Something all men eventually face...

Mike Leventhal is straight up when he explains that there are three things all men eventually face: death, taxes and an enlarged prostate. He should know - as the Executive Director for the Tennessee affiliate of Men's Health Network, Mike has spent his career helping men improve their physical and mental well being. Today he talks with us about caring for your prostate as you get older and, for those men who have had their prostates removed, how to manage the incontinence that's usually associated with the procedure.
 
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Music:
Rainbows Kevin MacLeod (incompetech.com)
Licensed under Creative Commons: By Attribution 3.0 License
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Transcript

Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America's leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers, all available at NAFC.org. 

Welcome back to another episode of Life Without Leaks. I'm your host, Bruce Kassover, and joining us today is Steve Gregg, the Executive Director for the National Association for Continence. Welcome, Steve. 

Steve Gregg: Thank you, Bruce. Looking forward to this today. This ought to be great.

Bruce Kassover: Yeah, I think it's going to be. Today's guest is a friend of the podcast. It's Mike Leventhal. You may remember that he's been on previously talking about his role as the executive director for the Tennessee affiliate of the Men’s Health Network, and he spoke with us about a lot of the good work that Men’s Health Network does to try and bring messages of better health prevention, taking care of themselves to men everywhere around the country, and with Mike's focus, particularly on the Southeastern United States. So welcome, Mike. Thank you for joining us again. 

Mike Leventhal: Great to be back. 

Bruce Kassover: Tell us this, today, one of the things that I was hoping we could talk about, we've spoken about Men’s Health Network as an organization and its general goals, but maybe you want to tell us a little bit about some of the specific conditions that you guys tend to focus on a lot, particularly those that might be relevant to listeners and people who are visiting the National Association for Continence to try and learn more. 

Mike Leventhal: Well, the way I describe Men's Health, Bruce, is it's a very big tent, but the primary occupant is prostate cancer and prostate cancer awareness.

It's embedded in all of Men’s Health Network's programs and activities, including the prostate screenings that I mentioned when I was on our last podcast. BPH awareness campaigns, prostate education campaigns, publications, websites, and other resources devoted to prostate health. 

Bruce Kassover: Yeah, that's something that we've actually been trying to focus a lot more on recently because I mean, it really is something that is both very widely experienced, I mean, enormous numbers of men find that they have to deal with it, but also something that really is for many cases, very, very treatable. So what is your experience with the sort of people that you guys deal with? Is it something that men seem to be relatively aware of, or is it still something that's sort of mysterious to a lot of folks?

Mike Leventhal: Well, when I first got started 20 years ago, it was certainly something that that most men didn't want to talk about. And oftentimes the word ‘prostate’ would even make them blush today. I think it's gotten a little bit more mainstream. People are talking more about the benefits of early detection. Some of the treatment options have changed, too. And as you know, Bruce, if it's caught early, it's a hundred percent treatable. 

Bruce Kassover: Yeah. That is one of the things that we definitely try to stress is that people need to go and bite the bullet and do the thing that they don't want to do, which is get their prostate checked. Because if they find it early, there are so many different ways that it can be treated that it doesn't have to be as terrible as a lot of people imagine that it is. Do you find that there are a lot of misconceptions out there about it also?

Mike Leventhal: Oh, absolutely. I mean, men hate going to the doctor. And so because of that, oftentimes they don't get those diagnostic tests like a PSA early enough, and by the time they do go see a doctor because they've started having symptoms, or maybe they went to a doctor for another particular reason, because you know, prostate cancer is a silent killer. There really are no symptoms. They go to the doctor and they're told they have prostate cancer and they get angry and they're angry because they went to the doctor because before they went to the doctor, they didn't have prostate cancer.

Bruce Kassover: That's right. That's what caused it. That's the reason why it happened. 

Mike Leventhal: It was caused by the exam or men in their seventies to tell me, “I don't need to go to the doctor until I'm older.” I can go down a list of the different excuses that I've heard throughout my career about why they're not going to the doctor, why they're ignoring their health, why it's not important to them.

Bruce Kassover: Its, you know, one of the things that, that I'm sort of getting the feeling could actually be one of the downsides to the fact that we seem to be generally a lot healthier today than we have been in the past is that, you know, somebody who's 70 today doesn't look like or act like somebody who was 70 back when I was young and, and when, you know, a lot of us, if you remember, you know, what your grandparents were like when they were in their 70s, I bet you that they seemed a lot older than a 70 or 75 year old today is. Do you find that also? 

Mike Leventhal: Oh, absolutely. You're absolutely right. I go to the gym every day and I work out with guys that are 75, 78, and I would never, you would never know that by looking at them. They've done a great job on being well preserved. 

Bruce Kassover: Yeah. And I guess that's part of the reason why people will sit there and say, oh, I don't need to go to the doctor. Look at me. I'm in fantastic. I'm Jack LaLanne. 

Mike Leventhal: Oh yeah. That's a good one. Yeah. 

Bruce Kassover: Yes. Except for the fact that you know what, your body still ages and your cells still die and diseases still come and you still have to deal with them. 

Mike Leventhal: No question about it. And even if you are healthy and even if you do go to the gym every day and you eat right, you get plenty of sleep, you know, you still need to go and get those important diagnostic tests at least once a year.

Bruce Kassover: Yes. So now tell me this. So what does the Men’s Health Network do to help promote prostate health and prostate exams? 

Mike Leventhal: Well, of course, everything we've got is online. Everything is digital. So a prostate cancer awareness month, which is the month of September, we do widespread promotion when it comes to the importance of early detection when it comes to prostate cancer, but also BPH awareness.

You know, there's three things in life that are guaranteed. If you're a guy, death, taxes, and as you get older, enlarge prostate. So it's so important that guys realize that first of all, BPH and prostate cancer are mutually exclusive. There’s no direct correlation between those two particular conditions, diseases, and that it's easily treatable, again, with medication, with potential treatments. You can live a good quality of life with a condition like BPH. 

Steve Gregg: Hey, Mike, you've talked a lot about being educated about the prostate and aging and prostate exams. When does a man really need to start going in and having those conversations with his doctor, and how regularly does he need to have his prostate checked? And what are some of the diagnostic tests that he might be told about that would help understand the condition of his prostate?

Mike Leventhal: Sure. So, you know, prostate cancer is, as we know, is one of the most common forms of cancer in men. It can be cured early if detected early. Men at high risk should absolutely talk to their health care provider about screening, about prostate cancer age 40 or earlier. Others age 50. Now we're talking about men that are at high risk. And that includes men that have a family history of prostate cancer, African American men, men who were exposed to chemical agents like Agent Orange in the Vietnam War, and also Native American men.

But African American men have the highest rates of prostate cancer and absolutely should begin screening at age 40. And some of the tests that are available, you know, the PSA test, which is just a simple blood test that can often detect prostate cancer, and the digital rectal exam, which is the dreaded gloved finger test where a doctor simply puts a gloved finger into a man's rectum to physically feel the prostate for any type of abnormalities or enlargement.

There's also MRIs that can be done also on the prostate. So, yeah, there's several different diagnostic testing's available, but the PSA seems to be the gold standard. We're very fortunate to be able to have that test done nowadays, about 6 bucks a test. So that that's pretty reasonable for… 

Steve Gregg: So the key dates are 40, and if you're, if you're not African American and you're at low risk, maybe 50.

Mike Leventhal: Correct.

Steve Gregg: You'll have a in office exam and then a PSA test seems very reasonable and very straightforward. Now, we just need to do it. 

Mike Leventhal: Absolutely. I don't like to use the word ‘man up,’ but in this case, you know, yeah, you, you've got to take charge and do it. Absolutely. 

Bruce Kassover: I'm impressed by that 6 figure. I know, Steve, you have some thoughts about how costs and pricing has really had a, you know, a terrible effect on our health care system in general and, and, you know, how we tend to be a health care system that's more focused on curing things that exist then addressing things beforehand.

Steve Gregg: You know, listening to Mike talk, I was struck by the fact that if we took his advice, and men and women and started our screening earlier and then started preventative medicine, we could save a lot of money, both personally and to the healthcare system.

But so far, it doesn't seem to be something that we're, we've been able to encourage folks or compensate folks for prevention versus getting sick. And so I'm sure Mike would say, without putting words in his mouth, aside from the consequences of the cancer, boy, you sure would be better off if you started earlier and you looked at prevention versus disease treatment. Is that a fair statement, Mike? 

Mike Leventhal: Oh, yeah, you're spot on. Some of the guys that I know that have battled prostate cancer and are continuing to battle prostate cancer have confided in me and said, “I wish I, I was, you know, would have followed the advice of, of my neighbor and loved ones.” One man, in particular, his neighbor was a prostate cancer survivor, lived in one of these planned communities where, you know, everybody's living next door to each other, very close by, and they develop close relationships.

His neighbor had prostate cancer and he became an advocate and encouraged Ralph to get his prostate checked and he just, he put it off until he finally did go in, and he had advanced prostate cancer. And so now he's living with advanced prostate cancer as a chronic disease, and his quality of life is not what he expected it to be in his golden years. So I would second that – as Smokey Robinson would say, I second that emotion. 

Bruce Kassover: Yeah, I think that that one of the worst things to experience is regret. You know, in all of us, you know, we can think back and cringe or feel bad about things that we regret that, you know, have somehow influenced our lives, but especially regretting doing something that simple that could literally have a genuinely life or death effect has got to really be terrible.

So, yeah, I think that taking your advice is super important for people to do. But that does lead to, you know, you do take your advice, you go to the doctor, and I know you've mentioned that there are medications and things, but there's one thing that I want to talk about that's particularly relevant to the National Association for Continence and those who come to us for advice and insight and that is the fact that if you have prostate surgery, it's almost guaranteed that you're going to experience incontinence afterwards for at least a certain period of time. Is that something… now look, talking to people about getting their prostate exam examined is challenging; how hard is it, from your perspective, to talk to men about incontinence?

Mike Leventhal: Yeah. You know, stress incontinence and urge incontinence are absolutely associated with prostate cancer and treatment for prostate cancer. And it is a very, very sensitive subject to bring up. And so we, we oftentimes at Men’s Health Network are looking for new ways and maybe this is a way you could help us with trying to reach men about these subjects.

Obviously, you know, we all know what the ways to be able to live with incontinence are, you know, the pads and those types of things. And nobody wants to necessarily do that. I was at a prostate cancer survivorship symposium at Vanderbilt University this fall and listened to a discussion and it was, I know that it was also featured at AUA this past week, wat the artificial urinary sphincter. Steve, you're aware of this, aren't you? 

Steve Gregg: Yes. Yes, I am. 

Mike Leventhal: Yeah. Yeah. I just thought that this is a life change. I don't know what your opinion is. I just know enough to be dangerous about this. But after listening to the presentation at Vanderbilt and then the one at AUA this week, it seems like this device is life changing and this device can certainly help improve quality of life, especially for guys that are in prostate cancer survivorship mode. I'd like to know your thoughts. 

Steve Gregg: So, Mike, you have the bladder, which holds urine. And then coming out of the bladder, there's a little teeny sphincter, like you're talking about. And for the average person, it's sort of like an on off switch, squeezes shut so it doesn't, so fluid doesn't go through. Then the fluid passes through the prostate and then below the prostate there's another sphincter. So there are 2 sphincters and that's why it works – particularly when we're young – relatively easily. We don't leak too much, and you go to the bathroom, we can hold it a little bit longer. 

After a total prostate surgery, prostatectomy, oftentimes one of those sphincters is taken out. It's removed as part of the surgery, which means where I used to have the benefit of 2 sphincters, you know, two on off switches, I now only have one. And so the likelihood of leaking is increased. So there's a couple of things you can do about that. One is pelvic floor exercises to strengthen all the muscles to make my one good on-off switch better. Or two, depending on the severity, you know, could I replace one of those sphincters that was taken out? Well, that's really hard to do. But there's a lot of work in trying to create a sphincter that might fit, to make sure that you have a really great sphincter or you have two good sphincters. And they've been working on this for quite a while.

And so hopefully we'll start to see more of it. The big challenge we see, Mike, is Vanderbilt is a great urological institution, and there are several great urological institutions around America. The difficulty for a man to get to one of those institutions that has expertise, the doctors and know-how is often really tough. Because there are, as we heard recently at a meeting, there are not enough urologists in America. They're not necessarily geographically spread. They tend to be in larger urban areas. And so it's a challenge for him. That said, we would encourage listeners, men or their spouses, if that is something that he continues to leak and he can't find quality care, let us know or let you know, and we can get them to a center. Most of those centers are large urban practices, you know, New York, Philadelphia, D. C., Miami, Atlanta, easy. Smaller rural towns in America, not so easy. 

Mike Leventhal: Yeah, so it sounds like it's not for everybody, but this technology is exciting, and the people who have talked about their experience with the device itself, in fact, there was one gentleman there, he was so moved, he was almost moved to tears at the story of the couple that that basically said it's changed their life. It's turned their life around. So, it's just, you know, something that I'm excited about, the future of prostate cancer survivorship. 

Steve Gregg: I think the place that you and I both would agree is the message that we send repeatedly is “don't give up.” Don't ever give up. There is a solution for you. And there's, there are some really great folks, docs, that know what to do. And so, if you go see a doctor and he says, “Hey, Mike, I'm sorry. There's nothing I can do,” that's not the answer. You know, Valvano, thank you. Don't give up. Don't ever give up and come to your organization or ours and we can help you find a solution, but don't give up.

Mike Leventhal: Yes. And also, one of the things that I would like to bring up in regards to this sense of urgency that you have oftentimes when you're, when you're suffering from incontinence, ad especially among elderly people, are the risk for falls, falls in the middle of the night, trying to get from your bed to your bathroom.

As we all know, falls are the number one cause of injury and oftentimes death, too, among the geriatric population. And so, when you are waking up in the middle of the night, you're, you're half asleep. You're struggling to get out of bed. You're rushing to go to the bathroom. That's when accidents can happen.  And I mean falls. And so it's, that's something also to be very mindful of. I don't know what the solution is for that – if, if this artificial sphincter can help with that or not – but it's certainly something that we need to be aware of that is a risk factor. 

Steve Gregg: So, Mike, I think there are 3 general solutions. First is to understand what your drinking habits are, particularly later in the day and evening. So, for example, three martinis after 10 o'clock, that's probably not helping your managing your voiding in the middle of the night. But assuming that you're not drinking caffeinated beverages late or alcohol, which causes your urine formation late, that's sort of the first step.

The second step is, which is true for anybody, regardless of whether they're going to the bathroom a lot, is make sure you have a clear path between the bed and the bathroom. Dog toys, clothes on the floor, slippers. We hear that a lot, particularly from the data from the CDC on falls and older adults at night, you know, so make sure you have a clear path.

And then the 3rd one, before you really get to treatments are, you know, as you get older, one of the challenges that folks have is a blood pressure issue, right? So, you're laying down, you're sitting on the edge of the bed. If you try to get up really quickly, a lot of folks will find that they're a little wobbly or a little lightheaded.

So, sitting on the side of the bed for a moment is great. If, however, you have an urgency, then that's contraindicated, right? I can't sit on the edge of the bed. And so, at that point, you do 1 of 2 things. One is, you use a small absorbent product that you can put on and pull down in case you leak a little bit on the way to the bathroom, and in that way, you're not wet.

And then secondly, you go in to see your urologist and get treated for what the condition is. And if it's overactive bladder, that is, the nerves are too active, or what's called nocturia enuresis, they may have treatment options for you, But the first thing is to make sure I'm safe and protected and able to get to the bathroom without putting obstacles in my way.

And we all know we do it. All of us do it. So, as you get older, that's one of the first things you want to make sure… if I got to get up and go, and I got to go, I got to be able to get to the bathroom, and I don't want to fall over the dog. 

Mike Leventhal: Those are, those are great tips. 

Bruce Kassover: So, Mike, beyond this, what other thoughts do you have particularly related to incontinence that could help improve men's lives?

Mike Leventhal: Well, as I stated before, men oftentimes have difficulty following their prescription protocols. And one of the things that we try to stress at Men’s Health Network is, when a doctor writes you a prescription, to take the prescription as prescribed. And by doing so, in the case of guys that are dealing with urinary incontinence, it can oftentimes make that quality of life that we've been talking about throughout the entire course of the podcast that much better, and it can reduce the risk for falls and other types of injuries in the middle of the night. 

Bruce Kassover: You know, it's one of those things that sounds really super sensible and easy to do, but we all know it's very hard to actually follow your medication regimen. I mean, the story I always tell is, anytime I have to take an antibiotic for something, right, I guarantee that by like day three, it's the middle of the day and I wind up thinking to myself, did I take my antibiotic this morning, and I have no idea. And I want to have to go back and count pills and, you know, fingers crossed that I didn't, you know, accidentally drop it on the floor or something. 

Mike Leventhal: Yeah, well, one of the things – I take a lot of supplements throughout my day – one of the things that I do is, because I take so many sometimes, I forget if I took… Did I take my arginine? Did I take my Vitamin D? I'm responsible enough to, in the night before, I just arrange my supplements into morning, noon and night, into little jars to where I just can grab them and go if I'm on the road or I could just pop them in my kitchen when I'm at home.

Bruce Kassover: You know, I do something similar. I actually have one of those little boxes that's, you know, the days of the week and you put your medicines in it. And I mean, I love it because I actually, you know, can keep track of what I'm taking. The downside though, is it makes me feel so old. 

Mike Leventhal: I was about to say you're really showing your age now, Bruce.

No, for me, I haven't found a box big enough to hold all the supplements I take. I mean, I take about 25 supplements a day. I don't take medications necessarily unless I, unless I need them, but I do take supplements and how do I arrange my supplements, like, you know, you would your medications. Cause obviously my grandparents all had that same box that you just mentioned, and, and that's how they kept up with their meds for the day. 

Bruce Kassover: Oh, it’s true. And if you use fish oil capsules, those fish oils are gigantic. I have to use, like, a shoe box for each day, I think. So, Mike, you know, we are on Life Without Leaks. And one of the things we'd like to do before we go is ask our guests, if they could share with us one bit of advice to help people live a life without leaks. So what would yours be today? 

Mike Leventhal: Well, I'd say to guys, you know, I know that urinary incontinence is a sensitive subject and it can be embarrassing to talk about. But if you do have the symptoms, if you are suffering through this, from this condition, go see your doctor sooner rather than later. The time to act is now. There is no shame in this and there is hope. 

Bruce Kassover: I love that you just said that because one of the phrases that we like to use at the National Association for Continence to help people understand that this is natural and there's nothing to be embarrassed about is that “there's no shame in being human.” And I think your point aligns exactly with what we try and get across. And I hope that men take your words to heart and do just that. So thank you for joining us, Mike. I really appreciate your insights and everything that you guys are doing over at Men’s Health Network. So thank you. 

Mike Leventhal: Well, likewise, Bruce, and thank you for the time and the opportunity. Hope to speak to you again soon.

Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. Our music is Rainbows by Kevin McLeod. More information about NAFC is available online at NAFC.org.