Participants: Dr. James Marcum (Host), Carlton Vollberg
Series Code: BRX
Program Code: BRX00012B
00:01 Welcome back!
00:03 We have been talking about how to prevent disease with
00:04 Dr. Carlton Vollberg.
00:06 I have worked with Carlton
00:07 Vollberg for years and he is
00:09 great at preventative medicine.
00:10 Many people do not understand how important prevention is.
00:13 How it can save a life.
00:16 He can prevent a lot of un-needed medications and
00:18 treatments down the road.
00:20 So that is what we are talking about today,
00:21 is how to prevent problems.
00:23 Dr. Vollberg our next question regards prostate.
00:27 This gentleman writes from San Diego and his name is Bob.
00:30 He says:
00:38 So I guess the first thing we have to know is What is a PSA?
00:41 Prosthetic Specific Antigen,
00:43 and yes you should be concerned.
00:46 If you are in your early 40's and have an elevated
00:48 PSA it needs to be addressed.
00:50 I don't know if this specifies how high the PSA is,
00:52 but regardless I'm assuming it is over 4.
00:55 4 is the upper limits of normal.
00:57 The real point here is that if you are 42 or 43, a 4
01:01 is too high, it should be down in the 2's.
01:04 So we also have to look at family history.
01:08 Does your father, does your grandfather, do any of these
01:11 people have a history of prostate cancer?
01:13 This is prostate cancer until proven otherwise.
01:15 He needs a biopsy, it is that simple.
01:17 I would get to the doctor without delay and have this
01:19 taking care of.
01:20 There are some good treatment options if you
01:22 do have prostate cancer, it may very well not
01:24 be prostate cancer.
01:26 It may be Benign Prosthetic Hypertrophy.
01:28 That can be treated conservatively and
01:31 with good results.
01:33 So we want to make sure there is no prostate cancer.
01:35 So you wouldn't wait 6 months and then repeat it
01:37 and see if we have 2 high ones?
01:39 No, recently in fact, in the last 6 months
01:42 I have had 2 men in their 40's.
01:44 I had one that was 42 and then one that was 47,
01:47 and both these people came in with a borderline PSA.
01:51 It was a round 4.
01:52 But it was higher than normal right?
01:53 It was just outside of the range, and even if it had
01:56 been 3.8 they would have gone to see the urologist
01:58 because if you are under 50 you clearly
02:01 should be less than 4.0.
02:03 Now what is a urologist?
02:04 A urologist is a specialist in prostate and bladder.
02:07 Good, they are the ones that do the biopsies?
02:09 They are the ones that do the biopsies and so what I generally
02:10 do, I don't make the decision if they
02:12 are going to get a biopsy or not.
02:13 My job is to make sure I don't miss anything.
02:15 So what I am going to do is to send this person to the
02:18 urologist and have them look at the patient.
02:20 If they decide they want to watch it for 6 months,
02:21 I am going to defer to their judgment because
02:23 I use good the people.
02:24 I trust them, but I think by and large,
02:27 if you are under 50 and you have a PSA that is 4
02:29 or greater, they are probably going to do a biopsy.
02:31 Now when would you start checking this lab test
02:34 PSA to look for prostate problems?
02:36 How old are you when you start checking that?
02:38 That is a very good question.
02:39 There have been some controversy with the
02:40 PSA in the past.
02:41 When do you start?
02:42 Do you start at 50?
02:43 Do you start at 40?
02:44 There is a couple of factors that you have to
02:46 look at, generally speaking it is 50.
02:49 There have been some studies that I have seen that suggest
02:51 that maybe we should start looking at a little bit earlier.
02:53 Certainly if there is a family history,
02:55 you are going to start checking it.
02:57 If your dad had prostate cancer at 42 you are not going to
03:00 wait until 50 to have yours checked.
03:02 You will probably want to just check it a little bit
03:04 sooner than your parent or grandparent had
03:06 if they had prostate cancer.
03:08 Now let's talk about the process.
03:10 You've heard that men have prostate cancer that just
03:12 lies there dormant, that everyone has it.
03:14 Is there much truth to that?
03:16 It probably is, I think most men live long enough
03:19 there is a very good chance they are going
03:20 to get prostate cancer.
03:21 If you get prostate cancer and you are
03:24 85 or 90 years old,
03:26 it's probably not going to end your life.
03:27 But if you are 40 or 45 or 50 then you need to
03:29 think about being a little more aggressive.
03:32 You wouldn't necessarily check an 85-year-old?
03:35 That's a judgment call, you talk to the patient
03:38 about these things and I have a patient right now
03:41 that is 92 years old.
03:42 This guy is on no medication, he is probably one
03:45 of the healthiest patients in my practice.
03:47 He's an Adventist, and practices a good lifestyle,
03:50 he is a vegetarian, and this gentleman had an elevated
03:53 PSA so I discuss the options with him, because I think
03:56 he may live another 10 or 15 years.
03:58 Okay, I hope that answers your question Bob.
04:02 Let's go to the next question.
04:03 It comes from Ken in Nebraska and Ken says:
04:18 I guess we need to talk about his family history of colon
04:21 cancer, when should he have the screening colonoscopy?
04:23 And what is a colonoscopy?
04:24 Well a colonoscopy is a test that is used to either
04:28 look at preventing colon cancer, or if you have colon
04:31 cancer they can use this test to find it and locate
04:34 it and get a biopsy.
04:35 Recommendations for individuals 50 or older should
04:39 have a baseline screening colonoscopy.
04:41 No questions asked, 50 years old you need
04:43 a colonoscopy, period.
04:45 If there is any family history of colon cancer,
04:48 first-degree relative, father, mother, sister, brother.
04:51 10 years before the index case, in this case if the individual
04:57 was in his 50's, you want to start in the 40's.
05:00 So for instance, my grandfather had Metastatic
05:04 Colon Cancer at 46.
05:05 He was not a first-degree relative, but I elected to
05:07 have a colonoscopy in my mid- 30's.
05:09 It was probably a little aggressive,
05:11 but I did it for peace of mind.
05:13 My mother on the other hand needed to go in
05:15 10 years early to have hers done.
05:17 So it is very important that you look at this.
05:19 Colin cancer is definitely preventable.
05:22 That is why screening is highly recommended,
05:25 if you don't screen for it you are not going to know.
05:27 And you may not know, you may not have any bleeding.
05:30 I mean you just may all of a sudden one day start
05:32 losing weight and then it is too late.
05:34 Once the cancer spreads, it is very hard to treat it.
05:37 Is a colonoscopy rather uncomfortable?
05:39 Isn't that where they put it up the rectum and look around.
05:42 Right, it sounds worse than it is.
05:46 Truthfully you are not going to remember the colonoscopy.
05:48 The worst part about it is the prep.
05:49 So the night before they make you drink this material
05:54 that helps you go to the bathroom.
05:56 You will be going to the bathroom about every hour
05:58 for about 4 or 5 hours to get a completely clean out.
06:00 And that is worse than the colonoscopy.
06:02 When you go in for the colonoscopy, they put an IV in,
06:04 and they give you some medication, they sedate you
06:06 and you don't remember anything.
06:07 That is the easy part.
06:09 They clean you out so they can see around right?
06:11 They clean you out the night before in for about
06:13 4 hours is not very much fun.
06:15 We know getting back to being uncomfortable, some of these
06:17 screening tests, I bet they do not sound too comfortable?
06:20 Do you still do the rectal exam for prostate?
06:21 Or did they quit doing that?
06:23 No and that is another a good question.
06:24 Because I don't think I would want that.
06:26 I have had patients come into my office,
06:27 and they are 50 or 55 years old,
06:30 and I will say when was your last rectal exam?
06:32 They will say I haven't had one for 5 or 6 years.
06:34 Well did they check the PSA?
06:36 Well they always check the PSA.
06:37 Here's the interesting point about that for men.
06:41 You can have a normal PSA and have prostate cancer.
06:44 So you have to do a digital rectal exam.
06:47 You may feel a nodule, you may feel something up there.
06:49 You may even feel a mass in the Cecum,
06:52 in the rectum, so.
06:54 You have to do the digital rectal exam every year.
06:57 And women should have it as well.
06:59 Even though they do not have a prostate, when they have their
07:01 GYN exam, they have a rectal exam done.
07:04 So it is not much fun, but I have been able to detect
07:07 a mass in the rectum before, and we have felt nodules
07:10 on the prostate with people with a normal PSA.
07:12 I have people with a real high PSA,
07:14 and they do not have prostate cancer.
07:16 I guess we have something to look forward to.
07:18 You have something to look forward to.
07:20 Well tell me this, do you still have them turned to
07:23 the left and cough and all that?
07:24 Well the reason you have them turn to the left is
07:27 that you do not want them to cough on you.
07:29 So that is the reason you had them do that.
07:31 Okay, well that is all part of a good physical.
07:33 Yes, that is part of a good physical.
07:34 Well let's go back to the questions here.
07:36 This is Jill from Ontario Canada and she says:
07:47 So I assumed that Jill's blood sugar is starting to
07:49 go up and she doesn't want take medicine.
07:51 Well Jill I think it is reasonable, depending on
07:54 your blood sugar is to try some conservative therapies.
07:57 Put you on a diabetic diet, get involved in an exercise
08:00 program, unfortunately many people that come to see me,
08:04 do not want to make the sacrifices they need to.
08:06 They come in and say they do not want any medication.
08:08 So I say what are you prepared to do?
08:10 Are you willing to go on a diet?
08:12 Are you willing to lose 30 or 40 pounds?
08:14 Are you willing to try and do an hour of
08:17 exercise 5 days a week?
08:18 Invariably most of these people don't want to do it
08:22 and they end up wanting an easier fix.
08:24 They take the medicine?
08:26 They'd rather take a pill, and I think in many
08:27 ways we are a overmedicated society.
08:29 I think medications have their place,
08:31 but it is nice to occasionally see somebody that
08:33 wants to try and control it with lifestyle changes.
08:36 It is very appropriate, if your sugar is just a
08:38 little bit borderline, a little bit high,
08:40 try some lifestyle changes.
08:41 Exercise is very important to get the weight down.
08:44 I think as long as you are being supervised.
08:47 by your doctor it is reasonable to try a diet.
08:50 Now I know you are very active in spiritual
08:53 aspects of your patients.
08:54 When you come in with the routine physical,
08:57 you do not want to hit everyone over the head,
08:59 but how do you introduce God and the spiritual aspect?
09:03 Like we believe that we can change chemistry through the
09:06 Bible, "a merry heart doeth good like medicines. "
09:09 Rest is very important.
09:10 Like you said exercise, how do we get people to
09:13 plug-in to that Higher Power?
09:15 I think, as in any aspect of life, leading by example
09:19 is the best thing that you can do.
09:20 Where appropriate, if patients ask me to have a prayer
09:23 with them, or if they want some guidance in that area,
09:26 I am more than happy to pray with my patients.
09:29 I try not to overburdened people with religion and
09:33 spirituality because I think that my example,
09:37 if I am living up to what I know is right, should be
09:40 sufficient to help them hopefully see
09:43 what is leading me, which is Jesus Christ.
09:46 So when people ask me to pray with them,
09:49 or they asked me to keep them in my prayers
09:52 and their prayers, I try to do that for them.
09:55 We have some books and literature in the office,
09:59 nondenominational literature that people find enjoyable
10:03 that have some healthy principles for living and I try
10:06 to encourage people to read those as well.
10:08 It's always exciting when God answers a prayer.
10:11 I see when someone you pray they will be able to have the courage
10:14 to exercise, that they will do it and see
10:16 God working in their life.
10:17 It is very, very exciting.
10:18 As a primary care physician,
10:20 people become attached to me.
10:21 So they may see a specialist,
10:23 but they always want to come back and get my opinion.
10:27 They trust me and so that is a tough situation to be
10:30 in sometimes come because you care about these people.
10:33 You want to help them.
10:34 So we have many people that come in and they ask us
10:37 to keep them in our prayers and we are certainly
10:40 happy to do that for them.
10:41 I think that is what's great about medicine,
10:43 that you can have someone that you can identify with,
10:46 and go to and trust and not only talk about the
10:49 physical problems, but you can also go to the spiritual
10:53 problems as well, because you work on different
10:55 aspects of healing.
10:58 Well let's go to our next question from Joan,
11:00 she is writing from Fort Myers Florida and she says:
11:17 So she is asking about Alzheimer's disease.
11:20 Is there anything we can do to prevent it?
11:22 If they are getting Alzheimer's, is there anything
11:25 we can do to treat it?
11:26 That is a very good question Joan, unfortunately
11:28 there is nothing you can do to prevent it.
11:30 If he is going to get it, he is going to get it.
11:32 Now there are some medications out there that can
11:35 slow this down, maybe keep him in a normal state
11:37 a little bit longer and help him to adjust to his
11:39 surroundings and live a little more fruitful life.
11:42 But he is 84 or 85 years old, so he is already pretty
11:45 old and has lived 14, 15 years past normal life expectancy,
11:48 so thank God for that
11:50 but I think at this point, what will probably need to happen,
11:54 he would need to get a good examination done.
11:56 Make sure he does not have a B12 deficiency or some
12:00 other medical reason for him to have Dementia.
12:02 Then if all those things check out and they are
12:05 negative, then I would probably send him to see a neurologist,
12:07 maybe even get an MRI of the brain
12:09 to make sure he hasn't had a stroke.
12:11 Sometimes you have a stroke in a certain area,
12:13 it can affect those things and almost act like Dementia.
12:16 So it is important to make sure he does not have a tumor,
12:19 or a stroke, or some metabolic process going on in his system
12:23 that could be causing him to have these difficulties.
12:25 Now there are some medications out there that are
12:28 used to treat this kind of condition.
12:30 Have you seen them be very useful?
12:32 Some of these medications, there is a couple medications
12:36 out there, Namenda, things like Aricept, medications that
12:39 are commonly used to treat different types of Dementia.
12:42 Really again it depends on if he does have Alzheimer's.
12:46 What if he has Multi-infarct Dementia.
12:49 Where he has had many strokes, sometimes those medications
12:52 do not help very much with that.
12:54 It is important to get the diagnosis.
12:56 Having see his primary care doctor and
12:58 get a basic workup.
12:59 Then if needed be referred to a sub specialist.
13:02 This next one is from Laurie in Washington and
13:04 it is a short question.
13:12 That's a very good question.
13:14 Do you need them both?
13:15 Well it depends, many family practitioners and even
13:19 Internalists will do routine GYN exams.
13:22 I'm an internist and I elected not to do that.
13:25 It is not something that I really enjoy.
13:26 I do have an extender in the office that does some
13:29 of those exams for my patients,
13:31 but by large I send most of those off to a GYN doctor.
13:34 They do those studies all day long and they are much
13:37 better doing it by manual exam I am.
13:39 I decided that I'm going to probably stay
13:43 out of that realm.
13:44 As far as having a GYN doctor do your primary care,
13:48 I think GYN's are very good at what they do.
13:52 They are surgeons and are very good at delivering babies.
13:55 Very good in women's health, but they are probably not
13:57 the best trained to handle hypertension and diabetes.
14:00 They probably are not completely up on all different screening
14:04 tests, now some of them may be.
14:06 I would probably say you need to have a primary care
14:09 physician as well.
14:10 I would agree with that.
14:11 Okay the next question will talk about cholesterol.
14:26 So he has a family history of very high cholesterol.
14:28 And we know how old again?
14:30 His dad was in his 70's, so that probably will put
14:32 him in the 50's, 40's to 50's.
14:35 So we said the LDL was how high?
14:37 180! - 180! And the father has had cardiovascular disease?
14:41 There is a couple of things to look at.
14:44 You have a family member with heart disease.
14:46 A family member with high cholesterol.
14:49 You have high cholesterol, depending on what your age is,
14:52 I am assuming your age is probably middle age or beyond.
14:55 So you have some risks there.
14:57 You need to have a good cardiovascular workup,
14:59 treadmill, make sure there is nothing going on.
15:01 Chances are pretty good that if your father had
15:03 heart disease you may develop heart disease.
15:05 I definitely would do a workup to make sure that's fine.
15:08 Really you need to work on getting your cholesterol down.
15:11 If you were my patient, I would probably end up
15:14 recommending some medical therapy as well
15:15 as a comprehensive lifestyle modification program.
15:19 Most people tolerate the cholesterol
15:20 medications very well.
15:22 Yes the cholesterol medications are very safe and
15:24 well tolerated generally speaking, they do require a
15:26 little bit of surveillance,
15:28 liver functions and so forth.
15:29 But by large they are well tolerated.
15:31 You know there has been a lot of news about
15:34 cholesterol recently, but I think I would rather
15:38 take a cholesterol medication.
15:39 I think the risk of cardiovascular is far greater
15:42 than the side effects of the medicine.
15:43 Absolutely! I think there's a lot of data both
15:45 for primary and secondary prevention,
15:47 particularly some of the older drugs,
15:48 that would suggest that you could prevent first or
15:52 second heart attacks or strokes
15:54 if you take the medication.
15:55 We have thirty seconds to answer this one.
16:04 I guess they talk about depression and that stuff.
16:07 Is there anything they can do for that?
16:08 I think reassurance and get your annual physical
16:10 every year and make sure you talk to your doctor
16:11 about your concerns and your complaints.
16:13 Look at family history and make sure that
16:15 you keep up with your spiritual life.
16:17 That you pray, that you look to God, and you also
16:20 maintain your exercise program and all those things
16:24 together will help you be a better person.
16:27 Well you know we touched based on prevention.
16:30 We talked about colonoscopy and screening for prostate.
16:33 the bowels, blood pressure, cholesterol and mental health.
16:37 I mean if we can prevent one person out there, what would you
16:41 tell someone, after listening today my advice would be for
16:45 anybody to just be checked.
16:46 Right! I think you need to take a step, go see a doctor.
16:49 Find somebody that will really sit down with you.
16:52 Look around in your community and if you ask around
16:54 there is always going to be 2 or 3 names that come up.
16:56 Find that doctor, go in and press them.
17:00 Do not expect them to come to you.
17:02 Take your list in there, I have had patients come to
17:04 me and say my father died of this, my mother had this,
17:07 what do we need to be doing based on my age,
17:09 and then we develop a comprehensive program.
17:11 Excellent advice!
17:13 We want to thank you for joining us today as we talked
17:16 about ways to prevent disease.
17:17 Thank you and we will see you next time!