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Video Ask the Doctor: Urology, Internal & Sleep Medicine

TheTV.info
51:30   |   today at 14:03

Transcription

  • if you have or suspect you may have a
  • health problem or if you require answers
  • to specific healthcare questions or
  • concerns you should consult your
  • physician or health care provider and
  • not depend solely on information
  • presented in this program
  • hello I'm dr. Steve garner and welcome
  • to ask the doctor it's great to be with
  • you today this is our 17th season and as
  • you know this program was created to
  • assist you in understanding medical
  • issues so you can take charge of your
  • own health now it's more important than
  • ever to become an informed patient and
  • we're here to bring your timely health
  • discussions for this episode we have
  • something really special you'll be glad
  • you didn't go out tonight now we have
  • dr. Angela kuma a urology attending at
  • neo methodist hospital and dr. Gerard
  • Lombardo internal medicine and sleep
  • medicine specialist at new york
  • methodist hospital and welcoming we're
  • going to get to talk to you in a little
  • while and of course I however miss I
  • would be without mentioning kissed and
  • Elizabeth on new on-air assistant how
  • are you doing kissing I'm great I'm so
  • glad to be here once again how are you
  • we flew by I don't know what happens
  • like I just saw you a couple days ago if
  • it feels like yeah what's uh anything in
  • the highlight of your week you know I
  • just love fall so much and I've been
  • eating a lot of pumpkin oh you ready for
  • ya what do you ever go out is trick or
  • treating anymore that's done I do dress
  • up but I don't think people wouldn't
  • give me candy anymore yeah but don't
  • tell don't be so sure okay I want to
  • thank you Kirsten and now for this
  • episode again with shaking things up you
  • know we usually take phone calls the
  • phone's gone today what we're doing is
  • we're doing some housekeeping now we
  • have a lot of emails from all over the
  • world it's amazing what we get here that
  • we have to answer we've been remiss so
  • we're going to take care of that and
  • then we said what more than have
  • somebody who's talking about sleep I
  • mean one of the biggest problems of the
  • American public has is getting enough
  • sleep and you hear all these things
  • going to increase my risk of cancer i'm
  • going to be not able to dry properly
  • different things and we're going to talk
  • to dr. Lombardo who is a world-class
  • expert in that book that i would suggest
  • in advance it's a great book nope no
  • pictures I'm checking it out so you got
  • to read all the pages is about 400 sleep
  • to save your life so definitely I
  • recommend this this is a great book and
  • it'll put you to sleep so so to speak
  • and of course dr. Kumar who's been on
  • the show before very rare to see a
  • familiar Allah
  • just did it Ben get a little shy oh no
  • no I mean I think you know people are
  • just happy to see a doctor that they
  • like regardless of whether it's a male
  • or a female I think so it's good and be
  • happy to see you or any of the men out
  • there so it's great to have you and you
  • just had a baby I did yeah she's six
  • months old now she's a beautiful baby
  • girl healthy happy baby very pleasant I
  • have something in the news you're gonna
  • be very mean and very sure how to sleep
  • through the night that a big problem in
  • newborn sure yeah it can be for some
  • summer blessed and go right through the
  • night but there are those with colic and
  • things like that so we're gonna get into
  • that we're gonna get into that but I
  • don't want to take too much time with
  • this light-hearted Messier let's get
  • right to this some important news items
  • of the week number one can you get rid
  • of your tattoo I read an interesting
  • story just came out yesterday and the
  • question is what percentage of young
  • people who get tattoos when they get old
  • they want to have a removed have any
  • idea 50 yeah I would get a step aside
  • again did you read the same honor that's
  • it very good I just think that when
  • people get tattoos they're you know it's
  • a big deal to ink something on your body
  • so there's probably a pretty high degree
  • of regret what's something like it is
  • and it turns out certain tattoos like
  • the yellow and blues are harder to get
  • out and if you're a smoker they're very
  • hard to get the tattoo is out so if you
  • plan to get it I was good another good
  • reason to give up smoking all right so
  • you got to watch those tattoos that way
  • you Kirsten you ever consider a tattoo
  • yes I have considered I might have one
  • whoa can we see it that's right here oh
  • ok do seize the day nice very nice I
  • don't regret it either so it's not i'm
  • not one of those statistics that's very
  • I think it's not you know some people
  • get a kind of Lodge grotesque you know
  • print someone's name on that they no
  • longer with things like that yeah
  • exactly yeah so I'm and any other one is
  • now this is not so much for girls but
  • for infants and pacifiers they don't do
  • very well of their boys it seems that
  • they have emotional stunting of their
  • development and or something of their
  • emotional development that might be
  • better and the boys but in particular
  • and why apparently when you have
  • pacifiers you can't imitate emotional
  • appearance of someone else's face oh you
  • look to your mother she smiles you see
  • the smile if you're not wearing a
  • passive
  • not sucking on one you would smile like
  • that well frown will look sad and it
  • seems like the baby can't develop
  • normally so it's a reason not to let
  • that the baby boy play with the pacifier
  • too much interesting so yeah one on the
  • under corollary though Sid's is much
  • lower babies will put to sleep with the
  • pacifier so it's always some you know
  • two sides to a story but it sounds like
  • moderation is the answer here and then
  • the other one yoga a day maybe better
  • than an apple to keep the doctor away
  • and just something in the yogurt that
  • lowers the blood pressure the systolic
  • blood pressure and this helps you avoid
  • heart attacks and so on and they follow
  • people for 30 years and they didn't
  • develop high blood pressure the same
  • rate if you had at least three yogurts a
  • week firstly yoga's pretty good yeah I
  • think yogurts great you know you have
  • all the probiotics in it it's good for
  • gastrointestinal and you know vaginal pH
  • it's great for you good stuff so it's
  • something to consider so stay on that
  • yogurt now I'm I've already met the
  • doctors i will come back and meet them
  • in between and talk a little bit more to
  • them but i want to of course mention my
  • senior bennett you see run senior out
  • there again hi he's always he's always
  • on time and it's a pleasure to have my
  • change right so let's take a short break
  • okay we get everything set up I see dr.
  • Lombardo look look what he brought in
  • here we got all these devices to help
  • you sleep better and we're gonna hear
  • about it throughout the course of the
  • show this this demo was given to mr.
  • Regis Philbin on his own it was similar
  • yeah we had almost as good as very
  • similar but not as Howard back so get so
  • anyway let's take a little break and
  • when we come back we'll be taking your
  • calls 718 well we won't take the calls
  • they just seeing if you're listening
  • take care we'll see you in 30 seconds
  • and welcome back we're on topics of
  • urology internal medicine and sleep
  • medicine and before we get to the
  • demonstration kiss that I think you have
  • a shout out yes indeed I do dr. garner
  • today we have a shout out that goes to
  • Katherine vaso Katherine thank you so
  • much for watching we appreciate it thank
  • you for hands are like that we like it's
  • good to see you out there fastening you
  • know this is tricky to do a trivia quiz
  • but I have I thought I just wanted to
  • see the amongst three of you how you
  • doing this out of all the boys names and
  • girls names the 22 rose to the top what
  • was the most common boys name for 2012
  • and the most common girl's name I don't
  • know what Peter is that your final
  • answer yeah no no but do you enjoy I'm
  • gonna try Michael Michael used to be
  • back in the old days Peyton Peyton used
  • to be actually I'm gonna let the
  • audience play at home and this way and
  • we'll come back to that in about 30
  • minutes okay and also I just for I
  • always like to have a religious quiz
  • what's the oldest Catholic Church in the
  • borough of Brooklyn another thing just
  • could think about it think about it at
  • home and we'll give the answer in about
  • 30 minutes okay so now i'm gerry dr.
  • lombardo is brought in all this stuff
  • and his sleep medicine stuff start us
  • out I'm really in a curious as to what
  • we're looking at here okay well I think
  • it's good place to start is to think
  • about how common sleep disorders are
  • there are 80 sleep disorders and within
  • those 80 we have two major categories
  • and some we're going to cover today
  • disorders of excessive daytime
  • sleepiness so you're overtired and can't
  • function during the day and disorders of
  • insomnia so to get back to the excessive
  • daytime sleepiness we have obstructive
  • sleep apnea syndrome which is a
  • condition we'll talk about in a minute
  • and we have sleep disordered breathing
  • in the form of simple snoring and then a
  • whole spectrum in between those two so a
  • very important
  • message to get out there is to always
  • mention to your doctor the key symptoms
  • that you might have of obstructive sleep
  • apnea syndrome and the risk factors will
  • talk about and I'll demonstrate in a
  • second so very what is that what is
  • which one which one is there well what
  • we're going to do is something very
  • simple is to measure next size so simply
  • take a tape measure such as this
  • anything over sixteen and a half inches
  • for the neck is a risk factor for sleep
  • tanya certainly in men and women I
  • always size up like a half hour like a
  • little comfort in there yeah we're
  • talking about the exact size so the size
  • of the neck when combined with things
  • like hypertension high blood pressure
  • obesity being overweight and actually
  • men are the higher risk than women for
  • sleep apnea you want to make sure you
  • talk to your doctor and go prepared to
  • mention to your doctor you have symptoms
  • you're there a snoring your spouse sees
  • you joking or gasping during sleep with
  • loud snoring and what looks like a
  • resuscitative type gasp and if you have
  • these things please mention to your
  • doctor and you don't will be able to
  • take it to the next step so sixteen and
  • a half is the key for men sixteen and a
  • half the men and women it's another we
  • do it it's a half inch less but
  • certainly so fifteen and a half to 16
  • for women sixteen and a half one more
  • for men interesting could you measure
  • doctor she's fine I can see it looks
  • okay so that's very it's very
  • interesting i'm looking forward to
  • seeing the rest of the stuff he okay one
  • of the things that we did for this show
  • is kissed and went out on the street and
  • she started to talk to people about
  • questions they might have from one about
  • two doctors tonight how was that it was
  • really fun i went to a prospect park and
  • i also went over to queens to astoria
  • park and I quiz some people to see how
  • much they knew about certain we have a
  • very smart audience you found right yeah
  • very smart and then they wanted to ask
  • the doctors some questions too well my
  • let's see how smart they're let's let's
  • roll the first video with this remember
  • where this is from this was from
  • prospect park roster this is Gary okay
  • let's see what Gary hostess
  • so i'm here with gary can ask some quiz
  • questions Gary what is prostate cancer
  • and it's up to do with the bladder it is
  • a cancerous growth in the prostate
  • prostate cancer i believe is when your
  • prostate gland is affected is infected
  • or it has like a malfunction so first
  • quiz question what is prostate cancer
  • cancer of the prostate what did I tell
  • you is that what do you really think of
  • those answers as answers so but anyway
  • we have dr. Kumar to tell us what is
  • cancer of the prostate what is prostate
  • cancer sure well just to elaborate on
  • some of the answers that our friends in
  • Prospect Park gave us the prostate is a
  • gland which sits in between the bladder
  • and the urethra and it is indeed when
  • cancer arises from that gland it can you
  • know it can be asymptomatic actually you
  • don't usually feel it it's usually
  • detected sometimes by a blood test and
  • sometimes by rectal exam that's how
  • doctors try to take a feel of the
  • prostate the painful no it's usually not
  • really exam oh haha depends who's doing
  • it that's a good advertisement do you
  • know you don't cause pain right no of
  • course this is uh you guys want a
  • prostate exam you got it okay so um I
  • want to get to another one in dr.
  • Lombardi's demos but I want to hear
  • another question well the next one was
  • we were wondering what causes prostate
  • cancer hmmm went into the park again
  • exactly let's see what causes prostate
  • cancer what causes prostate cancer what
  • causes plastic I would like to say diet
  • and poor exercise and treatment of the
  • body but I don't think I could be
  • totally accurate with that Oh at that
  • answer ah they're not sure genetics I
  • don't what causes prostate cancer I'm
  • not sure we kept like a little panel
  • seems like the same I recognize somebody
  • yeah yeah I asked a few people some
  • different question though these are good
  • these guys are all right what what's the
  • answer to that question think that
  • that's a great question and I think you
  • know whoever figures out the answer to
  • that is going to be a billionaire
  • certainly there is some genetic
  • predisposition people who have a first
  • degree relative a brother or a father
  • with prostate cancer are at higher risk
  • for developing prostate cancer we see a
  • higher prevalence of prostate cancer in
  • african-american men and i think you
  • know it's very interesting that one of
  • the people you know commented on diet
  • and exercise because i think that you
  • know there the studies that actually
  • have looked at diet and the relationship
  • between diet and prostate cancer have
  • been equivocal but there is some
  • evidence that you know maintaining a
  • good healthy diet you know having
  • antioxidants you know not maintaining a
  • high degree of acidity in your body that
  • that can be protective against any type
  • of cancer just your your overall general
  • health thank you learn your learning I'm
  • learning lad you dr. Lombardo pretty
  • good answer some excellent set us up for
  • the next wonder because we're going to
  • take a short break but I like to give a
  • little tease what are we gonna see so
  • we're gonna start with snoring that's
  • forty percent of people snore forty
  • forty percent and that's on a spectrum
  • of severity all the way to Afghan so
  • we'll talk a little bit about snoring
  • and the treatment let me take a little
  • in-house poll here Kirsten I know you
  • recently married is your husband a
  • snorer I'm gonna say no comments yes
  • I'll comment my husband snores so I got
  • 100 100 percentage if it's easier and I
  • snore as well that's one hundred and
  • fifty percent well so and what even is
  • she gonna show us something that can
  • make you stop snoring well certainly
  • things that can help reduce the snoring
  • and sometimes treated how can you leave
  • at this point I mean take a quick break
  • but don't go too far because in about
  • one minute we're going to hear what can
  • make your husband stop snoring
  • and welcome back to ask the doctor we're
  • on topics of urology internal medicine
  • sleep medicine where we have dr. Anjali
  • SH kumar and dr. Gerard Lombardo we were
  • filling him before the doctor Lombardo
  • was going to give us a little tip on
  • what to do about husbands who snore
  • Jerry ok well if I may spouses who snore
  • because women's snore as well we have to
  • be fair so snoring first of all occurs
  • in forty percent of our population so
  • it's a common thing as many will talk
  • about the next day at the coffee machine
  • but the noise is actually caused by
  • fluttering of the tissue in the back of
  • the throat and that's usually the palate
  • flopping up and down against the back of
  • the tongue so what's the back of the
  • throat tissue that's vibrating and
  • causing the snoring noise so what we can
  • do is always advise some things to
  • reduce the amount of snoring such as
  • drinking a lot of alcohol prior to bed
  • will definitely make the snoring worse
  • sleeping on one's back we'll make the
  • snoring worse so you want to try and
  • have a side position any sedating
  • medication certainly will make it a more
  • severe sleep deprivation where you're so
  • tired you fall into that deep sleep
  • again especially on the back will make
  • snoring more severe so we're going to
  • show a few of the treatments then for
  • those who come in and have simple
  • snoring and again we'll talk a bit about
  • more severe apnea where the same tissue
  • blocks the tube but for simple snoring
  • with tissue that's vibrating we have a
  • few things that we can recommend relax
  • dr. Kumar to help me if you'd pass that
  • so much I reaching thank you so much I'm
  • the surgical assistant so this is a body
  • position pillow that fits around the
  • back so this if you can envision in the
  • back and the straps come around in the
  • front and hold it in place and what that
  • does is when you roll onto your back and
  • sleep it's uncomfortable enough that you
  • roll on to one of the other shoulders
  • and simply by read
  • using the amount of time you spend on
  • your back you'll definitely reduce the
  • fluttering noise because it's very
  • positional related so as the jaw falls
  • back the tissues flutter and block and
  • it's very loud and for those again
  • sleeping next to a snoring person you'll
  • note that the snoring is always less so
  • usually less severe there's a canonical
  • you could say I don't know about that
  • okay and this is about 60 70 bucks on
  • the internet Thank You that's come on
  • and if you want to use a cheaper or less
  • expensive version of that you go to your
  • 99-cent store and you buy three tennis
  • balls and put them inside that sock that
  • you don't know what to do with you and
  • one that's lost the made of it is lost
  • anyway and you take some safety pins and
  • position it on a t-shirt exactly that
  • height that is here but in the back and
  • just the three tennis balls are enough
  • to keep you moving side to side and
  • reduce the snoring and that's called
  • position yes good tip easy and dollar
  • ninety-eight but why saving you like a
  • gem the the bed partner the spouse
  • jabbing you is a cause of sore ribs more
  • than anything else it doesn't help so
  • I'm gonna I'm gonna hold the next one
  • okay I gotta go because they're getting
  • called in the park yet Kirsten who's
  • next well what's great is we have a
  • couple of questions on sleep Oh dr.
  • Lombardo so let's check out the videos
  • alright so this is John at Prospect Park
  • and here's your first quiz question John
  • how do you know if you're not getting
  • enough sleep how do I know I'm a pacing
  • the floor passed out on the floor isn't
  • one around the floor okay um I feel like
  • it would be there's a lot of ways of
  • knowing that but give us an example um
  • generally I'm tired and have a lot of
  • mental fatigue and um I mean they also
  • say based on biorhythms and that kind of
  • thing that you need eight hours of sleep
  • and that you need certain types of sleep
  • and that there's certain times of night
  • that you get certain time
  • of sleep that the body really needs me
  • personally yes a fatigue fatigue in the
  • morning definite eat good questions Greg
  • still out there what do you what do you
  • think well Lindsay and Todd both sort of
  • hit it right on the head by saying that
  • the quality of sleep so the type of
  • sleep you're getting and certainly the
  • quantity but the quality of the sleep
  • impact on your daytime performance and
  • we call that quality of life and quality
  • of life now is a big thing in all walks
  • of medicine where we try and make sure
  • that you're living life the best you can
  • and we're talking about waking life but
  • the flip side of that coin is the sleep
  • so healthy sleep is very well defined
  • both in terms of how you are sleeping or
  • the quality and the quantity Thank You
  • Justin no other another sleep question
  • coming up I'll check it out and is it
  • true that missing three nights of sleep
  • in a week leaves you with the same
  • judgment as someone that's alcohol
  • impaired I would believe so thank you
  • you know if that's true I'm a little bit
  • nervous over you is that true it is true
  • unfortunately and I say unfortunately
  • because there are highway accidents that
  • account for countless deaths related to
  • sleep deprivation so the study that was
  • done compared lost sleep to alcohol
  • consumption and one's ability to operate
  • a motor vehicle that study specifically
  • showed that losing sleep being sleep
  • deprived would bring a person to the
  • illegal limits in terms of alcohol level
  • in the body and also affect their
  • judgment when it came to driving
  • stepping on the brake in time and
  • unfortunately sleep deprivation does
  • account for many many deaths on the
  • highway very stuff I mentioned with new
  • baby and stuff there are times when you
  • go out not having slept enough for three
  • nights well usually what I do is if the
  • baby wakes up one night then my husband
  • will get up the next night so we always
  • make sure that we get enough sleep I
  • mean I agree with dr. Lombardo you know
  • sleep is just extremely important and
  • you can't function properly
  • but it seemed like it in college and
  • stuff i don't know kissing when you
  • could somehow your body could do more
  • you know you can force yourself to stay
  • up and you could pass the test the next
  • day and then go to sleep did you ever
  • have that that's very true I remember a
  • couple of all nighters but the next day
  • wasn't very pleasant Johnny see you
  • would not suggest an all-nighter for
  • anybody out there taking a test well
  • certainly not but having been guilty of
  • that myself College and certainly our
  • teens tend to have a social life that
  • brings them to studying and staying up
  • and it's always monday morning syndrome
  • where they can't stay up so now thank
  • you kissing did you make it into the
  • next question remember which bar oh yeah
  • actually we're back in queens and we're
  • back talking about prostate cancer and
  • i'm asking him some questions how common
  • is prostate cancer one in every five men
  • I think it's common in men over 50 oh
  • well to the best of my knowledge is very
  • common especially with older adults in
  • this country 40 and over you know I
  • myself had to have a prostate exam and
  • I'm reaching 40 you know but I think it
  • is very common according to what I've
  • heard it depends on your age of men
  • usually it's about thirty five percent
  • of men will have high BP a which doesn't
  • necessarily mean you have prostate
  • cancer but chances are that since it's
  • very slow growing cancer there is a
  • possible that you might get it but you
  • probably pass away before it actually
  • affects you interesting a lot of
  • thoughts on prostate cancer and what do
  • you think trying to bring it together
  • sure prostate cancer is definitely very
  • common it affects about one in six men
  • so it's one of the most common cancers
  • around and as you get older the risk
  • that you will develop prostate cancer or
  • that a man will increases so you do see
  • it more you know in more men you know
  • over the age of 60 or 70
  • than you do in younger men of the age 30
  • or 40 and one person made an interesting
  • comment you know that you may be more
  • likely to you know have something else
  • affect you in your lifetime rather than
  • prostate cancer a lot of men can be
  • living with prostate cancer and it never
  • affects them and that's absolutely true
  • and that's you know one of the
  • controversies right now about prostate
  • cancer screening interesting because you
  • one guy could live with having cancer
  • and he knows not going to spread but
  • another guy is like a worry boy is
  • saying I'll feel comfortable having this
  • cancer growing even if it's growing so
  • slowly I want to have it out right
  • exactly there's a lot of psychological
  • anxiety associated with a diagnosis of
  • prostate cancer and the problem is that
  • it's impossible or it's very difficult
  • to predict whether you know a cancer is
  • going to affect you or if it's going to
  • be slow slow growing and not affect you
  • at all but but certainly you know it's a
  • very controversial topic right now and
  • it's something that warrants a lot of
  • discussion between patients and their
  • urologist good stuff because I know it's
  • on the mind of a lot of men now and
  • we're all confused with the PSAs and
  • stuff like that who knows but anyway
  • funny to show us the third way how to
  • stop snoring so I mentioned the back of
  • the tongue flopping back and causing
  • some of that rattling noise and there's
  • a device called an oral appliance and
  • it's similar to what a sports my
  • grandmother had done okay maybe grandma
  • Senhora da I think those are a thief
  • sorry it's like another third yeah and
  • it's it has a hinge of some type so this
  • one has the hinge in the front the idea
  • is that as you're on your back and the
  • lower jaw Falls I'm gonna make the noise
  • sorry but demonstrating it drags the
  • tongue back and flutters against the
  • back of the throat so the oral appliance
  • is built so that it moves the jaw
  • forward on the bottom and even if you're
  • on your back the jaw cannot fall back
  • and drag the tongue against the pharynx
  • and flutter so this is a very effective
  • treatment for snoring how much is that
  • one cost yeah what you know thank you
  • dr. Kumar very important is not n ot
  • don't go into
  • local pharmacy and pluck something off a
  • shelf this has to be built by a
  • professional who understands teeth
  • shifting TMJ you'll get into a lot of
  • trouble unless it's built properly they
  • can run 500 to $1,500 is it custom-made
  • custom-made and certainly the insurance
  • carriers are all covering this right now
  • very important especially when there's
  • some apnea and I'll talk about that I
  • think I'm during a honeymoon and you
  • have the snoring I would probably let it
  • keep snoring because this day I don't
  • know we could talk about that later
  • ready for that kiss what do you got in
  • the next video at the next video you
  • know we have another question about
  • prostate cancer symptoms what are the
  • symptoms I don't know I just dessert any
  • symptoms at all maybe urination I don't
  • know the symptoms Wow what are the
  • symptoms problem urination incontinence
  • basically that's about it it's symptoms
  • of prostate cancer you're a nation yeah
  • that's an interesting question when it's
  • very advanced it may cause some symptoms
  • of you know blocking urination if it's
  • if it's spread outside of the prostate
  • it can cause bone pain usually prostate
  • symptoms are caused by benign
  • enlargement of the prostate and that can
  • certainly cause frequency urgency the
  • need to run to the bathroom so you know
  • prostate cancer itself doesn't really
  • cause symptoms I think I'm getting some
  • symptoms so we're going to do is take a
  • little break and when we come back we're
  • going to be answering some more
  • questions I went dr. Limbaugh to set us
  • up so they don't leave us at the
  • commercial what's going to be presented
  • next well we're going to go down the
  • line of treatment severity towards
  • surgery and a CPAP machine to complete
  • pap is what I want to see is yeah I want
  • to see how people can go to sleep with
  • this on but you'll show us that right it
  • works excellent so what we're going to
  • do is going to take a short break you
  • can take a short break and we'll be back
  • in a little while and we'll be talking
  • about the CPAP machine
  • and welcome back to ask the doctor where
  • our topics are in urology internal
  • medicine and sleep medicine now just
  • before the break we asked dr. Lombardo
  • to tell us about the CPAP machine sure
  • here absolutely so again with thinking
  • of ways to open up the back of that
  • airway so we can send a column of their
  • that gently moves the tissue out of the
  • way so that each breath is clear there's
  • no snoring no noise and most importantly
  • the oxygen gets to your body to help
  • your organs and to help you restore as
  • you should during sleep so the machine
  • is called a CPAP machine continuous
  • positive airway pressure first thing I
  • want to do is show you how quiet amazing
  • engineering now that pump is on I came
  • here early so this is sending air and
  • when it's attached to a mask there is no
  • sound so that's always good news for the
  • bed partner the spouse will not hear a
  • loud noise from the machine as was the
  • case ten years ago you put this in
  • between doing your spouse away with the
  • actual sits on the night table okay I do
  • get a question sometimes I see couples
  • with apnea they want to know if they can
  • connect this to a white piece and have
  • one mass going to can't do it no can I
  • get a longer model it's all right it's
  • okay okay so so the mask then so the
  • hose attaches to some type of mask one
  • of the more popular mass now is referred
  • to as a nasal pillow so it's small and
  • it fits in the nose and this attaches to
  • this end and you're quite free to turn
  • side to side silent motor no snoring
  • most importantly no apnea and no ill
  • effects on your body from choking all
  • night the mask of old tended to look a
  • bit more bulky and certainly we do need
  • a full face mask on occasion that covers
  • nose and mouth so it goes over fighter
  • pilot
  • made pretty famous by the sopranos
  • episode where junior was wearing one of
  • these but certainly the full face mask
  • and this you can imagine what it feels
  • like to sleep with the polar base rarely
  • we do with who is that going home
  • silence well random I'm a little in
  • right Jason so we're trying to make them
  • more comfortable and certainly the
  • engineering amazing to help you sleep
  • you need something comfortable and we do
  • fit the person custom fit during a sleep
  • study and we measure the pressure
  • exactly and that's the prescription that
  • they get this will retail how much would
  • it sell for retail yeah well we get a
  • discount eight to twelve hundred dollars
  • the seller and it's covered by insurance
  • because the health care costs to someone
  • not treated is double that of someone
  • treated petrol lombardo our patients
  • very compliant with using the sleep
  • equipment once they start using it is it
  • something making it here too yeah they
  • can stick to the next one question I
  • think if you do prop a follow up and
  • bring them back after 30 days there's a
  • little memory stick out of the back and
  • you can tell exactly how many hours the
  • person's on it so if you look at the
  • memory stick and you talk with them ask
  • them what the issues are you can usually
  • correct half of them such as mask fit I
  • don't like the mask and and and as long
  • as you bring them back the compliance
  • goes way up this is great because we've
  • heard about it now you've seen it and it
  • seems reasonable I think you know would
  • you treat your judge it you think I can
  • use that not possible it doesn't seem
  • that bad had a patient last week and dr.
  • Lombardi's changed my life again it's a
  • quality of life excellent excellent
  • thank you very much Kirsten where we got
  • next the next question is something I am
  • actually very curious about to its water
  • what foods are you supposed to avoid
  • before sleeping so let's check out the
  • videos finally what our foods to avoid
  • before going to sleep all foods I'll
  • food I eat everything before going to
  • bed nothing after 6pm perfect thank you
  • John
  • um sugar um coffee alcohol any processed
  • foods and someone said bacon recently um
  • and even like just fruit anything that
  • can like that's sort of like will wake
  • you up before going to sleep ah simple
  • carbs high sugar foods you don't want
  • any of those and the food a yes if
  • you're going to sleep beer don't need
  • food so don't eat food before going to
  • bed thanks Daniel oh that's some good
  • answers a whole by any of anything stand
  • out is the right one well Daniels
  • explanation was excellent the last one
  • you should not eat a large meal before
  • bed and it's amazing how many times I
  • guess it's a sign of how busy people are
  • there at their job and they dash home
  • it's late and they grab the meal don't
  • fill up your stomach prior to bed the
  • other answers were good as well you
  • should not anything caffeinated so think
  • about things that stimulate but you know
  • someone will say yeah I drink a liter of
  • pepsi all day and so most of that is
  • after dinner and that could easily be a
  • sleep problem with that interesting
  • let's go still a few rapid-fire video
  • question let's go right next to the
  • right let's do it this is about prostate
  • cancer alright so my first question is
  • how old are you how old am I ancient
  • 8585 perfect so do you think that you
  • and 85 year old man should go for
  • prostate screenings at this time I had
  • him done already when's the last time
  • you had one I had seat implants about
  • seven years ago enjoying himself in the
  • podcast and brought him down I don't
  • know what happened but it not great to
  • see you on the show yeah whatever this
  • is that so were you got for the the man
  • with the prostate issue so the one thing
  • the one thing I'll comment on is a
  • polyurea or knock Toria so frequent
  • passing of urine or passing of urine
  • during sleep where again that's not an
  • activity that is conducive so dr. Kumar
  • I'm sure would tell us about them
  • toria yeah absolutely getting up at
  • night to urinate is a frequent complaint
  • and it happens not only in men as they
  • age when they develop enlarged prostate
  • symptoms but also as people get older
  • their kidneys actually make more year in
  • and so getting up at night causing a
  • disturbance in the sleep is a big
  • problem that people have and it's not
  • the urinary frequency but it's the
  • disturbance in the sleep so you know we
  • tell people various things one is to
  • limit fluid intake after six o'clock and
  • really try to urinate out whatever is in
  • their system before they actually put
  • their head down to go to sleep same with
  • elevating the legs for a couple of hours
  • before bedtime so all that fluid that's
  • that's sort of out in the tissues can
  • come back into the circulation and you
  • can urinate that out before you go to
  • sleep so a lot of behavioral techniques
  • to try to limit the amount of times that
  • you get up at night to go to sleep and
  • you don't have that disturbance in your
  • sleep if you get up one or two times you
  • know that that's there's not that much
  • we can do about that a lot of people get
  • up one or two times but when you're
  • getting up more than that then that's a
  • problem the next question is on the tips
  • of many times indeed and it's talking
  • about the normal amount of sleep for
  • adults so let's see what is a normal
  • amount of sleep that adults should have
  • six hours an adult of my age should have
  • at least eight to ten hours a night
  • sleep I think seven to eight hours Alice
  • anything seven to ten hours what is a
  • normal amount of sleep that adults
  • should have what they're calling the
  • doll time in 10 hours at least 10 hours
  • ok ok 10 hours is that too much yeah
  • it's a hot topic certainly there's a
  • range so the average amount of sleep
  • necessary for good health is seven to
  • eight hours now we do have something
  • called a short sleeper and a long
  • sleeper i mentioned 80 sleep disorders
  • so these are actual diagnosis short
  • sleeper long sleeper and it's found that
  • five hours for some fortunate
  • individuals is enough for them to have a
  • good quality of life we spoke about that
  • and there are presidents of countries
  • and other leaders and they require only
  • that core five hours and they're fine
  • others need more nine ten hours but the
  • average is 7 to 8 hours 17 hours he's a
  • great question so i went to pause for a
  • quick email question and then going to
  • come right back to these videos we do we
  • have an email it's from row height us in
  • Mumbai India isn't that cool okay his
  • question is Sir I had an accident in
  • November of 2011 the flesh between my
  • right thumb and index finger got pierced
  • I got it stitch in the hospital but even
  • after the removal of the stitch it still
  • hurts today please send any solution mmm
  • I like wheezes sir very nice very
  • genteel polite so I have a sleep
  • specialist and a prostate specialist the
  • urologist what about between the fingers
  • a little sound aqui little scar
  • formation there he said it was between
  • his thumb and index finger yes I'm
  • guessing right here yeah probably it's
  • he's having a hard time healing that
  • area especially if it's on the right
  • hand if you're using the right hand a
  • lot so probably you want to give it some
  • rest and allow it to heal properly and
  • you know if it's formed a scar which is
  • painful you could also try scormus
  • massage with some like vitamin e cream
  • into the actual scar you know you could
  • also see like a plastic surgeon or some
  • but someone who may be able to inject a
  • corticosteroid into the scar that often
  • helps to soften scars very interesting
  • did he give a name well hide it just oh
  • okay I thought that was the town that's
  • his name it's from mumbai mumbai mumbai
  • mumbai the changing all the names you
  • just be my BAE right it's like change in
  • New York to New Jersey or something what
  • do we got here we got a video yeah we
  • got another video asking some questions
  • let's check it out what is a PSA a
  • public service announcement that's up
  • and do it prostate hey public service
  • announcement the dad out the door with
  • PSA rivi a PSA is prostate is basically
  • test to see
  • if the hormone that is released by the
  • prostate is high and that's an
  • indication of prostate cancer or
  • prostate growing hey Doc what is a PSA
  • so you get over the reins here so at the
  • Kumar is it worth knowing what PSA means
  • yes absolutely a PSA is a blood test
  • that is taken it's used to measure a
  • chemical which is secreted by the
  • prostate gland it stands for prostate
  • specific antigen the PSA level can be
  • elevated in a variety of conditions one
  • of which is prostate cancer it can also
  • be elevated when there's inflammation in
  • the prostate due to infection or urinary
  • retention and it can be elevated when
  • there's just benign enlargement of the
  • prostate from benign prostatic
  • hyperplasia so it can be elevated for a
  • variety of reasons but we do usually use
  • it to see whether it's elevated in the
  • setting of prostate cancer I like to
  • none of our video fans use the word
  • prostrate right I always tell my
  • frustrated since this and I isn't that's
  • pretty smart audience yeah it's a great
  • audience I like that okay let's go
  • threat to the next one because we have
  • so many you were used exactly we
  • actually have Anya and she's asking a
  • question to the doctor okay hi dr.
  • Lombardo I'm a restaurant manager and
  • I'm a they're farmers shift worker
  • and I was wondering how and what is the
  • amount of sleep I should get to get
  • enough do you think Larry okay so that's
  • on you right Silas shift workers make up
  • twenty-five percent of our workforce so
  • this is a very important question and
  • unfortunately that requires shifting
  • around the clock to make sure all
  • disciplines are covered and we see our
  • ambulance emergency room workers
  • restaurant etc and it is very difficult
  • to maintain a schedule sometimes that's
  • conducive to good health and good sleep
  • so there are a few key things that we
  • try and focus on and anya mentioned
  • again that seven to eight hour average
  • is very important so the amount and then
  • the quality remember it's not only hours
  • but is it
  • sleep so the thing that makes my ears go
  • up as I'm seeing a patient which shift
  • worker sleep disorder and that's the
  • name of it when there's a problem is I
  • ask them what is the shift schedule so
  • there's a variable shift where they can
  • start midnight to eight and then the
  • week after that they shift again and
  • then again and you can see a pattern of
  • the brain not being able to regulate the
  • circadian balance for normal sleep and
  • that's the challenge so you want to try
  • and be regular in terms of your shift
  • work try and keep a strict 12 to eight
  • for example and then you have strategies
  • if you have to split your sleep it's
  • okay to do four hours and four hours if
  • you have to and as long as you get that
  • 728 a general amount of sleep so there
  • are strategies such as that things like
  • asking friends not to call you come home
  • it's eight in the morning you just
  • finished your shift there are things to
  • do life pressures and stresses try and
  • get someone else to help with taking the
  • kids to school or doing the shopping so
  • you can get your protected eight hours
  • of sleep even if it's shifted into tube
  • we're going to turn it into overdrive
  • here because we've got it only about
  • five minutes left let's go right through
  • these let's see another video dr.
  • lombardo is it possible to catch up on
  • lost sleep so do you think it's possible
  • to catch up on lost sleep to an extent
  • to catch up I sleep all the time so I
  • couldn't answer that question um
  • actually yes you're right if you're in
  • if you're actually in a deficit your
  • body's gonna automatically have to catch
  • up so you're gonna be you're gonna be
  • fatigued throughout the day so you're
  • gonna you're you do catch up on sleep
  • you have to your body will shut down
  • where we are let's leave actually
  • unfortunately the answer's no so if you
  • go in for some reason you're up for over
  • a day a day and a half your body will
  • store that as a dead so there's money
  • debt and then sleep debt and certainly
  • you cannot make up the damaging effects
  • of lost sleep try i get to the last
  • question because that's what sexual
  • function and prostate so the audience
  • would speak sweet sleep this week so
  • well then in that case
  • that's the end of the answer was correct
  • next question ken prostate cancer be
  • prevented hopefully possibly yes like
  • anything I do think I without knowing
  • how he could be prevented I think a
  • healthy diet exercise lifestyle you know
  • a good mental stress free um we're
  • probably remedy all of that i think in
  • prostate cancer be prevented I know
  • who's got the right answer can it be
  • prevented I think we don't really know
  • of any great ways of preventing prostate
  • cancer there's some data that suggests
  • that medications like proscar and
  • dutasteride may prevent low-grade
  • prostate cancers but you know prostate
  • cancer absolutely healthy diet exercise
  • you know maintaining overall general
  • good health is always a good idea but as
  • far as preventing prostate cancer you
  • know I think no one by now is the end of
  • the store in the SONA I'm not going to
  • work huh what do you got next question
  • is from Gary and it's about as PSA i
  • just recently went to my doctor and he
  • told me my PSA was 3.0 last year and i
  • went to 6.0 so I'd like to know what the
  • procedure is what should what should I
  • do that's it not so much that he had a
  • six but that it went from three to six
  • yeah absolutely i think you know this is
  • a common situation where we see a
  • dramatic rise like that in a PSA level
  • the first thing that I would do is
  • recheck it make sure that that six is
  • accurate you also want to know if you're
  • having any urinary symptoms or you know
  • retention of urine or anything's going
  • on as far as possible inflammation in
  • the prostate at that time we would check
  • a rectal exam make sure we don't feel
  • anything new in the prostate any nodules
  • or anything like that and if we
  • suspected that maybe it was due to
  • inflammation then we could put you on
  • antibiotics and a medication to relax
  • the prostate for four to six weeks and
  • then we could recheck it again you know
  • if there's nothing else going on
  • on and we feel something on your rectal
  • exam and we recheck it in it truly is
  • six then it's up we might proceed right
  • at that point to say you know let's do a
  • prostate biopsy thank you dr. Lombardi
  • we have one coming up for you now yep
  • this question is from Kim dr. lombardo
  • is there any type of psychotherapy that
  • will help me fall asleep interesting is
  • there such a thing actually the proper
  • treatment of any insomnia involves
  • what's called cognitive behavioral
  • therapy so the short answer for Kim is
  • absolutely if you're having trouble
  • sleeping you should speak with your
  • doctor about getting some help from a
  • form of psychotherapy called cognitive
  • behavioral therapy which incorporates
  • all of the things that should help you
  • to get a good night's sleep interesting
  • so no quick fixes here we have time for
  • one more I think we do and this is Helen
  • talking about ambien I was not a good
  • sleeper so my doctor put me on ambien 10
  • min ago yeah but the thing is I found
  • that for me was no good because I will
  • get up in the morning I mean I night and
  • walk around go to the refrigerator
  • whatever and they will tell me the next
  • day and I didn't know nothing about it
  • so doctor what are your thoughts on
  • ambien ambien and we've been in the news
  • a lot yeah sure certainly it's an
  • important hypnotic that's the category
  • of drug relatively safe again as in the
  • last question any medication should
  • always be combined with cognitive
  • behavioral therapy most sleep disorder
  • specialist myself included believe that
  • the answer for insomnia is not in a pill
  • we don't want to just give a pill and
  • say go to sleep take this pill now
  • speaking again to ambien it does have
  • some potential side effects and it's
  • important to remember that any sleeping
  • pill works best when you follow good
  • sleep hygiene and you take it in sync
  • with your circadian balance for sleep so
  • we all have a tendency to have sleep
  • in a certain phase of our 24 hours so
  • the ambien works best again when it's
  • combined with proper hygiene proper
  • routine for sleep you want to relax and
  • wind down you don't want to be balancing
  • a checkbook and all excited and watching
  • a thrilling movie and expect that a pill
  • is going to shut everything off and put
  • you to sleep always combine it with
  • proper hygiene and other measures
  • excellent excellent Kirsten drum roll
  • for the last question yes the last
  • question is from Lawrence so let's check
  • him out hello dr. Kumar my name is
  • Lawrence Logan and I would like to know
  • can prostate cancer or any deformities
  • with the prostate affect sexual
  • performance in men please let me know
  • and have a good day thank you what do
  • you think about that in 30 seconds
  • prostate cancer and even benign
  • prostatic hyperplasia you know it
  • shouldn't really actually affect your
  • erectile function itself there is a link
  • between men who have symptoms of benign
  • prostatic hyperplasia and men who have
  • erectile dysfunction meaning that a man
  • who has symptoms of an enlarged prostate
  • not necess by nine enlargement is more
  • likely to have symptoms of erectile
  • dysfunction as well whether there's a
  • common pathway that causes both of those
  • conditions were not entirely sure but we
  • are starting to look at some of the
  • medications that we use for erectile
  • dysfunction to treat benign prostatic
  • hyperplasia as well thank you so much
  • the pituitary really I don't know where
  • this knife fluto around this that's it
  • for this episode of ask the doctor
  • before I thank histon I just want to say
  • the boy's name is Liam and the girls
  • name is Emma and it's the basilica of
  • st. James that was built in 1822 so
  • those at home that's what we have kissed
  • and thanks as always dr. Kumar and dr.
  • Lombardi really two of my favorite guess
  • I enjoyed the show thank you think thank
  • you for coming in it's always remember
  • to get second and third opinions be
  • proactive about your health stick to
  • your doctors don't be afraid to express
  • your concerns and visit our website
  • because you're going to get information
  • on our website there you can see the
  • tablet column you can see past shows you
  • can see questions forums that other
  • people have to discuss I want to thank
  • you Kirsten for going out
  • fields and getting those great questions
  • we got to do this again real soon a lot
  • of fun this was great so you got more
  • coming into email more questions to us
  • we're going to answer them and as I say
  • always have a great week be well and
  • i'll see you guys in the tablet take
  • care
  • you

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