November 5, 2024 • 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
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Speaker 1 (00:00):
All right, welcome south these Sex Internet radio listeners. Welcome, Welcome,
Welcome to the edition of the Doctor Levigne Medical Hour.
I'm your weekly host, Doctor Levine, coming to you live
from the studios of k lv I hear in Beaumont, Texas,
cross the street from Parkdale Mall, taking your phone calls,
(00:21):
trying to answer some questions about healthcare and medicine, as
it is complicated and confusing a lot of times. We're
here to try and get you some clarity moving forward
so you can make better decisions to try and stay
alive as long as possible and be as healthy as possible.
And yes, it does take better decision making and more
(00:45):
often than not as it stands now, with the information
Highway as the way it is, just the information you're
getting is very conflicting, and so we are here to
try and clear that up. Phone lines are open eight
nine to six kV I went one hundred and three
to three zero klv I love to hear from you.
(01:05):
It's two way radio and we're in the house ready
for some phone calls. In the meantime, I normally talk
about maybe some current events or maybe some things that
have happened throughout the week that I thought would be
interesting to bring up and talk about. A lot happens
every day in the world, and a lot happens every
(01:28):
day in the hospital, in the clinic, and some of
these are very interesting topics. Again, this is flu season,
this is vaccine season, so we really prioritize and talk
about it a lot. And again I want to keep
reiterating this simple fact about vaccines. I had this conversation
(01:52):
yesterday with a very frustrated family relative of someone who
was in the hospital with pneumonia. So their mother was
in the hospital contracted pneumonia, which is sort of super frustrated. What,
you know, how could this happen? She had all of
her vaccines, She doesn't have a lot of contact with
(02:13):
a lot of people. She pretty much stays at home
all the time. How could this have happened? How can
a person like that still get pneumonia? And I heard
another term as I was waiting for the show to start,
this layman's term called walking pneumonia, which really it was
(02:36):
a sort of information on the radio. You know, that
term really is not used much anymore in the medical world.
We don't use it in our terminology, but it is
a term that has been used in the layman's literature
for a long time walking pneumonia, And I guess it
would just indicate that a person has a lung infection,
(03:00):
but they're not sick enough to be in bed. They're
still walking around, right, They're walking with the lung infection.
That's all pneumonia means, which is a very common issue
as one gets older, is lung infection or pneumonia when
the actual lung tissue itself gets infected, and normally patients
(03:25):
will have respiratory symptoms and signs of infection. And most
people are becoming familiar with the term that medical doctors
have been using for many years now called sepsis sepsis,
and there's different types I should say, there's different severities
(03:45):
of sepsis. It's become sort of a very inflammatory term
when someone says you have sepsis. A lot of layman
and a lot of the general public has a lot
of crazy things about sepsis. And yes, this term sepsis.
(04:06):
Normally it just indicates what happens when you get an
infection from a bacteria or a virus. That's really all
it means. And infections are a very common medical trauma
as I call it. That happens to all of us,
especially as we get older and class. You all know
(04:29):
the reason for that, right if you listen to my show,
Because the immune system just doesn't work as well as
we get older. It's programmed into us that we're more
vulnerable to infections, and so we're bound to get something,
some sort of infection as we get older. As I
(04:50):
was trying to explain to this family member in the
hospital that yes, sounds like they did their part with
trying to protect their mother. They had some vaccines. They're
sort of limiting the interaction that they have with other people.
As again, we all sort of harbor certain organisms in
(05:14):
our respiratory system, and so when we laugh, when we
talk breathing, coughing, we sometimes will emit that respiratory air
with the respiratory droplets, and it sort of gets suspended
(05:36):
in the air, and whoever is around can then inhale
that with This is how respiratory viruses kind of jump
from person to person. It sort of gets suspended in
the respiratory mist in the air, and then someone else
breathes that in and that's how it gets inside another
person's lung and can potentially set up. And so this
(06:00):
stuff has been going on for years and will continue
to go on for years. But just this basic understanding
that again, the immune system is not perfect. Even in
someone who's young and healthy, it's not perfect. When we
see pneumonia and patients who are very young, they normally
(06:22):
don't have to be hospitalized, but yes, sometimes they get
hospitalized as well. Someone in their thirties, forties, fifties, with
no medical problems, they don't take any medications, but unfortunately
get a nasty organism in their lung and they have
to be hospitalized for potent antibiotics and medical support. But
(06:45):
again just talking about and prioritizing our elderly population, which
because of medical advancements in the treatment of cancer and
in the treatment of cardiovascal disease, which again these are
the two big diseases in our country that normally most
Americans will suffer from. Again, because of our lifestyle choices,
(07:08):
we're getting better at controlling these two diseases, and so
it's allowing patients to live longer well again, because the
aging process is alive and active. The longer we keep
patients alive, the more issues they tend to develop. Because
that aging process, it's getting heavier and heavier, and so
(07:29):
that immune system is one system that tends to be impacted.
And again my original message to all of you is, yes,
we want you to get the vaccines because what they
do is they tend to keep the active infection to
a mild case instead of a severe case. It tends
(07:51):
to promote mild reactions and sort of reduces the possible
of having a severe reaction, which this patient had a
very mild reaction and was doing quite well and probably
we'll get out of the hospital in a day or two,
versus a severe reaction where they have to be in
the ICU, they have to be hooked up to a
(08:13):
bunch of wires and have a bunch of tubes coming
out of them and be on a machine, not able
to talk for several days and potentially not make it
out of the hospital. That's sort of the big difference.
And so vaccines work. Yes, there's risk with everything that
we do. There can never be a zero risk as
(08:37):
it pertains to healthcare delivery, even if it pertains to
prescribing a motron or an advil or even an aspirin
to you. We prescribe aspirin all day long to patients
and recommend aspin for what we call primary prevention. As
I mentioned cardiof as disease being the big disease in
(08:57):
our country, we're always looking for ways to reduce that
risk in our citizens. And yes, for many years, taking
a daily aspirin was one way we did that. But
guess what aspirin is also, as we say, a blood
dinner and increases the risk of spontaneous bleeding in various
(09:20):
anatomical locations. And so big research study came out a
few years ago and say, oh, you know, we're prescribing
all this aspen to a lot of people and people
are starting to have complications. We need to sort of
back up and relax that recommendation and only hit the
high risk patients who really need that, because we were
(09:42):
sort of just blanketly recommending aspen to a lot of
citizens and they were experiencing the adverse reaction issues with that.
So again trying to do good things, but again risk
always comes with that and we have to do everything
we can to keep the risk down. Same thing with
the vaccines. The companies that generate these vaccines are always
(10:07):
working on ways to reduce adverse reaction, reduce risk, and
allow to be more specific for what it's designed to do.
And they are getting better and better with that, and
the churnover in terms of generating new boosters is becoming
fast and faster. That was a very slow process, but
(10:31):
my understanding is they've made some advancements in the way
they cancoct these vaccines. They now have sort of vaccine
engineers where they excuse me, have mathematical models and other
ways of predicting which virus is going to be the
one that causes most of infections and they can sort
(10:52):
of back up and put together a vaccine that should
be effective against this particular So they're working on that
stuff in the background all the time. So I sa
that if you do take a vaccine, it should work
better than it did before in helping you defend yourself
(11:14):
against these common organisms and keeping the reactions and the
severity of these infections to a minimum. That's the whole
idea of vaccines. Keeping the severity to minimum, you still
can get the infection. And again, just to remind you
that there's viruses and bacteria sort of in your environment. Yes,
(11:37):
maybe you don't get a lot of visitors and you
buy yourself. But we get a lot of patients in
the hospital who've had no visitors and they still get
infections because the microorganism world is always around us. I mean,
it's just part of our environment. We can't get rid
of it. So, yes, you don't have to have a
(11:58):
lot of visitors or or contact with any folks. I mean,
we've found patients who've come down with COVID, no one's
ever visited them, they haven't been anywhere, and yes they
get COVID just because again COVID is part of our
sort of residential respiratory virus environment, meaning it's it's in
(12:18):
the environment now, it's never going anywhere, so you don't know,
you don't necessarily have to have contact with anyone. Yes,
it limits your chance of getting it, keeps it to
a minimum, really, and that's all we're trying to do, right,
is lower risk, typically never zero, but lower risk by yes,
(12:41):
limiting contact with visitors and other people who might have
other mutations of the virus. But it doesn't necessarily prevent
you from ever getting anything, just because the bacterial world,
the viral world, is always there. But we've gotten very
are should say we've gotten better at understanding this world
(13:04):
and defending the average citizen against these sort of common
infections and vaccines is the way we do that. So
go get yours if you haven't gotten them, And again,
maybe there'll bid day where it's in a pill form.
That would be That will be awesome. Right, here's your pill.
We're sort of all accustomed to pills. And take your
(13:27):
pill and be done with it. And that's the way
you protect yourself against these. In fact, that would be awesome.
Phone lines are opened. Eight nine to six kV I.
What in one hundred and three three zero kov I'll
be back in two minutes. All right, welcome back to
(13:56):
Doc Medical op. Phone lines open. Eight nine to six
cave covid V and three three zero klv I. Phone
lines are open. Give us a buzz sitting up here
talking about various topics. One thing that happens a lot
is cramping in the legs. I get that question a
(14:17):
lot in the office doctor. When I go to bed
at night, my legs are cramping. They're aching what is
going on? And it's weird because most of time during
the day, because you're distracted and things are happening, you
don't really notice it. And then when you go to
bed at night and it's quiet and it's dark and
you just trying to get some rest, those legs start
cramping and aching, and what are the reasons for that?
(14:40):
And how can I fix that? So I thought I
would just chat a little bit about that. Just one
of those common physical elements and complaints that a lot
of citizens get, and a lot of different causes of
cramping of the legs, and I thought I would mention
a few common ones. I think number one at the
(15:02):
top of the list is just adverse reaction to prescription medication. Yes,
I'm guilty. I prescribe a lot of meds, and sometimes, yes,
I cringe a little bit at the number of medications
that the average citizen has to take. It's really disheartening
to know that a person has to consume fifteen different
(15:27):
tablets every single day to feel sort of normal. And yes,
we do have those patients and it is disheartening. And
I would have to say, I've been a physician over
twenty years. More and more I'm trying to limit my
prescribing of prescription medications and trying to at least do
(15:50):
my part to keep that medication list as clean as
possible and as short as possible, because god, it's just
so it's heartening to see once one has to take
that many minutes. Bob from Beaumont. How can we help you? Hey, Bob, Bob, Hello, Hello, sir,
(16:13):
how can we help you? You're live? Hello? Do you
have a question for us today? You're live on air?
All right, Bob calls back. Some technical difficulty out there.
But cramping of the legs. Prescription medications a lot of
(16:34):
times in my experience, causes the cramping of the legs,
which ones normally do that in my opinion, diuretics you
know them as hydrochlorothiside, for rosamide, chlorthalidone, torsumide, motola zone, demodex.
Speaker 2 (16:54):
Why is that?
Speaker 1 (16:55):
Why are so many people on diuretics? Because of things
like hypertension, heart disease, chronic kidney disease, which again come
from our lifestyle choices in this country that unfortunately, as
we get a little bit older and we remain sedentary
(17:18):
and that weight starts to climb, we start to get
develop these cardiovascal diseases. And to treat that other than
changing the lifestyle, which can be quite difficult for a
lot of our citizens. We will use prescription blood pressure
medications to help control the blood pressure and help control
(17:41):
some of the end organ impact of higher pretension, because
that's what higher pretension is, right, the silent killer, Because
a lot of times your blood pressure is elevated, you
don't feel it, but it's causing damage to your vital
organs such as your heart and your kidneys. And as
your heart starts to fail, and as your kidneys start
(18:04):
to fail, you start getting fluid retention, meaning you become
a little bit more swollen. A lot of people normally
come to the office with the swelling of their ankles
or the top of their feet, or their hands are swollen,
their face is swollen. Also when that happens, fluid can
(18:25):
get into the lung tissue. We talked about pneumonia, which
normally says that your lung tissue has an infection in it,
whether it be bacterial or viral. Covid is a virus,
whereas Streptococca's pneumonia is a bacteria that causes pneumonia. Pneumonia
(18:49):
has the same symptoms whether or not it's a virus
or bacteria. Right, the shortness of breath, the coughing, the congestion,
the fever, but certainly when you get heart failure, kidney failure,
that fluid or that swelling or a dema that we
call it in the medical world, the swollen ankles and
(19:11):
the top of the feet, that fluid can get in
the lung tissue as and cause shortness of breath and coughing.
Sometimes hard to determine if it's an infection or if
it's just fluid. Normally, for most doctors to think about infection,
we need those infection symptoms, right, fever, achiness, don't feel well.
(19:36):
Maybe when we get laboratory work back, the white blood
cell count is elevated. So a lot of times if
we have a patient staring at us and they don't
have the infection symptoms, but they might have some swelling
in their legs, they have a history of hypertension, maybe
the high blood pressure has not been well controlled and
(19:58):
they're starting to get shorter breath and they get some
swelling in their ankles. To us, that indicates more of
a fluid retention problem brought on by again heart failure
kidney failure. But we use diuretics a lot to help
control those symptoms, and one of the adverse reactions is
cramping in the low extremity. So a lot of times
(20:20):
when patients come and they mention that, I immediately go to
their medication list and a lot of times I will
find the culprit there on the list that causes cramping.
So if you're on a diuretic hydrochlorothyside or HCTZ chlorthalidone,
lasix bumex ferosamide, cramping can be one of those symptoms
(20:45):
of that, and sometimes we can adjust the medication. Sometimes
we can take your off the medication, but sometimes you
cannot get off these medicines because you need these medicines
to help control the fluid retention brought on by these
chronic illnesses brought on by the long standing highpertension, and
(21:07):
sometimes patients, I'm sorry practitioners will use muscle relaxers to
help with that. Sometimes electrolyte replacements such as potassium tablets
can help in those situations. Along the same lines of
the diuretics. That's another adverse reaction of diuretics is it
(21:28):
can lower your potassium level, and that's one symptom of
low potassum It's just sort of muscle twitching, muscle cramping
that requires a blood test to figure that out. And yes,
if your potassium is low, we will give you potassium
replacement with a prescription potassium tablet. I know that they
(21:50):
have that over the counter as well in a smaller dose,
and some patients will use those potassium tablets to help
resolve their cramping, So muster relaxers potassium replacement. I'm not
a big believer in the let me eat a couple
of banana sort of thing, or let me down some
(22:11):
gatorade to try and figure out if that's going to
help my cramping, or pickle juice. There's a few other
there's a few other choices out there that I've heard
patients talk about. But a lot of times it just
requires an adjustment of the medication and maybe some electrolyte
(22:31):
replacement or maybe a trial of some must relaxers and
it can't help. And again, I'm not a big fan
of giving your medicine to fix the side effect of
another medication. Again, less is more in these situations. We
try to get you off the medicine or change the
medicine that's causing a problem, but sometimes we can't, and
(22:51):
that's when, unfortunately, we're forced to give you something to
sort of help control the adverse reaction of one medicine
over the other. So leg cramp a lot of times
is medication related. Diuretics is a big cause of that.
Another big cause of the leg cramping are cholesterol medicines,
(23:14):
the statin class, right, we love them, we hate them,
but they are blockbuster medications and I am a big
believer in those medications. You know them as lippotour or
crest store or simvastatin or zocore. Thankfully, we have a
couple of other new classes of cholesterol medications on the scene,
(23:37):
and now we have more options from a prescribers standpoint
to prescribe medications to patients who might have adverse action
to these statins because they are sort of common. Other
than the leg cramping that we get from statins, we
get sort of a muscle weakness, are sort of a
(23:58):
muscle discomfort that can develop in the thighs and the
lower legs as well as the hips from statins. Again,
because cardiovastar disease is so common other than diuretics, other
than aspirin, statins are sort of a blockbuster commonly prescribed medication.
So a lot of people are taking these medications and
(24:21):
we see a lot of adverse reaction issues relate to
that and sort of that legs soreness, leg weakness, leg
cramping can occur with these statin medications. Now, the good
thing about the statins is a lot of times we
can just kind of adjust the dosage, sometimes reduce it
to a lower dose, or even do every other day
(24:44):
or every two days to try and allow you to
tolerate these medications. And yes, even though we are prescribing
it every couple of days, you are still getting some
benefits from the statin cholesterol medications. These medicines have been
around for years throughout my entire career, and they have
(25:05):
been studied in all sorts of different directions and the
evidence is quite clear these medicines are very good at
helping preserve cardiovascular disease and keeping it at a minimum
and keeping you out of the hospital and reducing your
risk of having more cardiovascular events. I'm a big believer
(25:27):
in status based on what I've seen in my career
when patients take these medicines and when they don't take
these medications. So we try everything we can to help
patients tolerate statins. I know sometimes patients get a little
aggravated with us when they're telling us that, hey, this
medicine is causing harm, and we say, yeah, we understand,
(25:51):
but can you try different doughs or lower tills. It's like,
why can't I just stop it? Phone lines are open
eight nine six kov I W one hundred three three
zero kalvi. I'll be back in two minutes. All right,
(26:20):
welcome back to Docta me Metical. Our phone lines I
open eight nine to six kalva I one one hundred
and three three zero kalv. I talking about leg cramps,
which appear to be a common issue in our country,
and I get that complain a lot, and again from
in my experience, it has a lot to do with
prescription medications such as diuretics or cholesterol medicines such as status.
(26:45):
But quite frankly, any medication that you are taking can
potentially cause leg cramping. I know the pharmacy world has
done a great job of getting involved with educating our
citizens about these medications and the harm potentially that can
happen when being prescribed to medication. You sort of get
(27:08):
this litany of information when you're at the pharmacists with
all the printed information with medications, and sometimes yes, it
can be overwhelming, just a lot of words, very busy
sort of paperwork that for most people because it's very
(27:28):
busy and it's just a lot of words and there
are a lot of reading. It's not read at the
end of the day, and sometimes the pharmacist will just
sort of prioritize certain high risk potential side effects versus
going through everything. But certainly we're just trying to keep
our citizens and patients involved with the decision making that's
(27:51):
going on, to make sure that they're informed about the
medications and what potentially can happen. And if you look
on these lists, cramping in very is on there from
most of these medicines that are prescribed, whether it be
a diuretic or a statin or just a blood pressure
medicine or something you might be taking for your stomach.
(28:11):
We have Jim from Beaumont. How can we help you?
You can hear me there, Jim, Yeah, we can hear you.
How can we help you?
Speaker 2 (28:22):
And we hear you just fine? How can we help Yes, Sim,
can you hear me? Okay, we may have a little
problem there, doc, But just to be on the safe side,
I ask about the question, and Jim has a question
about frequent urination at night and is there something he
can do to not be getting up so often at night.
Speaker 1 (28:45):
Yeah, absolutely, thank you, Jim, appreciate that. Yeah, we call
that nocturia n oct r a nocturia that's urinating a
lot at nighttime. And yes, another common physical complaint from
most of our male patients primarily, but it can happen
(29:07):
in females, and there's different causes of nocturia for a
man versus a woman. For a man, most of the time,
that just really indicates an enlargement of the prostate, because
that is the most common cause of nocturia in the
average man. Is just the prostate is getting bigger, and
(29:31):
as it gets bigger, it starts to obstruct or block
urine flow or i should say bladder emptying of urine
in an efficient manner, such that even though you go
to the restroom you feel like you finish, there's still
some retained urine in your bladder because of the obstruction
(29:55):
from the enlarged prostate. And certainly, yes, there is a
progression of this over several weeks to months where maybe
it starts out a little bit but then it really
starts to bother you where you're getting up multiple times
throughout the night to empty your bladder. But guess what,
because of the obstruction, you never really get to that point,
(30:17):
so you just sort of stay up all night releasing
urine that's being retained. Because the prostate is big, the
bladder sort of has pressure sensors and it's sort of
set to retain a certain amount of urine in the bladder,
and unfortunately, because you're retaining urine, those pressure sensors sort
(30:39):
of remain high, and it just sort of keeps you
going back and forth to the restroom.
Speaker 2 (30:44):
All night long.
Speaker 1 (30:45):
Again, this doesn't appear to be an issue throughout the day,
right because you're just sort of moving around and you
just go to the restroom when you can, But it
certainly can spill over to the next day where you
just find yourself going multiple times throughout the day of
the restroom. You sort of notice this maybe at work
or if you're taking a long trip and you're driving,
(31:06):
or even on a plane, where you realize that I
got to go to the restroom every hour or so
that's very very frequent and more frequent than you should.
You should be able to go several hours without having
to urinate, So anything more frequent than that tends to
be abnormal. But for most guys, it just has to
do with enlargement of the prostate. And so most doctors,
(31:29):
if you go to them or healthcare professionals and talk
about that, they will a lot of times check your
urine because again, we want to make sure there's nothing
in your urine that's causing you to urinate a lot.
A lot of times that's a symptom of urine irritation
or bladder irritation. Is urinating frequently. So some other common
(31:52):
causes of that would be infection, which we call a UTI,
or it could be blood, or it could be sugar.
A lot of times patients who develop type two diabetes,
one of their first symptoms is urinating a lot. So
we like to check the urine and do what they
(32:15):
call a urine analysis, so that we're looking at the
makeup of the urine and see if there's any sugar
in it, if there's any bacteria in it, there's any
blood in it, or just what it looks like again
to allow us to go through the process of elimination
and what's causing you to urinate frequently, so we'll do
a urine sample. We'll also a lot of times do
(32:37):
an electrolyte panel again looking at your kidney function, looking
at your electrolyte levels, because sometimes certain diseases can generate
electrolyte problems, whether it be high or low, as well
as causing you to urinate frequently. So that's normally a
(32:59):
part of the workup for someone who has nocturia. And
certainly sometimes we will do some imaging of the bladder
or the pelvis region again looking for anatomical defects that
might be causing you to have to urinate frequently. All
(33:21):
I'm saying is, in my experience, it's an enlarged prostate
that typically causes I would say high percentage of the
nocturia issues in men I would say at least ninety percent.
And certainly we get a PSA right, which stands for
prostate specific enigen It's a hormone that is directly tied
(33:44):
to prostate. A lot of times if there's any enlargement
of the prostate, if there's any infection of the prostate
or irritation of the prostate, and certainly we sort of
know it's relationship with prostate answer, the prostate level will
start to rise, and normally a normal prostate is between
(34:06):
one to four. So anytime it goes above that, it's
a bit more pathological rise our level and we start
to get a little bit nervous about some sort of
active prostate disorder. Now, can you have an enlarged prostate
with the normal PSA? Absolutely, we say that all the time.
(34:28):
Doctors can perform what they call a digital rectal examination
or DRE for short, DRE to basically palpate the prostate
a little uncomfortable for most patients and sometimes for practitioners. Again,
it's fallen out of favor for routine prostate cancer screening controversial.
(34:53):
I'm not a big fan of it, but there are
still some doctors who are doing those. Again, because when
you do this particular exam, you're only able to examine
a part portion of the procetate, not the whole prostate,
and so there can be pathological issues on the part
(35:13):
that you do not palpaid. So it's sort of an
ineffective exam in terms of feeling the whole prostate. So
because it's sort of uncomfortable, it's not giving you all
the information you need. It's sort of gotten controverse in
terms of its need to be done for prostate cancer screening,
(35:34):
but again some doctors are still doing it, but certainly
the PSA level is still very popular. It's a very
sensitive test, but sometimes non specific, meaning your PSA can
be elevated because of an infection, maybe because it's just big,
or maybe because of prostay cancer. So a lot of
(35:57):
times for me primary care physician, if we see a
person who has an elevated PSA, we will certainly refer
them to the prostate doctor or urologist so that they
can sort of help us figure out why is the
PSA elevated. It's not always because of cancer. It sometimes
can just be from an enlarged prostate, but normally with nacturia,
(36:21):
those are sort of the things that we think about.
And the good thing is that we have good medicines
that are very effective to help reduce the frequency of
haven urinate at night. So if it is your prostate,
we have a few medicines that we can use to
kind of open up that obstruction or relieve that obstruction.
You know them as flomax or tamsialosin or the probably
(36:47):
the most commonly prescribed medication for that. An old medicine
that was used when I was coming out is called
hydron hytrn had some issues with lowering your blood pressure
causing some dizziness and so it's a little dirty, had
some side effects, and so this new class of medicines
(37:08):
Flomax came out or tamsillosin, and has really allowed us
to medicate that particular problem with minimal side effect issues.
But if we find an infection, we give you antibiotic
which normally helps with that. Again, sometimes the prostate can
get infected, but there's normally good antibiotics for that. And
(37:30):
you know, if it's blood, we normally will send you
to a urologist so that they can do their evaluation
a lot of times looking actually inside the bladder to
see maybe why there's blood in your urine. But normally, yes,
we can get the nocturia fixed and most of the
time it is from the prostates. I hopefully that answered
your question. Bonelines are open eight nine six scalv I
(37:52):
won one hundred three three zero Kova. I'll be back
in two minutes. All right, welcome back to DOCTA me
metagad phone lines I open eight nine six kov I
want one hundred and three three zero Okovia talking about nocturia,
(38:17):
and I did prioritize guys as normally prostate issue. But
for ladies, when they start urinating a lot at night,
a lot of times, that indicates what we call overactive bladder.
And guys can get that too, but it's just less common.
But for ladies, because of things like childbirth and menopause,
(38:40):
the bladder very close to the intestines and the vaginal area.
A lot of times, because of a weakness of the
what we call pelvic floor, things start to sort of
fall a little bit and the bladder sort of gets
reaped positioned and loses its normal orientation, and that certainly
(39:04):
causes the dynamics of the urine flow and how the
bladder functions. But one common element is sort of this
disconnect that the bladder gets from the central nervous system
i e. The brain, where for the most part, when
things are working, the brain sort of talks with the
bladder and the bladder talks with the brain, and things
(39:27):
are sort of under control, where if you don't need
to urinate, you don't have to. But certainly when your
bladder fills up with urine, you go to the restroom.
It's a nice little system. But unfortunately for ladies when
they get older, that system breaks down and the bladder
sort of becomes more independent and is causing you or
giving you the sensation that you have to urinate all
(39:49):
the time, that sort of discomfort that you get in
your lower abdomen. And we call that overactive bladder. And
not quite sure why some ladies get it in some don't,
but that seems to be the bigger, more common issue
as a female gets older. And again, good medications on
(40:11):
the market for that, several actually that have been put
on the market to help control that. We sort of
go through the same sort of process of elimination with
checking the urine. Sometimes, yes, we will do blood work.
Sometimes we will do some imaging again to look at
the bladder and see if there's anything else going on,
(40:32):
because certainly, like I said, as the pelvic floor weakens,
then the bladder falls and gets repositioned. Sometimes it can
cause obstruction of urine flow, just like with the guy
with the prostate. For ladies, it's because the bladder is
sort of in the wrong position and it starts to
retain urine and again those same dynamics or what we
(40:57):
call eurodynamics that occurs with a who has a big prostate.
Ladies can get sort of the same issue where the
urine is not able to get out again because there's
sort of a kinking or narrowing of the exit site
of the bladder because it's sort of in a different
position it was years ago, and we treat that a
(41:20):
little bit differently. Most of the time you have to
get to a urologist because of the anatomy, and the
lady's anatomy is a little bit more complicated. We certainly
can try flomax, same thing and late men will try
it in ladies to see if they can get them
some relief, but a lot of times they will have
(41:40):
to go to the urologists for a more complete evaluation
and maybe some other medical or even mechanical therapeutics to
resolve that issue. For overactive bladder, whole list of medications
that work very well and can get that tame down.
But again, if it's an infection, we have a slew
(42:01):
of antibotics. If it's you know, other processes, again, the
urologists are there to sort of help us out and certainly. Yes,
we want to check for sugar and other issues that
can cause the frequent urination as well, so hopefully that
answer your question for nocturia. We'll appreciate you checking in
(42:21):
this week again. Reminder, go get those vaccines and don't
drink and drive, and drink some water every now and then.
We'll see you guys, think week. Take care,
All right, welcome south these Sex Internet radio listeners. Welcome, Welcome,
Welcome to the edition of the Doctor Levigne Medical Hour.
I'm your weekly host, Doctor Levine, coming to you live
from the studios of k lv I hear in Beaumont, Texas,
cross the street from Parkdale Mall, taking your phone calls,
(00:21):
trying to answer some questions about healthcare and medicine, as
it is complicated and confusing a lot of times. We're
here to try and get you some clarity moving forward
so you can make better decisions to try and stay
alive as long as possible and be as healthy as possible.
And yes, it does take better decision making and more
(00:45):
often than not as it stands now, with the information
Highway as the way it is, just the information you're
getting is very conflicting, and so we are here to
try and clear that up. Phone lines are open eight
nine to six kV I went one hundred and three
to three zero klv I love to hear from you.
(01:05):
It's two way radio and we're in the house ready
for some phone calls. In the meantime, I normally talk
about maybe some current events or maybe some things that
have happened throughout the week that I thought would be
interesting to bring up and talk about. A lot happens
every day in the world, and a lot happens every
(01:28):
day in the hospital, in the clinic, and some of
these are very interesting topics. Again, this is flu season,
this is vaccine season, so we really prioritize and talk
about it a lot. And again I want to keep
reiterating this simple fact about vaccines. I had this conversation
(01:52):
yesterday with a very frustrated family relative of someone who
was in the hospital with pneumonia. So their mother was
in the hospital contracted pneumonia, which is sort of super frustrated. What,
you know, how could this happen? She had all of
her vaccines, She doesn't have a lot of contact with
(02:13):
a lot of people. She pretty much stays at home
all the time. How could this have happened? How can
a person like that still get pneumonia? And I heard
another term as I was waiting for the show to start,
this layman's term called walking pneumonia, which really it was
(02:36):
a sort of information on the radio. You know, that
term really is not used much anymore in the medical world.
We don't use it in our terminology, but it is
a term that has been used in the layman's literature
for a long time walking pneumonia, And I guess it
would just indicate that a person has a lung infection,
(03:00):
but they're not sick enough to be in bed. They're
still walking around, right, They're walking with the lung infection.
That's all pneumonia means, which is a very common issue
as one gets older, is lung infection or pneumonia when
the actual lung tissue itself gets infected, and normally patients
(03:25):
will have respiratory symptoms and signs of infection. And most
people are becoming familiar with the term that medical doctors
have been using for many years now called sepsis sepsis,
and there's different types I should say, there's different severities
(03:45):
of sepsis. It's become sort of a very inflammatory term
when someone says you have sepsis. A lot of layman
and a lot of the general public has a lot
of crazy things about sepsis. And yes, this term sepsis.
(04:06):
Normally it just indicates what happens when you get an
infection from a bacteria or a virus. That's really all
it means. And infections are a very common medical trauma
as I call it. That happens to all of us,
especially as we get older and class. You all know
(04:29):
the reason for that, right if you listen to my show,
Because the immune system just doesn't work as well as
we get older. It's programmed into us that we're more
vulnerable to infections, and so we're bound to get something,
some sort of infection as we get older. As I
(04:50):
was trying to explain to this family member in the
hospital that yes, sounds like they did their part with
trying to protect their mother. They had some vaccines. They're
sort of limiting the interaction that they have with other people.
As again, we all sort of harbor certain organisms in
(05:14):
our respiratory system, and so when we laugh, when we
talk breathing, coughing, we sometimes will emit that respiratory air
with the respiratory droplets, and it sort of gets suspended
(05:36):
in the air, and whoever is around can then inhale
that with This is how respiratory viruses kind of jump
from person to person. It sort of gets suspended in
the respiratory mist in the air, and then someone else
breathes that in and that's how it gets inside another
person's lung and can potentially set up. And so this
(06:00):
stuff has been going on for years and will continue
to go on for years. But just this basic understanding
that again, the immune system is not perfect. Even in
someone who's young and healthy, it's not perfect. When we
see pneumonia and patients who are very young, they normally
(06:22):
don't have to be hospitalized, but yes, sometimes they get
hospitalized as well. Someone in their thirties, forties, fifties, with
no medical problems, they don't take any medications, but unfortunately
get a nasty organism in their lung and they have
to be hospitalized for potent antibiotics and medical support. But
(06:45):
again just talking about and prioritizing our elderly population, which
because of medical advancements in the treatment of cancer and
in the treatment of cardiovascal disease, which again these are
the two big diseases in our country that normally most
Americans will suffer from. Again, because of our lifestyle choices,
(07:08):
we're getting better at controlling these two diseases, and so
it's allowing patients to live longer well again, because the
aging process is alive and active. The longer we keep
patients alive, the more issues they tend to develop. Because
that aging process, it's getting heavier and heavier, and so
(07:29):
that immune system is one system that tends to be impacted.
And again my original message to all of you is, yes,
we want you to get the vaccines because what they
do is they tend to keep the active infection to
a mild case instead of a severe case. It tends
(07:51):
to promote mild reactions and sort of reduces the possible
of having a severe reaction, which this patient had a
very mild reaction and was doing quite well and probably
we'll get out of the hospital in a day or two,
versus a severe reaction where they have to be in
the ICU, they have to be hooked up to a
(08:13):
bunch of wires and have a bunch of tubes coming
out of them and be on a machine, not able
to talk for several days and potentially not make it
out of the hospital. That's sort of the big difference.
And so vaccines work. Yes, there's risk with everything that
we do. There can never be a zero risk as
(08:37):
it pertains to healthcare delivery, even if it pertains to
prescribing a motron or an advil or even an aspirin
to you. We prescribe aspirin all day long to patients
and recommend aspin for what we call primary prevention. As
I mentioned cardiof as disease being the big disease in
(08:57):
our country, we're always looking for ways to reduce that
risk in our citizens. And yes, for many years, taking
a daily aspirin was one way we did that. But
guess what aspirin is also, as we say, a blood
dinner and increases the risk of spontaneous bleeding in various
(09:20):
anatomical locations. And so big research study came out a
few years ago and say, oh, you know, we're prescribing
all this aspen to a lot of people and people
are starting to have complications. We need to sort of
back up and relax that recommendation and only hit the
high risk patients who really need that, because we were
(09:42):
sort of just blanketly recommending aspen to a lot of
citizens and they were experiencing the adverse reaction issues with that.
So again trying to do good things, but again risk
always comes with that and we have to do everything
we can to keep the risk down. Same thing with
the vaccines. The companies that generate these vaccines are always
(10:07):
working on ways to reduce adverse reaction, reduce risk, and
allow to be more specific for what it's designed to do.
And they are getting better and better with that, and
the churnover in terms of generating new boosters is becoming
fast and faster. That was a very slow process, but
(10:31):
my understanding is they've made some advancements in the way
they cancoct these vaccines. They now have sort of vaccine
engineers where they excuse me, have mathematical models and other
ways of predicting which virus is going to be the
one that causes most of infections and they can sort
(10:52):
of back up and put together a vaccine that should
be effective against this particular So they're working on that
stuff in the background all the time. So I sa
that if you do take a vaccine, it should work
better than it did before in helping you defend yourself
(11:14):
against these common organisms and keeping the reactions and the
severity of these infections to a minimum. That's the whole
idea of vaccines. Keeping the severity to minimum, you still
can get the infection. And again, just to remind you
that there's viruses and bacteria sort of in your environment. Yes,
(11:37):
maybe you don't get a lot of visitors and you
buy yourself. But we get a lot of patients in
the hospital who've had no visitors and they still get
infections because the microorganism world is always around us. I mean,
it's just part of our environment. We can't get rid
of it. So, yes, you don't have to have a
(11:58):
lot of visitors or or contact with any folks. I mean,
we've found patients who've come down with COVID, no one's
ever visited them, they haven't been anywhere, and yes they
get COVID just because again COVID is part of our
sort of residential respiratory virus environment, meaning it's it's in
(12:18):
the environment now, it's never going anywhere, so you don't know,
you don't necessarily have to have contact with anyone. Yes,
it limits your chance of getting it, keeps it to
a minimum, really, and that's all we're trying to do, right,
is lower risk, typically never zero, but lower risk by yes,
(12:41):
limiting contact with visitors and other people who might have
other mutations of the virus. But it doesn't necessarily prevent
you from ever getting anything, just because the bacterial world,
the viral world, is always there. But we've gotten very
are should say we've gotten better at understanding this world
(13:04):
and defending the average citizen against these sort of common
infections and vaccines is the way we do that. So
go get yours if you haven't gotten them, And again,
maybe there'll bid day where it's in a pill form.
That would be That will be awesome. Right, here's your pill.
We're sort of all accustomed to pills. And take your
(13:27):
pill and be done with it. And that's the way
you protect yourself against these. In fact, that would be awesome.
Phone lines are opened. Eight nine to six kV I.
What in one hundred and three three zero kov I'll
be back in two minutes. All right, welcome back to
(13:56):
Doc Medical op. Phone lines open. Eight nine to six
cave covid V and three three zero klv I. Phone
lines are open. Give us a buzz sitting up here
talking about various topics. One thing that happens a lot
is cramping in the legs. I get that question a
(14:17):
lot in the office doctor. When I go to bed
at night, my legs are cramping. They're aching what is
going on? And it's weird because most of time during
the day, because you're distracted and things are happening, you
don't really notice it. And then when you go to
bed at night and it's quiet and it's dark and
you just trying to get some rest, those legs start
cramping and aching, and what are the reasons for that?
(14:40):
And how can I fix that? So I thought I
would just chat a little bit about that. Just one
of those common physical elements and complaints that a lot
of citizens get, and a lot of different causes of
cramping of the legs, and I thought I would mention
a few common ones. I think number one at the
(15:02):
top of the list is just adverse reaction to prescription medication. Yes,
I'm guilty. I prescribe a lot of meds, and sometimes, yes,
I cringe a little bit at the number of medications
that the average citizen has to take. It's really disheartening
to know that a person has to consume fifteen different
(15:27):
tablets every single day to feel sort of normal. And yes,
we do have those patients and it is disheartening. And
I would have to say, I've been a physician over
twenty years. More and more I'm trying to limit my
prescribing of prescription medications and trying to at least do
(15:50):
my part to keep that medication list as clean as
possible and as short as possible, because god, it's just
so it's heartening to see once one has to take
that many minutes. Bob from Beaumont. How can we help you? Hey, Bob, Bob, Hello, Hello, sir,
(16:13):
how can we help you? You're live? Hello? Do you
have a question for us today? You're live on air?
All right, Bob calls back. Some technical difficulty out there.
But cramping of the legs. Prescription medications a lot of
(16:34):
times in my experience, causes the cramping of the legs,
which ones normally do that in my opinion, diuretics you
know them as hydrochlorothiside, for rosamide, chlorthalidone, torsumide, motola zone, demodex.
Speaker 2 (16:54):
Why is that?
Speaker 1 (16:55):
Why are so many people on diuretics? Because of things
like hypertension, heart disease, chronic kidney disease, which again come
from our lifestyle choices in this country that unfortunately, as
we get a little bit older and we remain sedentary
(17:18):
and that weight starts to climb, we start to get
develop these cardiovascal diseases. And to treat that other than
changing the lifestyle, which can be quite difficult for a
lot of our citizens. We will use prescription blood pressure
medications to help control the blood pressure and help control
(17:41):
some of the end organ impact of higher pretension, because
that's what higher pretension is, right, the silent killer, Because
a lot of times your blood pressure is elevated, you
don't feel it, but it's causing damage to your vital
organs such as your heart and your kidneys. And as
your heart starts to fail, and as your kidneys start
(18:04):
to fail, you start getting fluid retention, meaning you become
a little bit more swollen. A lot of people normally
come to the office with the swelling of their ankles
or the top of their feet, or their hands are swollen,
their face is swollen. Also when that happens, fluid can
(18:25):
get into the lung tissue. We talked about pneumonia, which
normally says that your lung tissue has an infection in it,
whether it be bacterial or viral. Covid is a virus,
whereas Streptococca's pneumonia is a bacteria that causes pneumonia. Pneumonia
(18:49):
has the same symptoms whether or not it's a virus
or bacteria. Right, the shortness of breath, the coughing, the congestion,
the fever, but certainly when you get heart failure, kidney failure,
that fluid or that swelling or a dema that we
call it in the medical world, the swollen ankles and
(19:11):
the top of the feet, that fluid can get in
the lung tissue as and cause shortness of breath and coughing.
Sometimes hard to determine if it's an infection or if
it's just fluid. Normally, for most doctors to think about infection,
we need those infection symptoms, right, fever, achiness, don't feel well.
(19:36):
Maybe when we get laboratory work back, the white blood
cell count is elevated. So a lot of times if
we have a patient staring at us and they don't
have the infection symptoms, but they might have some swelling
in their legs, they have a history of hypertension, maybe
the high blood pressure has not been well controlled and
(19:58):
they're starting to get shorter breath and they get some
swelling in their ankles. To us, that indicates more of
a fluid retention problem brought on by again heart failure
kidney failure. But we use diuretics a lot to help
control those symptoms, and one of the adverse reactions is
cramping in the low extremity. So a lot of times
(20:20):
when patients come and they mention that, I immediately go to
their medication list and a lot of times I will
find the culprit there on the list that causes cramping.
So if you're on a diuretic hydrochlorothyside or HCTZ chlorthalidone,
lasix bumex ferosamide, cramping can be one of those symptoms
(20:45):
of that, and sometimes we can adjust the medication. Sometimes
we can take your off the medication, but sometimes you
cannot get off these medicines because you need these medicines
to help control the fluid retention brought on by these
chronic illnesses brought on by the long standing highpertension, and
(21:07):
sometimes patients, I'm sorry practitioners will use muscle relaxers to
help with that. Sometimes electrolyte replacements such as potassium tablets
can help in those situations. Along the same lines of
the diuretics. That's another adverse reaction of diuretics is it
(21:28):
can lower your potassium level, and that's one symptom of
low potassum It's just sort of muscle twitching, muscle cramping
that requires a blood test to figure that out. And yes,
if your potassium is low, we will give you potassium
replacement with a prescription potassium tablet. I know that they
(21:50):
have that over the counter as well in a smaller dose,
and some patients will use those potassium tablets to help
resolve their cramping, So muster relaxers potassium replacement. I'm not
a big believer in the let me eat a couple
of banana sort of thing, or let me down some
(22:11):
gatorade to try and figure out if that's going to
help my cramping, or pickle juice. There's a few other
there's a few other choices out there that I've heard
patients talk about. But a lot of times it just
requires an adjustment of the medication and maybe some electrolyte
(22:31):
replacement or maybe a trial of some must relaxers and
it can't help. And again, I'm not a big fan
of giving your medicine to fix the side effect of
another medication. Again, less is more in these situations. We
try to get you off the medicine or change the
medicine that's causing a problem, but sometimes we can't, and
(22:51):
that's when, unfortunately, we're forced to give you something to
sort of help control the adverse reaction of one medicine
over the other. So leg cramp a lot of times
is medication related. Diuretics is a big cause of that.
Another big cause of the leg cramping are cholesterol medicines,
(23:14):
the statin class, right, we love them, we hate them,
but they are blockbuster medications and I am a big
believer in those medications. You know them as lippotour or
crest store or simvastatin or zocore. Thankfully, we have a
couple of other new classes of cholesterol medications on the scene,
(23:37):
and now we have more options from a prescribers standpoint
to prescribe medications to patients who might have adverse action
to these statins because they are sort of common. Other
than the leg cramping that we get from statins, we
get sort of a muscle weakness, are sort of a
(23:58):
muscle discomfort that can develop in the thighs and the
lower legs as well as the hips from statins. Again,
because cardiovastar disease is so common other than diuretics, other
than aspirin, statins are sort of a blockbuster commonly prescribed medication.
So a lot of people are taking these medications and
(24:21):
we see a lot of adverse reaction issues relate to
that and sort of that legs soreness, leg weakness, leg
cramping can occur with these statin medications. Now, the good
thing about the statins is a lot of times we
can just kind of adjust the dosage, sometimes reduce it
to a lower dose, or even do every other day
(24:44):
or every two days to try and allow you to
tolerate these medications. And yes, even though we are prescribing
it every couple of days, you are still getting some
benefits from the statin cholesterol medications. These medicines have been
around for years throughout my entire career, and they have
(25:05):
been studied in all sorts of different directions and the
evidence is quite clear these medicines are very good at
helping preserve cardiovascular disease and keeping it at a minimum
and keeping you out of the hospital and reducing your
risk of having more cardiovascular events. I'm a big believer
(25:27):
in status based on what I've seen in my career
when patients take these medicines and when they don't take
these medications. So we try everything we can to help
patients tolerate statins. I know sometimes patients get a little
aggravated with us when they're telling us that, hey, this
medicine is causing harm, and we say, yeah, we understand,
(25:51):
but can you try different doughs or lower tills. It's like,
why can't I just stop it? Phone lines are open
eight nine six kov I W one hundred three three
zero kalvi. I'll be back in two minutes. All right,
(26:20):
welcome back to Docta me Metical. Our phone lines I
open eight nine to six kalva I one one hundred
and three three zero kalv. I talking about leg cramps,
which appear to be a common issue in our country,
and I get that complain a lot, and again from
in my experience, it has a lot to do with
prescription medications such as diuretics or cholesterol medicines such as status.
(26:45):
But quite frankly, any medication that you are taking can
potentially cause leg cramping. I know the pharmacy world has
done a great job of getting involved with educating our
citizens about these medications and the harm potentially that can
happen when being prescribed to medication. You sort of get
(27:08):
this litany of information when you're at the pharmacists with
all the printed information with medications, and sometimes yes, it
can be overwhelming, just a lot of words, very busy
sort of paperwork that for most people because it's very
(27:28):
busy and it's just a lot of words and there
are a lot of reading. It's not read at the
end of the day, and sometimes the pharmacist will just
sort of prioritize certain high risk potential side effects versus
going through everything. But certainly we're just trying to keep
our citizens and patients involved with the decision making that's
(27:51):
going on, to make sure that they're informed about the
medications and what potentially can happen. And if you look
on these lists, cramping in very is on there from
most of these medicines that are prescribed, whether it be
a diuretic or a statin or just a blood pressure
medicine or something you might be taking for your stomach.
(28:11):
We have Jim from Beaumont. How can we help you?
You can hear me there, Jim, Yeah, we can hear you.
How can we help you?
Speaker 2 (28:22):
And we hear you just fine? How can we help Yes, Sim,
can you hear me? Okay, we may have a little
problem there, doc, But just to be on the safe side,
I ask about the question, and Jim has a question
about frequent urination at night and is there something he
can do to not be getting up so often at night.
Speaker 1 (28:45):
Yeah, absolutely, thank you, Jim, appreciate that. Yeah, we call
that nocturia n oct r a nocturia that's urinating a
lot at nighttime. And yes, another common physical complaint from
most of our male patients primarily, but it can happen
(29:07):
in females, and there's different causes of nocturia for a
man versus a woman. For a man, most of the time,
that just really indicates an enlargement of the prostate, because
that is the most common cause of nocturia in the
average man. Is just the prostate is getting bigger, and
(29:31):
as it gets bigger, it starts to obstruct or block
urine flow or i should say bladder emptying of urine
in an efficient manner, such that even though you go
to the restroom you feel like you finish, there's still
some retained urine in your bladder because of the obstruction
(29:55):
from the enlarged prostate. And certainly, yes, there is a
progression of this over several weeks to months where maybe
it starts out a little bit but then it really
starts to bother you where you're getting up multiple times
throughout the night to empty your bladder. But guess what,
because of the obstruction, you never really get to that point,
(30:17):
so you just sort of stay up all night releasing
urine that's being retained. Because the prostate is big, the
bladder sort of has pressure sensors and it's sort of
set to retain a certain amount of urine in the bladder,
and unfortunately, because you're retaining urine, those pressure sensors sort
(30:39):
of remain high, and it just sort of keeps you
going back and forth to the restroom.
Speaker 2 (30:44):
All night long.
Speaker 1 (30:45):
Again, this doesn't appear to be an issue throughout the day,
right because you're just sort of moving around and you
just go to the restroom when you can, But it
certainly can spill over to the next day where you
just find yourself going multiple times throughout the day of
the restroom. You sort of notice this maybe at work
or if you're taking a long trip and you're driving,
(31:06):
or even on a plane, where you realize that I
got to go to the restroom every hour or so
that's very very frequent and more frequent than you should.
You should be able to go several hours without having
to urinate, So anything more frequent than that tends to
be abnormal. But for most guys, it just has to
do with enlargement of the prostate. And so most doctors,
(31:29):
if you go to them or healthcare professionals and talk
about that, they will a lot of times check your
urine because again, we want to make sure there's nothing
in your urine that's causing you to urinate a lot.
A lot of times that's a symptom of urine irritation
or bladder irritation. Is urinating frequently. So some other common
(31:52):
causes of that would be infection, which we call a UTI,
or it could be blood, or it could be sugar.
A lot of times patients who develop type two diabetes,
one of their first symptoms is urinating a lot. So
we like to check the urine and do what they
(32:15):
call a urine analysis, so that we're looking at the
makeup of the urine and see if there's any sugar
in it, if there's any bacteria in it, there's any
blood in it, or just what it looks like again
to allow us to go through the process of elimination
and what's causing you to urinate frequently, so we'll do
a urine sample. We'll also a lot of times do
(32:37):
an electrolyte panel again looking at your kidney function, looking
at your electrolyte levels, because sometimes certain diseases can generate
electrolyte problems, whether it be high or low, as well
as causing you to urinate frequently. So that's normally a
(32:59):
part of the workup for someone who has nocturia. And
certainly sometimes we will do some imaging of the bladder
or the pelvis region again looking for anatomical defects that
might be causing you to have to urinate frequently. All
(33:21):
I'm saying is, in my experience, it's an enlarged prostate
that typically causes I would say high percentage of the
nocturia issues in men I would say at least ninety percent.
And certainly we get a PSA right, which stands for
prostate specific enigen It's a hormone that is directly tied
(33:44):
to prostate. A lot of times if there's any enlargement
of the prostate, if there's any infection of the prostate
or irritation of the prostate, and certainly we sort of
know it's relationship with prostate answer, the prostate level will
start to rise, and normally a normal prostate is between
(34:06):
one to four. So anytime it goes above that, it's
a bit more pathological rise our level and we start
to get a little bit nervous about some sort of
active prostate disorder. Now, can you have an enlarged prostate
with the normal PSA? Absolutely, we say that all the time.
(34:28):
Doctors can perform what they call a digital rectal examination
or DRE for short, DRE to basically palpate the prostate
a little uncomfortable for most patients and sometimes for practitioners. Again,
it's fallen out of favor for routine prostate cancer screening controversial.
(34:53):
I'm not a big fan of it, but there are
still some doctors who are doing those. Again, because when
you do this particular exam, you're only able to examine
a part portion of the procetate, not the whole prostate,
and so there can be pathological issues on the part
(35:13):
that you do not palpaid. So it's sort of an
ineffective exam in terms of feeling the whole prostate. So
because it's sort of uncomfortable, it's not giving you all
the information you need. It's sort of gotten controverse in
terms of its need to be done for prostate cancer screening,
(35:34):
but again some doctors are still doing it, but certainly
the PSA level is still very popular. It's a very
sensitive test, but sometimes non specific, meaning your PSA can
be elevated because of an infection, maybe because it's just big,
or maybe because of prostay cancer. So a lot of
(35:57):
times for me primary care physician, if we see a
person who has an elevated PSA, we will certainly refer
them to the prostate doctor or urologist so that they
can sort of help us figure out why is the
PSA elevated. It's not always because of cancer. It sometimes
can just be from an enlarged prostate, but normally with nacturia,
(36:21):
those are sort of the things that we think about.
And the good thing is that we have good medicines
that are very effective to help reduce the frequency of
haven urinate at night. So if it is your prostate,
we have a few medicines that we can use to
kind of open up that obstruction or relieve that obstruction.
You know them as flomax or tamsialosin or the probably
(36:47):
the most commonly prescribed medication for that. An old medicine
that was used when I was coming out is called
hydron hytrn had some issues with lowering your blood pressure
causing some dizziness and so it's a little dirty, had
some side effects, and so this new class of medicines
(37:08):
Flomax came out or tamsillosin, and has really allowed us
to medicate that particular problem with minimal side effect issues.
But if we find an infection, we give you antibiotic
which normally helps with that. Again, sometimes the prostate can
get infected, but there's normally good antibiotics for that. And
(37:30):
you know, if it's blood, we normally will send you
to a urologist so that they can do their evaluation
a lot of times looking actually inside the bladder to
see maybe why there's blood in your urine. But normally, yes,
we can get the nocturia fixed and most of the
time it is from the prostates. I hopefully that answered
your question. Bonelines are open eight nine six scalv I
(37:52):
won one hundred three three zero Kova. I'll be back
in two minutes. All right, welcome back to DOCTA me
metagad phone lines I open eight nine six kov I
want one hundred and three three zero Okovia talking about nocturia,
(38:17):
and I did prioritize guys as normally prostate issue. But
for ladies, when they start urinating a lot at night,
a lot of times, that indicates what we call overactive bladder.
And guys can get that too, but it's just less common.
But for ladies, because of things like childbirth and menopause,
(38:40):
the bladder very close to the intestines and the vaginal area.
A lot of times, because of a weakness of the
what we call pelvic floor, things start to sort of
fall a little bit and the bladder sort of gets
reaped positioned and loses its normal orientation, and that certainly
(39:04):
causes the dynamics of the urine flow and how the
bladder functions. But one common element is sort of this
disconnect that the bladder gets from the central nervous system
i e. The brain, where for the most part, when
things are working, the brain sort of talks with the
bladder and the bladder talks with the brain, and things
(39:27):
are sort of under control, where if you don't need
to urinate, you don't have to. But certainly when your
bladder fills up with urine, you go to the restroom.
It's a nice little system. But unfortunately for ladies when
they get older, that system breaks down and the bladder
sort of becomes more independent and is causing you or
giving you the sensation that you have to urinate all
(39:49):
the time, that sort of discomfort that you get in
your lower abdomen. And we call that overactive bladder. And
not quite sure why some ladies get it in some don't,
but that seems to be the bigger, more common issue
as a female gets older. And again, good medications on
(40:11):
the market for that, several actually that have been put
on the market to help control that. We sort of
go through the same sort of process of elimination with
checking the urine. Sometimes, yes, we will do blood work.
Sometimes we will do some imaging again to look at
the bladder and see if there's anything else going on,
(40:32):
because certainly, like I said, as the pelvic floor weakens,
then the bladder falls and gets repositioned. Sometimes it can
cause obstruction of urine flow, just like with the guy
with the prostate. For ladies, it's because the bladder is
sort of in the wrong position and it starts to
retain urine and again those same dynamics or what we
(40:57):
call eurodynamics that occurs with a who has a big prostate.
Ladies can get sort of the same issue where the
urine is not able to get out again because there's
sort of a kinking or narrowing of the exit site
of the bladder because it's sort of in a different
position it was years ago, and we treat that a
(41:20):
little bit differently. Most of the time you have to
get to a urologist because of the anatomy, and the
lady's anatomy is a little bit more complicated. We certainly
can try flomax, same thing and late men will try
it in ladies to see if they can get them
some relief, but a lot of times they will have
(41:40):
to go to the urologists for a more complete evaluation
and maybe some other medical or even mechanical therapeutics to
resolve that issue. For overactive bladder, whole list of medications
that work very well and can get that tame down.
But again, if it's an infection, we have a slew
(42:01):
of antibotics. If it's you know, other processes, again, the
urologists are there to sort of help us out and certainly. Yes,
we want to check for sugar and other issues that
can cause the frequent urination as well, so hopefully that
answer your question for nocturia. We'll appreciate you checking in
(42:21):
this week again. Reminder, go get those vaccines and don't
drink and drive, and drink some water every now and then.
We'll see you guys, think week. Take care,
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