally on multiple websites, maybe even your
insurance website, they basically tell you what you need. In
my office, I have some printed paperwork so that patients
can review that while they're sitting waiting for me to
come into the room, to remind them that if they
(40:27):
don't have it, then we need to order it because
a lot of times there's scheduling conflicts that occur. You
have to postpone, you have to wait, and then a
whole year goes by and you didn't get your cancer
screening for breast or prostate colon or even lung cancer.
And those smokers out there. We are finding these cancers
a lot sooner. But there's cancers that we don't screen for,
(40:49):
kidney cancer, pancreatic cancer, liver cancer, ovarian cancer kind of
that can cause some pretty signific issues. We screen for
blood cancer with just the CBC, and we don't screen
for brain cancer, which we find that often patients coming
(41:12):
in off the street new on st seizure, new on
said headache, maybe they're having stroke like symptoms. We do
a scan and they have a large brain tumor. So
we don't screen for every cancer, but we do screen
for those four or five, and you need to be
sure you're up to date so that we can find
that as soon as possible and get you to the
(41:34):
appropriate doctor. Again, don't let the fact that you don't
have insurance get in your way. A lot of these
screening tests are becoming more affordable. And again, when you
man get diagnosed with a stage four man, you're talking
about a huge financial hit. I mean, because cancer screening
is not cheap as most things in this country, but
(41:56):
that involves some highly specialized people, highly specialized equipment and medications.
And medications are outrageous, so it is unfortunate that some
patients get caught with no insurance and they get diagnosed
for the stage where cancer. That's a tough, tough situation.
I don't know that we've figured that one out yet,
but try to get in stage one normally more easy
(42:17):
to fix, and your pregnosis is typically excellent. Thank you
for join us on the edition of the show. Don't
drink and drive, Drink some water, eat some vegetables. We'll
see you guys next week.
Speaker 2 (42:27):
Take care,
All right, Internet ready listeners, Welcome, Welcome, Welcome, Welcome to
Doctor Levine Medical Hour. This is your weekly host, Doctor Levine,
coming to you live from the series of kov I
Hear in Boma, Texas. Thank you for joinings from the
edition of the show. We are here every Saturday typically
to answer your questions about healthcare and medicine as I
(00:23):
see it and as we see it. After having a
two way conversation about the situation, which is what healthcare
is all about now is shared decision between the physician
and their patient, which is a little bit different from
when I first hit the scene. It's more of a
(00:44):
decision between the doctor and the patient so that the
patient can be informed and a lot more information out
there the patients have available to them if they would
like to be more informed. Phone lines are open eight
done six kov I one one hundred three three zero.
Speaker 2 (01:00):
Okayovi.
Speaker 1 (01:02):
We'd love to hear from you, talk with you and
try to answer your questions and get you some information
to help you figure out what is good and what
is not so good.
Speaker 2 (01:11):
For that.
Speaker 1 (01:13):
Haven't heard too much about the measles outbreak. Seems like
that concern has calmed down, but they did issue some
suggestions that just like we mentioned before, if you are
concerned about acquiring measles or your concern that maybe your
protection is not where it needs to be, just go
(01:35):
get a booster. It's that simple. It's that easy. Again,
it's to offer that human body some protection against invasion
of certain micro organisms. In this particular situation, virus. And
there's a bunch of viruses out there. We target a few,
We target the ones that typically cause high percentage of
(01:56):
the infections in the community. And seems like the measles
outbreak has somewhat calmed down. Don't hit too much. But again,
if you're concerned, just go get a vaccine.
Speaker 2 (02:07):
It's that easy.
Speaker 1 (02:08):
It's normally not in doctors' offices. He would have to
probably go to the pharmacy, which again that industry has
pretty much taken over the vaccine issue or providing vaccines
to the local community. You know, very convenient, get your medicines,
(02:30):
pick up some milk and yeah it didn't get your vaccine.
And they normally keep good records and they've done very
well at putting a or should say, providing a service
that was I would say lacking for many years. Again,
(02:50):
most primary care decisions offices. It's difficult to provide vaccines.
There's a lot more logistical issues come up, and you know,
you need a lot of support and a lot of
know how to put that program together and keep it
running on a regular basis. And we have vaccines in
(03:12):
our office in our clinic, but it's provided by a
company that we partner with, so they make it real
easy to perform the giving of or providing a vaccine.
So that's how we do that. But yeah, just go
get a measless vaccine and get yourself some protection against
(03:36):
these organisms. I thought I spent a little time today
on just screening exams, as you know when missus Lavine
is on the air. And by the way, she wanted
us to mention to all the mothers out there, happy
Mother's Day. This is Mother's Day weekend tomorrow Sunday, the
(03:57):
day that restaurants normally are just crazy busy, and I
was a waiter at several different restaurants. I worked at
Crazy Ages when it was here back in the day,
and as as well as worked at Olive Garden there
by Saint Elizabeth Hospital, work there a couple of years
(04:20):
and Mother's Day was always packed I mean super packed
long waiting lines and just bringing mom out and thanking
her for all of the help and the care over
the years. But I don't know, sometimes it's maybe a
little bit too busy, and it's probably better to just
stay at home and do something at home because it's
(04:42):
very stressful coming in and out of the restaurant and
having to wait and being rushed through your meal. Maybe
something more personal and more lovely at home, you know,
for everyone to come together and cook something almost like
things giving. Just everyone brings something and we'll have some
(05:04):
dinner at home and celebrate Mother's Day at home without
all the commotion because restaurants get pretty busy during this
Mother's Day day. But anyway, Happy Mother's Day to all
the mothers out there. But I thought I spent some
time talking about cancer screening. We don't really do a
whole lot of talking about that on the as much
(05:26):
as I promote vaccines. When missus Lavine is on there,
sometimes we do get into talking about that. But yes,
cancer screening. As you know, cardiovast disease is number one
cause of morbidity mortality in our country and then cancer
is numbered two. So either it's heart attack, stroke or
(05:49):
some sort of cancer that tends to cause the morbidity
mortality in Americans. And as you know listen to my show,
a lot of that has to do with our lifestyle, right.
We always have to pay attention to our lifestyle, and
that primarily means what you're putting in your mouth every day.
It really comes down to that what are you putting
(06:11):
in your mouth every day as it pertains to your
food items and your beverage choices. In my opinion, after
over twenty years a doctrine and interviewing thousands of patients
in office in the hospital, to me, it's pretty clear if.
Speaker 2 (06:30):
You want to be healthy, got to eat right. Yes,
you can.
Speaker 1 (06:34):
Always find the one person that defies the odds and
they eat whatever they want and they're then and they
don't go to the doctor, they don't take any medicines,
and they're just doing just fine. But for the majority
of us, it doesn't work like that. We really have
to put some effort into promoting our health and preserving
(06:58):
our health as we get older, just because the aging
process will start to kick in and we have to
make some changes with the way we do things if
we don't want Number one, cardiovasc disease, and number two,
we want to decrease our chance of having a cancer.
But nonetheless we do screen for some cancers, not all
(07:22):
of them. However, we might have colleagues or friends or
family that unfortunately get diagnosed with very advanced cancer, certain
cancers that we don't really have an active screening program
to screen for, and a lot of those of the
(07:43):
intra abdominal cancers like kidney cancer or pancreatic cancer are
even a variant cancer. We do at a certain age
sort of promote gynecological examinations, and as a part of
that examinations, practitioners are throwing in ultrasounds of the intrabdominal area,
(08:06):
again looking for evidence of malignancy in the ovaries. But
again the results of that are mixed, meaning how often
do you do it, how many years, when do you start,
when do you stop? Those recommendations are a little fuzzy
as it pertains to ovarian cancer. So some ladies are
(08:28):
getting caught with very advanced ovarian cancer even though they're going.
Speaker 2 (08:32):
To the doctor. Right.
Speaker 1 (08:35):
We hear that frequently when a person is doing everything
they've been asked to do by their doctor and the
medical community, and they still get caught with a disease
that they have to deal with. And it's just that
normally going to a healthcare professional for routine visit or
(08:56):
going to your primary everything, a lot of times will
not be picked up. It's just only so much we
can try and screen for. It's only so much we
can pick up. And there's still things that can happen
to you that are not frequent but can happen. And
that's sort of where kidney cancer falls into place, and
(09:18):
pancreatic cancer, liver cancer, that's where it's an ovarian cancer,
that's where some of that falls into place. But other cancers, yes,
we are screening for. I think most people are familiar
with mammograms or breast examinations or breast X rays and
(09:39):
our hopes to try and screen for breast cancer. And
for most physicians practitioners that normally starts in the forties
are at forty. Some will say fifty, but for me,
I start at the age of forty or I start sooner.
(10:00):
If there's a lot of breast cancer in the immediate
family what we call first degree relatives, that would be
your mother or your sister. So if your mother, your
sister came down with cancer in their thirties or their twenties,
then that puts normally your patient at super high risk
(10:23):
for maybe developing that same cancer and them because normally
there's a strong genetic predisposition. As we talk about breast cancer,
I mean, there's so much information now out there about
breast cancer, screening, how to treat it. It's become very
sophisticated compared to when I first came out, And unfortunately
(10:47):
I'm not an oncologist and haven't necessarily kept up with
the literature in terms of what is the decision tree
as it pertains to breast cancer if you could die nosed,
But certainly I am a big believer in prevention or
early diagnosis. I'm in primary care, so that's what we
(11:10):
spend our time doing all the time, and breast cancers
no different. We do find breast cancers in thirty year
old patients, unfortunately normally a big shot, and it can
be spontaneous, meaning there's no history of it in their family.
But then they come down with that and again at
(11:31):
the age of forty, that's when I normally start introducing
annual mammograms to my female patients. But if there's a
strong family history, then we do it sooner. Now a
lot of these breast cancer screens are being done by
gynecologists just because a lot of young females don't have
a whole lot of medical issues, so they don't find
(11:53):
a need to go to a physician, but they do
buy into the need to screen for vagin i'm sorry,
cervical cancer and just want women health, female health right
and GANA colleges pretty much tackle that responsibility, and so
they're doing a lot of those first mammograms, first pap smears,
(12:15):
and there is some suggestion that in patients again with
strong family hishuy of early breast cancer, that they do
have some genetic predisposition, and they have promoted doing genetic
testing of genetic screening in those patients, and if they
find that the genetic screening is positive, then they start
(12:36):
those mammograms even before the age of forty, maybe in
their thirties, and just sort of target them and make
sure they're getting proper screening. Certainly, the self breast examination
that they can do once a month themselves is a
good way to screen for that because a lot can
happen within twelve months and what I mean by that is,
(13:02):
ladies can have normal routine mammograms, and then between that
next mammogram, let's say six months later, they may have
a new lump or a new hard lesion that grows,
that grows in that meantime. So it's always good to
(13:23):
double down and do their self breast examination because a
lot of ladies actually find their own breast cancer just
doing their breast exams, you know, once a month, and
there's videos on how to do that. You don't have
to get too fancy with it. Basically, just sort of
want to what we call palpait that area once a month,
(13:45):
looking really for what they call a dominant lesion whereby
you feel a marble or just something that's hard, doesn't
have to be painful, but certainly new, never felt it before,
and only that will promptly come into the office, will
order a repeat mammogram because a lot of times you
(14:07):
may have had one four months ago. Now you feel
a new lump, we'll go ahead and order a new mammogram,
and sometimes we'll throw in an ultrasound of that area
too to look for the lesion that you're palpating. Certainly
fibrocystic breast disease can be sort of an interference with
(14:29):
a lot of ladies. I hear that comment a lot
when I talk about doing a self breast examination and
will sort of say, a, you know, I have a
lot of lumps already and it's kind of confusing. And
I get that, but normally with cancer, it's going to
be what they call a dominant lesions. These this whatever
(14:51):
you feel is going to stand out as something new,
and it tends to get large and larger month by month,
and most ladies can sort of I feel that, but
I would just have Honestly, if I was a female,
if I felt something I was concerned about, I would
just go get a mammogram. I mean, it's a very easy,
(15:13):
simple test. Now, I wouldn't say it was the most
comfortable test. Based on what my patients are telling me.
They sort of have to compress the breast tissue between
these two plates, and that can be very uncomfortable when
they're putting you through that, and I know that that
(15:35):
deters a lot of patients from even getting mammograms. I've
heard patients come back saying I'm never getting another mammogram
again because they didn't have quite the greatest experience with
maybe the technician that actually does the test, maybe there
was some inconsideration of the pain and discomfort and how
(15:56):
it's done, and it's just puts a bad taste in
the mouth, and then they say, I'm not going to
go again, which is unfortunate, because what we're trying to
do with most cancers is detect at an earlier stage. Right,
and most people are familiar with the staging of cancer
and how cancer doctors work. There's normally a one, two, three,
(16:17):
fourth stage right, and one is normally one that's sort
of a focal stage. It hasn't what they call metastasize
or spread. It's just there stage one versus four Stage four,
where normally that means it's left its original site, the
(16:38):
breast in this particular situation, and it's gone to another site,
whether it could be the bones or the liver or
wherever it decides to go. That will be a stage four,
And then there's the stage two and three in between.
And again the staging and the nomenclature of cancer has
(16:59):
again got more fiscate. Sometimes there's an A or B
attached to it, which means there's certain specific characteristics about
this person's cancer that helps make decisions about their treatment plan.
So sometimes you hear a stage four A or stage
three B, which, again, the cancer world is very robust
(17:20):
in terms of its research and its interests. There's a
lot of interest in cancer treatment and cancer discovery and
how to get better and better and better every year,
and so the nomenclature follows that as they get more
knowledge than the way they talk about it and the
way they describe it gets more sophisticated. For me, not
(17:43):
so much again, because I don't do that every day.
We get taught that in medical school, but after you
get out and you start doing your sort of whatever
your career is, you don't get that exposure as much
as you need to stay up with that. You focus
on other things like cholesterol and blood pressure and making
(18:04):
sure people are getting their screening examinations, and you sort
of lose lose focus on that and focus on what's
most important for you. But certainly breast cancer screening is
most people familiar with, but I will be I'll tell
you know, we still have patients that get diagnosed with
stage four and it puzzles me. It boggles my mind
(18:30):
to think that that can still happen in today's America
with all of the conversation about breast cancer and breast
screening and mammograms. And again the expense might be an issue,
but even in someone who has no insurance, the cost
(18:50):
of getting a lot of these routine screening exams is
most generally fairly affordable. You know, it's not out of
reach like it you used to be. You know, thousands
of dollars to get this screening. Even blood work if
you have no insurance, is still doable, and a lot
(19:10):
of times you can get a great panel of screening
blood work, you know, probably for eighty dollars one hundred
dollars at a lot of these freestanding lab businesses which
we have here in the Golden Triangle, such as Acutacs
or lab Core or Quest. Even the bigger hospitals here
(19:33):
Baptists and Elizabeth Mid County, a lot of times their
labs will work with you to get some just routine
basic labs to see how you're doing. And the same
thing with X rays. They now have more freestanding X
ray businesses that sort of cater to the population where
(19:53):
if you don't have insurance, you normally can show up
and pay cash and get that mammograham, get that cat
scan if you want a cat skin of something. Remember
cat scan technology is old now and the prices have
come way down in terms of if you need a
cat scan a lot of times again you can somehow
(20:15):
rustle up some nickels and some pennies in that couch
and gets your cat scan of whatever you're looking for,
or head set of your head, or again a mammogram.
And normally we do it annually or sooner if you
have some sort of concern or a lesion. That's how
we do that. So breast cancer we still see stage four.
(20:38):
God it boggles me some people Again, they're busy, they're distracted.
Time just sort of gets away from them. They have
all these other priorities and it's not something that thinking about.
Maybe they're a caregiver and they have a job and
have kids, have grandkids. I hear that a lot where
mothers are taking care of their grandchildren and for whatever reason,
(21:01):
the mother maybe not available to be a mom, and
maybe there was an early death and they're having to
assume responsibility of being a mother when they're in their
sixties or seventies, and so just their priority shift and
they go year after year without getting proper screening, which
(21:22):
is unfortunate because again we want to catch everything. In
stage one, when it's focal, it's not gone anywhere most
of the time. That means the prognosis is excellent. In
today's arena of cancer treatment, the prognosis is excellent versus
stage four, and even in stage four, man, they're getting
(21:44):
pretty good at prolonging your life and preserving your function.
Because remember that was the big thing back in the
day when I was growing up. But still remember growing
up watching Dallas on TV eight o'clock Friday PM, right
that iconic introductory music and song. I still remember that.
(22:07):
I have it in my brain. But when Miss Ellie
got diagnosed with breast cancer, I just still remember that
as a young kid, and all the things she went through,
having to have surgery and a big what they call
mas sectomy, which is when you remove the breast tissue,
and how they used.
Speaker 2 (22:24):
To do that.
Speaker 1 (22:24):
They would just remove everything and certainly would leave the
patients sort of maimed if you will, physically. But they've
come so far now with even treating a stage four
breast cancer that a lot of times you can preserve
breast function, you can preserve a person's life. But nonetheless,
(22:45):
we're talking about cancer screening today on DOCTORA V.
Speaker 2 (22:52):
Medical.
Speaker 1 (22:52):
If if you have any questions about give us a
call eight nine six kalvy I one hundred and three
to three zero kalvy. I'll be back in two minutes.
All right, welcome back to doctor m Metilour FuMB line
to open eight nine six ko here one hundred.
Speaker 2 (23:09):
And three to three zero. OK.
Speaker 1 (23:10):
Yeah, talking about cancer screening and what most patients are
eligible for when you go to your healthcare professional.
Speaker 2 (23:19):
For a routine visit.
Speaker 1 (23:21):
That is part of our evaluation is what cancer screenings
are you doue for. And we spend some time talking
about breast cancer screening with the mammogram or an ultrasound,
we're not really doing mr Eyes of the breast. Some
ladies come in wanting that that tends to be an
issue with insurance company and paying for that. A lot
of times ladies have maybe had a breast documentation. And again, men,
(23:47):
if you've never had a mammogram. When ladies go in
to get the mammograms, they have to sort of press
down on the breast and flatten it out and sometimes
that can injure or fracture the breast prosthesis that has
been put in for breast augmentation, and they don't want
to go through that, or again they just feel like
it's too painful. They've maybe had several before and they
(24:09):
don't want to do it anymore, and they're just trying
to do their part to get screened, so they'll do
MRIs of the breast. So that's a very infrequent way
to do it, but it can be done. It's just
who's going to pay for it. And as I mentioned,
if insurance companies don't want to pay for it, the
pricing of some of these X rays is coming down
to a point where it is within reach of someone
(24:32):
who has no insurance. So don't be afraid if you
don't have insurance to ask, you know, what is a
cash price for this particular procedure and can I.
Speaker 2 (24:43):
Pay it out?
Speaker 1 (24:43):
And again, these companies want your business. They're trying to
provide a service, and yes they're in business. They want
to get patients in there, so they're more than willing
to work with you, So don't be afraid to do that.
But beyond breast cancer screening, the other more common screenings
that we have is prostate cancer screening for men, and
(25:06):
again that's a pretty easy, straightforward way to do things.
Speaker 2 (25:11):
At this point.
Speaker 1 (25:11):
We normally just do a blood test called a PSA,
which stands a prostate specific eengen. Some doctors old school
typically will include what they call a DRE a DRE
right digital rectal exam. That's digital is digit your finger
rectal examination where in a vary for most people, uncomfortable situation. Yes,
(25:36):
a practitioner healthcare provider inserts their digit in the rectum
and to palpate the prostate which sits right there beyond
the entrance of the anus. It is palpable at that point,
and for many years was a part of prostate cancer screening.
Speaker 2 (25:57):
You had to perform a DRE DR as a part of.
Speaker 1 (26:03):
Prostate cancer screening in addition to the PSA. That was
an annual test when I came out of a residency
and medical training. And fast forward to today and there
are certainly cancer screening regulatory bodies that do not that is,
do not recommend the DRE exam anymore DRE. So guys
(26:27):
can sort of relax and be comfortable because, yeah, when
hitting fifty they would know that. Oh my god, I
got to get that exam. Oh man, they set up
all last night, previous night, worn about it, right, But now,
based on the current literature, it's unnecessary to get the
drag exam. Certainly, if you're practitioner believes in that exam,
(26:51):
you can. It's up to you if you want to
get it done, but you're not missing out in my opinion,
be sure and get the PSA examination. For me, I'm
not a fan of the DRE examination. Always thought it
was an uncomfortable examination to the patient, and a lot
of practitioners don't like doing them as well. It's sort
of a vulnerable position for the patient, and you know,
(27:13):
it's just not a comfortable thing to do. And I
always felt like it was an inadequate exam, and it
is because the prostate is maybe the size of a
walnut with the shell on it, are a little bit
smaller than that, and when you do the DRE examination,
and you do it correctly, you're only able to examine half,
(27:38):
typically only half of the prostate itself, where the other
half goes unexamined. And that's been the limitation of these
rectal examinations. Is doing it does not guarantee that you
don't have cancer, because the cancer could technically be sitting
on the half that you did not palpay, which is
(27:58):
where the PSA comes into play, because typically any significant
prostate cancer will bump the PSA test.
Speaker 2 (28:08):
Above at level four.
Speaker 1 (28:10):
So we a lot of times do PSAs in the office.
We do them annually, and my current understanding of the
recommendations today is African Americans start at forty. All other
nationalities or ethnicity start at the age of fifty. Or
if you have early prostate cancer in your family, your
father brother maybe had prossect cancer less than fifty years old,
(28:33):
then we would start in that patient ten years sooner
to try and catch the cancer sooner. And again we
would just start doing PSA levels, and normally a significant
cancer will cause the PSA number to go four point
zero or above, such that if your prostate cancer test
(28:57):
level is ten, that's on the high side.
Speaker 2 (29:00):
I mean, we do sometimes.
Speaker 1 (29:01):
See thirty forty eighty, which is super duper high. But
some guys get a PSA level in their fifteen twenties,
they go to the eurologists, they get their bopsi's in
it's negative for cancer. It's just at the prostate's enlarge
and there's other factors that cause a PSA level to
be high, which is again it's not a perfect screening test,
(29:23):
but it's the best we have now based on understanding.
A lot of these urologists to do prostate cancer treatment
all the time are utilizing MRII technology to visualize the
prostate and apparently prosta cancer shows up very well on
MRII testing such that they're foregoing the rectal examination the
(29:48):
DRE because it's inadequate. You only get to palpate half
of it and just looking at it with an MRI.
I don't know that every patient is getting an MRI.
If they go into the doctor's office with an elevated PSA,
you know, normally did we send them to the urologist.
These are surgeons of the bladder and genital urinary system
(30:10):
that would be the kidneys, the urders, and the bladder.
They operate, but they also provide medical care as well
for various genital urinary problems. But they normally go through
their process of elimination as it pertains to elevated PSA,
do some urine tesks, some labs, and again depending on
the story, they do sort of various things and haven't
(30:32):
quite pinned it down sort of how they decide what
their decision tree if they're going to monitor, meaning yes,
it's elevated, but we're just going to sit tight and
we're going to have you come back in three months,
six months, and it's going to continue to follow the
PSA or hey, let's do an m r leis to
a bopsey, let's figure out what it is. It's a
(30:55):
little fuzzy to me as a primary care physician. Again,
the screening part has been about the same process. Cancer
screening was kind of controversial there at one time in
terms of whether or not it was needed and just
this whole discussion of it's a non aggressive cancer that
doesn't deserve to be sort of screened for because it
(31:19):
doesn't necessarily advance that much. Most guys who get it
don't necessarily need any treatment, and the treatments were causing
problems like what we call incontinence where you couldn't control
your urine or infections or erectilitis function. So why are
we harming these patients when really the cancer doesn't need
(31:41):
to be messed with. We can just leave it alone
and they can have good function, it's not going to
kill them, why are we screening for it? So that
was just all this controversy for a while, and I
think that has sort of died down and settled down,
and based on my experience with my patients, I think
they want to know anytime they have cancer.
Speaker 2 (32:01):
They just want to know.
Speaker 1 (32:02):
I mean, they really want to try and stay on
top of that and get to the bottom of it
and get treated again. We want to do something in
an early stage versus a later stage. And it's a
simple blood test, right, just go in, get some blood, boom,
you know it, and just sort of stay on top
of that. So it wasn't really a controversial issue for me.
(32:25):
I just started screening again African Americans at the age
of forty it's annual, and then all other ethnicities at
the age of fifty annual until we get up to
about the age of seventy, maybe sixty eight, or if
your life expectancy is less than ten years, then we stop. Personally,
(32:45):
I stopped screening for prostate cancer with the PSA. I
might have some really healthy, high functioning seventy year old
guys coming in. I mean, everything's working really take no medicines,
they're physically active, their life expectancy should or can go
(33:07):
beyond ten years. So yes, I would continue to screen
for project cancer in that population, maybe every other year,
because again as a lot in my experiences, as one
gets older, that the risk of the cancer does sort
of decline. So you unlikely to have clinically significant prosect
cancer cause harm to a male as they get older
(33:31):
if it has not been picked up by the age
of seventy or so. But it still can happen, and
so we still will do it maybe every other year.
And someone who's in their seventies, they're healthy or they're
high functioning, you're expecting them to live another ten years,
and so you continue to screen. It's the same thing
with breast cancer. I think for the average person, we
(33:53):
start or I'm sorry, we stop, or we slowed down.
Let me put it that way, we slow down. Breast
cancer screen at the age sixty five seventy and slow down.
I talk with patients, hey, do you want to get screened?
Speaker 2 (34:03):
Do you not?
Speaker 1 (34:05):
And if they do, then I start going maybe every
other year, but I still encourage them to do their
monthly breast exams again to pick up on anything that
they might feel. And normally those breast cancers in the
later stages of a person's life tend to be less severe.
Same thing with prosect cancer. You get dicnosed in your
seventies maybe eighties, it tends to be less severe than
(34:27):
someone who's in their fifties or forties who gets diagnosedits
that tends to be a more aggressive cancer. So again,
for you guys out there, prosect cancer screening after Americans out,
start at forty. For everybody else, start at fifty annual.
Phone lines are opened eight done, six klvy at one
hundred and three three zero kov. I'll be back in
(34:47):
two minutes. All right, welcome back to TAGRAPH Medical. Our
phone lines open. We have Henry from Baytown. How can
we help you?
Speaker 3 (35:01):
Yeah, just a real quick question, doc, How you're done? Okay,
Whenever you take your medication, like for instance, I do
in the morning, and then uh, and then I take
whenever I eat, et cetera. Sometimes within that hour period
I start doing my bow movements, I have to go
to the bathroom. Does those pills actually get flushed out
(35:23):
when you go to the bathroom?
Speaker 1 (35:25):
You mean the tablets are capsules that you consume the
same morning when you have a bow movement.
Speaker 2 (35:33):
Are they eliminated?
Speaker 3 (35:37):
No, yes, like for instance, blood pressure, I take one, Okay,
so they actually stay in there there?
Speaker 2 (35:43):
Yeah, yeah, they actually.
Speaker 1 (35:45):
I guess everybody is different depending on the health of
their cash intestino system, and may take up to three
or even seven days for the pill to get through
your entire system and then be eliminated.
Speaker 3 (35:58):
Okay, yeah, all right, that's that's one of the questions
I need to ask, and then we have more time.
I need to ask some other question, but I'll do
that at a later date. Thank you, You have a good.
Speaker 2 (36:06):
Day, all right, brother, appreciate it.
Speaker 1 (36:08):
And yeah, you know, you have to remind yourself that
the colon is basically storage for feces, and storage means
it can sit there for a while. And we see
a lot of constipation issues in this country because again
(36:29):
various reasons. Again, most Americans are consuming a low fiber
diet just because we are consuming a lot of processed
foods and beverages every day. It's very convenient, it's cheaper,
and fiber gets stripped a lot of times out of
the process. When you're eating processed food, fiber gets taken
(36:51):
out of it, and so if you're consuming a lot
of these products, your bile function does so down. Number
two sedentary and number three as a result of the
poor diet and being sedentary normally it introduces disease and illness,
which then means medications. Medications and generate more consumpation, so
(37:12):
it slows bowel function down, primarily being sedentary, that's a
big one. And the food, so it might take a
whole week for tablets that you consume to get through
the entire GIS system. So again probably not a big
deal in this particular situation. But talking about cancer screenings,
(37:35):
we talked about mammograms for breast PSA for prostate cancer
screen a couple of other notable cancer screens that we
do as lung cancer. This is primarily designed for heavy smokers,
normally for fifteen twenty years or more. We start screening
at the age of fifty five, typically with a cat
(37:57):
scan of the chest. We normally do that annually. Again,
it can be moved up and moved back depending on
the patient's clinical history. So if you are a smoker,
you've smoked for many years, you still smoke, you should
try and get your screening started and it's normally got
to be a cat scan. Chest X ray is okay,
(38:19):
but tends to miss smaller cancers such that you could
have a normal check that chess X ray and still
have cancers. That's where we're going for these cat scans
because they give us a larger view of your lung
field as it pertains to seeing stage one cancers against
Stage one is normally smaller and maybe a little bit
(38:39):
more hidden. You can't see it on a chest X ray.
So we're doing these cat scans again, starting at the
age of fifty five, and then we do colon cancer screening.
And colon cancer screening has more options now. They just
came out with the blood tests called shield Shi E
l D, which I was introduced to a couple of
(39:01):
about a week ago, two weeks ago, which is a
blood based test. Right, as you know, the colonoscopies have
been sort of the gold standard way to screen for
colon cancer for many years, and then came sort of
the stool kit that came to your house, the colon
Guard you've seen the commercials on TV again trying to
make it more convenient. Now they have a blood test
(39:22):
that came out where you can get your colon cancer
screening through the blood isn't America wonderful? Phone lines are
open eight and nine six Kalvy I wanted hundred through
through zero o kov I had last break. All right,
doctor Lavine Medical our last segment. Phone lines are open,
(39:45):
but we sort of at the end of the show,
hour goes by so rapidly. Again, just trying to remind
patients to get your cancer screening. Most of the time,
when you go to healthcare provider's office, they will at
your profile and determine what you are eligible for. But
all of this stuff in terms of cancer screening is
(40:06):
available to you, and if you want to know what
you're due for normally on multiple websites, maybe even your
insurance website, they basically tell you what you need. In
my office, I have some printed paperwork so that patients
can review that while they're sitting waiting for me to
come into the room, to remind them that if they
(40:27):
don't have it, then we need to order it because
a lot of times there's scheduling conflicts that occur. You
have to postpone, you have to wait, and then a
whole year goes by and you didn't get your cancer
screening for breast or prostate colon or even lung cancer.
And those smokers out there. We are finding these cancers
a lot sooner. But there's cancers that we don't screen for,
(40:49):
kidney cancer, pancreatic cancer, liver cancer, ovarian cancer kind of
that can cause some pretty signific issues. We screen for
blood cancer with just the CBC, and we don't screen
for brain cancer, which we find that often patients coming
(41:12):
in off the street new on st seizure, new on
said headache, maybe they're having stroke like symptoms. We do
a scan and they have a large brain tumor. So
we don't screen for every cancer, but we do screen
for those four or five, and you need to be
sure you're up to date so that we can find
that as soon as possible and get you to the
(41:34):
appropriate doctor. Again, don't let the fact that you don't
have insurance get in your way. A lot of these
screening tests are becoming more affordable. And again, when you
man get diagnosed with a stage four man, you're talking
about a huge financial hit. I mean, because cancer screening
is not cheap as most things in this country, but
(41:56):
that involves some highly specialized people, highly specialized equipment and medications.
And medications are outrageous, so it is unfortunate that some
patients get caught with no insurance and they get diagnosed
for the stage where cancer. That's a tough, tough situation.
I don't know that we've figured that one out yet,
but try to get in stage one normally more easy
(42:17):
to fix, and your pregnosis is typically excellent. Thank you
for join us on the edition of the show. Don't
drink and drive, Drink some water, eat some vegetables. We'll
see you guys next week.
Speaker 2 (42:27):
Take care,
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