Episode Transcript
[00:00:10] Speaker A: Hey, guys, thank you for joining us on the very first episode of the Senior Care Conversation. I am Hilary Bailey, your host. I am a physical therapist, assistant, and certified dementia practitioner by trade. I've been working in senior care for about 13 years, and so I'm excited to dig into all of the small and tiny facets of senior care so we can get you educated on what to do when we get old.
So I want to talk with you a little bit about the state of the union of what's going on in senior care these days. So, you know, as more Americans are aging into their 60s and 70s and beyond, the senior care system is reaching a critical point.
And the truth is becoming hard to ignore. But I believe this is also an opportunity to open up the conversation. Whether that conversation be with your parents or. Or your husband or your children, you want to start opening those conversations about what is going to happen when I age and when I need help. We can also start rallying support from the community, and we can begin to create a meaningful change.
We are living longer than ever before with all of the new medicines and vaccines and medical everything.
So it is a gift to live longer, but that often comes with chronic illness.
We have memory decline and mobility challenges.
So the need for daily support, whether that be with just activities of daily living, dressing, bathing, toileting, you know, driving to our doctor's offices, you know, making healthy meals for ourselves, doing our light housekeeping, because with those mobility challenges, things like that can get very difficult. So the need for daily support is increasing. And whether you are at home or you're in a facility, it's growing faster than our system can keep up.
Caregivers, both paid and unpaid, are exhausted.
They work long hours, they're paid. Low wages and emotional burnout are pushing professional caregivers out of the game.
So what happens next? Family members are stepping in to fill the gap, and they don't have training, they don't have support, and most importantly, they're not getting any rest. And why is that? Well, people, family members that are taking care of their loved ones are my age, between 45 and 65, so they have their families at home that they're still trying to raise. Maybe they've got grandkids also while trying to help their aging parents, and it is just too much, and they can't do both jobs well.
So then, you know, we want to talk about hiring someone to help in the home or putting them in a facility. You have to think about the cost of these things. The cost could be staggering. Guys, assisted Living facilities. You know, they say that the average is between 4 and $6,000 per month. I've seen assisted livings as high as $12,000 per month. You know, nursing homes, you know, if you don't meet the Medicaid criteria or you're not there for a skilled stay where Medicare will cover it, the cost can be sometimes between four and six thousand dollars as well. And home care is not cheap either. I own an in home care agency, and in home care can get expensive, especially if you want a skilled caregiver, you know, with your family 24, seven, you know, it can clear out your savings very quickly.
You know, too many families these days, and I see it all the time, they're forced to choose between going into debt, clearing out their retirement, or going without help. And going without help is a huge issue.
But here's the deeper issue. We don't talk about aging, not in our families and not in our culture.
Most of us are very unprepared financially, emotionally, physically, for the realities of getting older.
So back in the day, and I remember this, in my family, you know, the nuclear family, we cared for our aging parents. So I remember when my grandmother was very sick and passing away, you know, my dad and his sisters were there caring for my grandmother, taking turns doing that. You know, we didn't hire anyone to come in. We the family, we just did that. But these days, you know, kids are moving out of state, we don't live close. You know, we're having children later, which means we have children later in life, and then our parents are still aging, like I said earlier.
So the idea of the nuclear family is just outdated, right? And so we don't have a plan until that crisis hits. And we're like, oh, my goodness, what do we do now?
So what do we do? How do we help? How do we prepare?
I believe with anything else, it's the same with senior care. Knowledge is power.
The more knowledge you have, the easier life is going to be. And guys, this is what I want this show to be about. The senior care conversation is going to be all about education.
We are going to break the silence and we are going to arm you with real, honest, practical information that you can use today to plan for the future.
So when it's time for you to care for a loved one or for yourself, you're not scrambling, you are ready. We are going to talk everything, senior care, the way that it really is today and the way that it could be so life can be smooth and easy once we're getting older and we don't put pressure on our kids or ourselves when that time comes. Having a plan, what do they say planning to fail is or failing to plan is? Planning to fail? Something like that. So anyway, I hope that you will join us each week on this show where we dig into senior care.
Thanks and have a great day.
We'll be right back with more insight, expert advice and stories that matter to every generation.
And we're back. I'm Hilary Bailey and you're watching the Senior Care Conversation on NOW Media Television. Hey guys, welcome back to the Senior Care Conversation. I'm your host, Hilary Bailey. I am very excited about our guest today. It is Dr. Andrew Sun. He is a nationally recognized urologist and director of North Texas largest sexual medicine clinic. A Harvard trained physician with additional fellowship training from the Cleveland Clinic and UCLA, Dr. Sun focuses on helping men maintain sexual, hormonal and reproductive health as they age. He is known for his patient first holistic approach to care. Hey, Dr. Sun, how are you doing?
[00:06:38] Speaker B: Good, how are you? Thanks so much for being here.
[00:06:40] Speaker A: Awesome. Yeah, absolutely. Welcome. So one of the things we want to talk about today is, you know, as we age, our bodies change and things start to not work as well anymore. So can you give us some insight about why maybe that starts to happen as we age?
[00:06:55] Speaker B: Absolutely. You know, a lot of times we use a car analogy and just like anything else in the, you know, the world, as things go, as time goes on, things don't work quite as well. The fluids don't, you know, swish as easily. You might have to like change some things out. Well, certainly when we're talking about to guys about their sexual function, we, we basically use that analogy and say, look, you know, things aren't going to work the same way they used to. So some of that is hormonally based for men and women. The hormone sort of profile changes as we get older. It's much more dramatic in women, of course, menopause and all the changes that that brings. But even men will undergo a similar process, albeit a little bit more gradual. Some years ago they came up with a term for this called andropause, trying to say that it's equivalent. It's not exactly the same, but you know, there is a decline in testosterone levels in men as we age, roughly about 1 to 3% per year. These things can have a dramatic effect on energy, on mood, on sexual function, in addition to the actual physical workings of it as well when it comes to erectile function or things like that.
[00:07:59] Speaker A: Got you. Thank you so I can imagine. Especially, like in my work, I notice that it's hard for people to talk about things like sexual health when they get older.
How do you help patients feel comfortable in your office discussing things like this? Personal health concerns that center around their sexual health?
[00:08:18] Speaker B: Yeah, absolutely. You know, fortunately, I think things are generally getting a little bit better as a lot of advertisements online have started directing conversation about this. I think in, like, the 2000s, when we had commercials on Viagra, that really kind of opened up a bit of a Pandora's box. But absolutely, it's still an embarrassing conversation topic for a lot of people, men and women included. I tend to find in my patients that it's sort of on the extremes. Either they're super shy about it or they're less super open about it. But the biggest thing that I want to reinforce with, with everyone is that, you know, there is no such thing as, quote unquote, being too old to enjoy sex. I think a lot of people, when they come into my clinic, they're like, look, I'm X age 50, 60, 70, 80. Maybe I'm just too old for this. And I just tell them, honestly, you get to be the decider of that. Right. There is no age at which sexual health is no longer relevant. Sexual health is as. As relevant as it is that you want it as you want it to be. And oftentimes it's actually a great indicator of overall health, you know, especially on the male side, because, let's be honest, men are not as good as taking care of themselves. They don't seek care as much. They don't go to the doctor as much. But one of the things that they do tend to notice and probably care about a little bit more is sexual matters. And oftentimes that can be a sign of other things going on. You know, the same function, the same processes that cause erectile dysfunction, diabetes, high blood pressure, high cholesterol. These things are all important to your overall health. So it's a great marker of that.
[00:09:43] Speaker A: Okay, so why is it important to talk openly about things like bladder control or sexual health? What are some things that might be going on with someone in the senior community that might make them want to give you a call? Like, what are some signs and symptoms maybe to look for?
[00:10:02] Speaker B: Absolutely. You know, these are very, very significant quality of life issues that come up in both men and women, and I guess could say the primary one is relating to the bladder.
Just to break it down really quickly. All bladder physiology can be thought of in two aspects. There's the pump which is the bladder, and then there's the outlet or the opening. And you can only have four problems. A pump that's too strong or too weak and an outlet that's too loose or too tight. And it's basically different for men and women. And so as women age, it tends to be that they have more leakage or overactive bladder symptoms, especially if they have multi parent, like having a lot of children, because things just tend to loosen up a little bit. And so when women come in with presentations in older age, it's usually either recurrent urinary tract infections or leakage of urination when they cough or laugh or sneeze or stress or sorry, an urgency, incontinence, which means they suddenly have to go to the bathroom and have to run for it. And these things can have a pretty significant impact on your quality of life, your ability to go out and do things and live life normally. And on the male side it's similar, but actually the opposite because men have a prostate. And so for men, usually the difficulty is that they can't pee. They pee slowly. They get up at night 4 or 5 times to pee. When you get up at night 4 or 5 times to Pee, you're going to create a situation where you're not sleeping well. That can create sleep apnea, that can create sort of deficits in terms of how you're thinking, just being tired all the time. We actually think there's a significant fall risk, getting up four times, five times a night just to go to the bathroom. You're stumbling around in the dark. And as people age, this becomes more and more of an issue. So the bladder is something that we take for granted when we're young, but when it starts to break down as we get older, things can go wrong pretty quickly. And so it's very important to kind of talk to a urologist about this because that's what we specialize in.
[00:11:48] Speaker A: I love how you talked about how it changes their quality of life. I see this a lot in my work, especially my patients that we take care of in the home. You know, a lot of times we see clients who get very dehydrated. Why? Because they don't want to have to get up and go use the restroom or it makes them use the restroom too much. And they do have to worry about that leakage or they don't want to drink before they go out somewhere because they're worried they might have an accident. And you know, gosh forbid they have to wear a, you know, a pad or something. That's, you know, that's another thing about, you know, that, you know, affects their dignity. So from a. For a personal, you know, question too, what's something that people my age and like, maybe my husband's age, I mean, I know we can do some pelvic floor exercises, but what else can we do to take care of our sexual, Sexual health, our bladder, things like that?
[00:12:31] Speaker B: Yeah, in a lot of ways the two are linked because, for example, in women, one of the most common causes of urinary leakage is atrophy of the vagina. That happens after menopause. And why does that happen? It happens because of decreasing hormone levels. Estrogen, progesterone and testosterone. Although we think of testosterone as the male hormone, women actually still have much more testosterone than they have estrogen. Estrogen, it's just that the ratio is a little bit different. Whereas men have way, way, way more testosterone than estrogen. Testosterone is important for both sexes.
The sexual part, of course, you know, that's going to be very individual, depending on libidos and things that can change. We often, when we counsel, you know, partners, just intrinsically having a low libido or low sex drive, perhaps it's not an issue. Having a high sex drive is not an issue. The issue is when a couple has a different discordance between their sex drives and, you know, one being very high and one being very low. And that can be hormonally based and something that we can manage on the peeing side for men, usually we advise that all men starting around age 50, although you could even say earlier, should start getting their prostate checked. Prostate checks include the good old fashioned, you know, finger poke up the butt. And we don't do that quite as much as we used to, but it's still a part of it. But a lot of prostate checking is just done through the blood. And so we have a test called PSA, which examines for prostate cancer, for prostate growth and things like that. And on the female side, usually the symptoms will come first.
UTIs, urinary tract infections are much more common in women. If you're getting more than one or two of those a year, that's a reason to go to the doctor. And if you're having any sort of urinary dysfunction, fortunately, we have medications, we have surgeries, we have injections.
People will probably be surprised that we can actually inject Botox into the bladder. And just like if you inject Botox in your face and it smooths out the wrinkles, it smooths out the wrinkles. Of your bladder. And if you have a hyperreflexic bladder and you have to pee all the time and you can't go 10 minutes without going to the bathroom, things like that can be very helpful.
[00:14:27] Speaker A: Yes, absolutely.
So just for informational purposes, what is a good PSA level?
[00:14:36] Speaker B: Yeah, so PSA is a blood test. A prostate specific antigen is what it stands for.
And basically any number below 4 generally is considered okay.
If you're really young, say 50s or so, you probably want it below 3.
If your PSA is below 1, by the time you hit age 60, your lifetime risk of prostate cancer drops to 0.2%. And so it's really nice to have a low PSA. When it's low, we say, great, have a nice day. When it's high, it does not mean that you had prostate cancer. It just means that something is going on. And there's three things that can be going on, depending on make your PSA go up. It could be inflamed or infected. It could be an enlarged prostate, which happens to just about everyone. The percentage of men with enlarged prostate is the same percentage as their numerical age. So 60% of men at 60, 80% of men at 80, and then it could be prostate cancer. And so the high PSA level, which is something that usually is checked every year by your primary care doctor, usually triggers a referral to a urologist for us to do a little bit more digging to see which one of these three things it ends up being.
[00:15:36] Speaker A: Okay, thank you for that information.
So at the close of this segment, I would love for you to share a story with us, maybe with a client that you had or a patient that you had that their life really improved after coming to you and opening up to you about their issues.
[00:15:51] Speaker B: Oh, I can. There's so many, but I definitely. There's one guy that stands out, and he was a former police officer. He was a former, like, championship boxer. Actually, most of his life was spent doing that. When he came to see me, you know, he was probably early 60s, you know, had gotten divorced, was quite overweight, and just feeling very down about himself and about life in general. You know, nothing was really working. He didn't have the energy. He used to. We did a full sort of profile on him. You know, he had some enlargement of the prostate. Part of the reason why he was tired is because he was getting up so many times at night to pee. So we put him on some prostate medication. Suddenly he's peeing better, and that part's fixed. But he still had very low testosterone levels. Low testosterone, yes, it does happen naturally with aging, but it can also be caused by being overweight and not sleeping as well. And so we put him on testosterone therapy. And, you know, I really try to stress with patients, hormone therapy for many years has gotten kind of a bad rap. And testosterone, people always think about it from a bodybuilding standpoint, but it's a critical metabolic hormone that everyone needs to basically function. And so this guy's testosterone was so low that within three to six months after putting him in on testosterone therapy, he was. He lost like 20, 30 pounds. He was back in the gym. He was showing videos of him, like, hitting the punching bag again. He was dating again. Things were sort of working down south. He could pee easier. And literally, you know, told me and, like, you know, wrote it on the website, like, I feel like I'm 30 years younger.
And, you know, it's fantastic. And he's just metabolically healthier and he's just doing so much better. Whereas if he never sought the care that we can provide, you know, he would just kind of continue to be languishing. So those kinds of guys, we have all the time. Fortunately, the biggest step is just to be okay to talk about it and to seek the care with people who can help because there are things that we can do to help.
[00:17:38] Speaker A: I love that success story. So, Dr. Sun, for our viewers who want to learn more or reach out to you directly, where can they find you Online? Your website, LinkedIn, social media? What's the best way to get to you?
[00:17:49] Speaker B: Yeah, for sure. So I practice in a large urology group in Dallas, Fort Worth called Urology Partners of North Texas, or UPN.
And so you can find us on the website www.upnt.com.
there are like 35 of us, but certainly based on what symptoms you have and whatnot, you know, you can be directed to the best physician to treat you.
And so that's probably the best way and, you know, or Google us by our name.
[00:18:14] Speaker A: Okay, great. Well, guys, we will be right back with more awesome information from Dr. Senior. We'll be right back with more insight, expert advice, and stories that matter to every generation.
And we're back. I'm Hilary Bailey, and you're watching the Senior Care Conversation on NOW Media Television. Hey, guys, we're back. Welcome back to the Senior Care Conversation Again. I'm Hilary Bailey, your host, and we are back with Dr. Andrew Sun. We're continuing our important conversation around senior health and daily challenges.
So, Dr. Sun, you know, I work with, obviously, the Senior care population. And a lot of times, you know, people always say, oh, well, I'm just tired because I'm old, or I've just got that old people pain. You know, I'm just. It's because it's my arthritis, it's this or it's that. And one thing I do know is that it's not. I don't think it's normal to always feel tired or be in pain as we get older. What are your thoughts on that and is it normal?
[00:19:11] Speaker B: Absolutely. I mean, in fairness, there is some degree of truth to the fact that as we get older, things are never going to work quite as well as they did when we were 20. Right. So there's going to be some degradation of that at the same time. I totally agree. It is not normal to constantly be in pain and it is not normal to be totally tired all the time. Some of my most active, energetic patients who sleep the least amount are actually my elderly patients. As long as everything else is going well and everything else is sleep, movement, eating and sort of biology. Right. So you do have to make sure that the number one activity that all of us do any day, every day, is sleep. It always takes the lowest priority of our list of things when it should be the first thing, because everything else we do is based on that. Diet can play a huge role in this because not just being obese or being overweight, but just some of the times the things that we eat can give us more feelings of tiredness. For example, massive doses of carbohydrates at one stage will kind of make you feel tired. And that's a normal reaction. But you know, as long as we understand that movement is probably the thing that at least in this country, we are, I think, the worst at. And you know, we just do not move our bodies enough. Right. We sit around all the time. And that can be such a critical thing, not just for our own energy, but for our metabolism to keep our bones healthy, to prevent osteoporosis and things like that. And then hormones and hormones are important for men and women. They change as we get older. And men, it's primarily testosterone that we care about. In women, it's a little bit more complicated. Testosterone, estrogen, progesterone, things like this. But as you go through menopause, if you're a woman or as you just get older, as a man, the changes in the hormones can lead to dramatic changes in energy. Probably the best energy medication that I have, it's not caffeine, it's testosterone at Least when we're treating men. So all those things are important in terms of the pain. You know, probably most commonly, musculoskeletal and joint pains become an issue as we get older. That can be due to bone density issues, but I think a lot of it is due to muscle strength relative to weight.
And so, you know, I think one of the things that we don't emphasize enough even earlier in life, but especially as we get older, it's not just movement, but it's also resistance training, weight bearing, exercise for men and for women to strengthen the bones, strengthen the muscles. So much chronic pain could probably be alleviated just from doing a better job at that.
[00:21:28] Speaker A: Absolutely. And I love that you mentioned food. And I know earlier when I introduced you talked about you being, you know, a holistic physician as well. So there are. So there's so much information out there. You go online, they're like, oh, you need to be a vegan. No, you need to eat carnivore. No, you need to eat low carb. And it's just, it can be very confusing, especially for the senior population, because they're used to eating, you know, meat, potatoes and vegetables. Like, that's what they grew up on. That's what they eat.
So what do you recommend for your clients? What certain foods do you recommend for them to keep up their daily energy?
[00:22:01] Speaker B: For sure. You know, I think I agree there's so many different, shall we say, fad diets or different things that people follow. And time and time again, we go back to sort of the standard advice, which is if we just look at the people in the world that live the longest, like those blue zones folks, right? Whether they're in the Mediterranean, whether they're in Japan, the fundamental truth is they eat actual food, right? Not processed garbage, but real food, not that much of it, mostly vegetables. And they walk around a lot. And like, you know, we can go on to carnivore and keto and, and, you know, vegan, and there are, you know, all sorts of different things. But I do think that, you know, fundamentally, as long as you're eating real food, not too much of it, mostly vegetables, some protein, and you move your body, that's probably all you really need. And I think that trying to stick to these really, really stringent things, it's always a recipe for failure. You might be able to do it for a week or two and you might get some weight change in that middle time. Especially if you do something like keto, you lose a lot of water weight. That is not a Sustainable long term diet plan.
[00:23:03] Speaker A: Right, Right. So for our seniors out there who are complaining of being tired, you know, complaining of pain, what is like an objective measure for them to know when maybe they need to get some help and not think, oh, I'm just old, I'm tired, I just need to push through this. What are some things they can objectively measure within themselves to know, hey, maybe I need to reach out to a doc to maybe get some help?
[00:23:30] Speaker B: Yeah, that's a great question.
You know, I'll be honest, I might defer that question to you. What do you look for? Normally, you know, for us, we're mostly focused as urologists on very specific symptoms like their, their ability to pee. And we have scores for that and we have this thing called the Adam score, which is basically like, do you feel tired? And all this kind of stuff, but it's not that useful. I think in real world practice a lot of times it is up to the patient to decide themselves when the symptoms are significant enough to kind of, you know, seek care. And unfortunately that gets to the second point, which is a lot of people like to ignore things for too long.
Since you take care of elderly patients so much, how, what kind of things do you look for? I'm actually curious to know.
[00:24:11] Speaker A: Oh, we actually look for things like low appetite or a change in routine falls.
I find a lot of times when clients stop wanting to get up and walk around, it's because their balance is not as good as it used to be and they're afraid. But definitely fall food. I wish that was preached much more. I can't tell you how many times my clients go to the doctor and they just come home with another medication. And I'm not against medication by any means at all, but I also feel like some of the stuff can be changed with a change in diet or what they're doing throughout the day. Getting out of the chair and walking around, going outside in the sunlight for that, you know, that vitamin D.
Getting back to things that they love. Um, so yeah, that's, that's kind of what we, we look for or I have my caregivers look for in the home.
What is, what's the best way for seniors to talk to their doctors when they're just tired of feeling the way that they feel?
Let's, let's turn this back to like with sexual health.
[00:25:15] Speaker B: Yeah, you know, certainly the, the sexual health guys when they come into our clinic. Now usually for me it's a bit artificial because I hyper specialize in this. So like when they Come in. I know what they're doing here. For they, they only have like five things that they see me for. It's either erectile dysfunction, low sex drive, low testosterone. I do male infertility, although of course my population for that tends to be younger, although not exclusively, and things like that. And, and honestly I, at least the way that I do it, I have found that as long as I'm not awkward and I make it really open and easy, then suddenly people just sort of let their guard down. So I will just walk into the room and just straight up ask them, like, how, how's your sex life? Like, how's, how's your penis? Which sounds really kind of, you know, aggressive. But I guess people are like, oh, I guess we'll just talk about it. And it becomes a lot easier. Certainly when I have the couples, you know, there's a lot more balancing of like, you know, both people's concerns if you just focus on one. I'll tell you an anecdote. In the beginning of my practice, I focused exclusively on men and I treated a lot of low libido and I treated a lot of erectile dysfunction and I got a lot of unhappy wives because they would come in and tell me what, you know, you made him super, you know, horny and you gave him this like, raging erection all the time. But like, I don't even want, you know, I got these issues and like, ah, yes, I shouldn't be so single minded in that. And so we started a female sexual program as well, you know, in the same practice to basically make sure that couples could come in and get taken care of together.
And a lot of that, you know, like I said kind of earlier, comes back to like, hormones. But we definitely focus, you know, first on like the things you said, diet and making sure they're eating okay, their nutrition is not terrible exercise. We are big proponents of sort of everyone doing some strength or weight bearing exercises.
Because if you wait too long to do that until like you're just sitting around and doing nothing, it becomes a little bit more challenging. Although it's never too late to kind of get a program going.
And I just wanted to bring up just because it crossed my mind, your point is great and I didn't even think about it. Everyone in the developed world is already like teetering on the border of vitamin D deficiency, but no one more so than people who just sit inside the house all the time, right? And you could be in Texas where it's hot and sunny all the time, but if you don't go out and you're not taking vitamin D supplements, you are not getting enough vitamin D. And that's going to have a dramatic impact on your bones, but also your energy and everything else.
[00:27:37] Speaker A: Absolutely. So one more question for you in this segment. I was curious to know, you know, we all love Dr. Google, we all like to go in there and Google our symptoms and what's going on with me. What, as far as sexual health goes, since that is your specialty, what is a good website, credible website that seniors, well, anybody can go onto to get actual good information about their sexual health?
[00:28:01] Speaker B: That's a great question. And I think more so than in most other fields of medicine, we are inundated with garbage in the sexual health world. Right. There's always going to be somebody trying to make some money selling you something, especially when it comes to sex. And so I usually reference people to sort of reputable academic websites, things like the Cleveland Clinic or the Mayo Clinic or Harvard or places like that. When it comes to erectile dysfunction, fortunately, there are a lot of us urologists these days that specialize in this. And I can tell you some of my friends, there's a very good friend of mine in Houston who's a sexual health expert, very well similarly trained with me. His name is Jonathan Clavell. He's got a great YouTube channel. You know, it's hosted by urologists with like a lot of good digestible information.
So there's, there's definitely more good info out there. Some of it's on YouTube, but there is a lot of garbage as well. So you just want to make sure that the person that's giving you the info has some sort of, you know, credibility to give that. So hopefully a fellowship trained sexual health urologist or a urologist of any kind or a sort of reputable academic website. Anytime something sounds too good to be true, when it comes to sexual medicine, it probably is too good to be true. And if there's a big banner on the top that's trying to sell you some kind of supplement that'll magically make things work again, you probably want to think twice about that.
[00:29:22] Speaker A: So what you're saying, Dr. Sun, is TikTok is not a good platform for sexual health because, you know, people love TikTok as well and they'll do anything that anyone on TikTok tells them to do, which is very, very scary. So. Well, thank you again. For those interested in exploring treatment options with you, where can they follow your work or schedule a visit?
[00:29:42] Speaker B: Yeah, absolutely. So we see patients at our Primary practice in Dallas, Fort Worth. We're in Arlington. Our website is www.upnt.com, which stands for Urology Partners of North Texas. We see the whole gamut of urology, everything from inpatient, outpatient stuff. And we have a lot of information on our website as well.
And we also see patients through telemedicine. So if you're not close by, we can still help you out if you want to make an appointment with us online.
[00:30:11] Speaker A: Awesome, guys. We are going to be right back with more from Dr. Sun.
We'll be right back with more insight, expert advice, and stories that matter to every generation.
And we're back. I'm Hilary Bailey and you're watching the Senior Care Conversation on NOW Media Television. Welcome back to the Senior Care Conversation, guys. I'm Hilary Bailey, your host, and I want to welcome back Dr. Andrew sun one last time to address something that many families silently face. And I see this a lot in my practice, in my caregiving agency, when loved ones will not open up about their health, they want to stay quiet. I don't, I'm not exactly sure what's behind that, but I'm hoping Dr. Sun can shed some light. Why do you feel like some seniors stay quiet about their health problems? What do you think's behind that?
[00:31:00] Speaker B: Definitely something we notice a lot. And it's really unfortunate because, you know, so much could be improved by just kind of sharing openly and talking about it. But a lot of times we don't like to. I think that's true for everyone. I do tend to think that is more true for many men. I think a lot of times it happens to be a cultural thing. You know, it's machismo. It's, I'm fine. I don't need to bother anybody. I don't want to be a burden for others. You know, you're, you're so used to being the caretaker of, of the family, I guess. And then when you become like, quote, unquote, the one that needs to be taken care of, there's certainly a lot of psychological resistance to that for anyone.
Although just because I'm a male sexual health provider, I tend to see a lot of it in my guys more. So they either just pretend like they don't have a problem or they just don't want to talk about anyone. It's really unfortunate. I do think, like I said, it's very cultural.
And I'm not sure exactly what the best way to deal with that is besides offering up ourselves as an open, warm, embracing and supportive system to talk to people about it, try to normalize that conversation more often.
[00:32:05] Speaker A: I think you're completely right. And what I've seen as well is I think they start to feel like, oh, if I'm starting to get sick, there goes my independence. And that is the number one thing that scares seniors to death is losing their independence or having to rely on someone, you know, to help take care of them. So, you know, for us when, you know, when we have to have difficult conversations with our clients, when things are changing and, or we need to change their care plan because they're just declining, you know, I find in my practice that we just validate how they feel, you know, especially if we're just coming into the home. Like, I know that this is scary, having someone in your home, having someone that has to take care of you. We just don't want them to feel attacked or that were trying to run their life. Do you have any advice maybe on the best way to start a conversation with a senior maybe, or a man needs help with their sexual health without making them feel attacked?
[00:33:00] Speaker B: Yeah, for sure. I think whether it's a loss of autonomy, whether it's, you know, in my world of sexual medicine, a lot of times the feelings are emasculation and like feeling less of a man, especially when to it comes. It comes to things like erectile dysfunction. You know, a lot of people, unfortunately, I think, discount how important that can be in terms of the psychological health of a guy when things don't start to work anymore or the things that made him feel manly are no longer working.
And a lot of, you know, for me it's just about, hey, look, this is super common, right? It literally happens to everybody. That's probably statistic is, although I don't think there's any real data for this, but I think think it's true. 100% of men at age 100 probably have erectile dysfunction. Right? So 90% at 90, 80% at 80. It just kind of goes down from there. These are normal things and we can either like bury our head in the sand and ignore it, or we can, you know, work at helping it. Now sometimes there's, there's limits to what we can do, but there's a lot out there that we can help with and support. And it doesn't have to necessarily be medications. I think from a conventional medical practice standpoint, one of the other barriers is a lot of people think, well, I'm just going to go to the doctor, he's just going to like, prescribe me some medications and I'm just going to be taking more medications for the rest of my life. Because once you hit a certain age, it just seems like you always just get new medications added and you never get other medications taken away. And there is some truth to that concern. So I totally understand that and understand the hesitancy for men to want to come in if they think that that's the way it's going to go, which is why we try to present more holistic options. It's not just about prescribing pills. There's. There's lifestyle modification, there's programs, there's physical therapy. There's lots of different things that you can do. And if you make it less scary, I think, and you make it more natural and acceptable, but you can still, you know, do something about it or fix it.
Men, especially, like, if you tell them there's a fix for something, they tend to respond to that pretty well. I think that you can get them to open up and start to kind of go on that journey with you. And it's. That's never a quick fix.
There's always multiple components to it. But hopefully they'll join us for that journey and they'll end up being a much better situation afterwards.
[00:35:09] Speaker A: So a lot of times, I guess my question to you would be, what signs should family members, children look for that something may be wrong that their parent is not speaking up about?
[00:35:25] Speaker B: I find for us, one of the biggest ones has to do with urination habits and bowel and bladder habits. Because these things, I mean, I understand that men are not going to talk to their families about their sexual situation, regardless of how good it is, right? But when it comes to bowel and bladder habits, whether it's pooping or, you know, peeing, these things generally tend to decline with age in both sexes. So constipation becomes pretty common. You can have overactive bladder, you can have leakage. You can also have enlargement of the prostate and getting up at night several times to pee. Intrinsically, these are embarrassing things, and they don't like to talk about it. So what it presents as is urinary tract infections. Or you can notice as the guy or the woman is eating dinner, they're just like, not drinking a lot. They're like, oh, are you not thirsty? And they're like, no, I just don't like to drink as much. But, you know, what they're actually doing is they're artificially restricting their fluid intake because they're afraid of having to pee too much. And that is like a Secret way of kind of them demonstrating that this is actually the problem that they're having. What's interesting about urinary tract infections is that urinary tract infections actually is still one of the number one killers of people.
Falls are big, but UTIs are actually huge and they present differently. Most people think of urinary tract presenting the way that it does in a young person, which is usually urinary symptoms, frequency, urgency, burning pain, foul smelling urine. In the elderly population, urinary tract infections do not present like that. They actually present as mental confusion, delirium, memory loss, just general fatigue and malaise. And so when you see those kinds of things, yes, it could be, you know, something else going on, but it can actually even be something as germane as a urinary tract infection. The presentation of different things changes as we get older and it becomes a little bit different how to find those things. So you're looking for change from baseline, you're looking for appetite loss, you're looking for decreased fluid intake, and you may be actually diagnosing a urinary tract infection through all this.
[00:37:25] Speaker A: I am so glad that you brought that up. That is something that we see every day. I worked in a nursing home as a physical therapist for five or six years and of course I learned by listening to the nurses there, if a patient had a fall, the first thing they did was do a urinalysis, right, to see if they had a uti. So that has really helped me in my practice now. You know, I had a client and her daughter called me and you know, when we first met her, she was walking with her walker able, you know, we were only seeing her like twice a week for four hours. And then her daughter called me, she said, hillary, I do not know what is wrong with my mom. She can't get out of bed, she doesn't know who she is. I'm really scared. I don't, you know, I don't know what's happened. She, you know, I don't think she's had a stroke. And I said she probably has a uti. And so they took her to the ER and she did. She had a UTI and she had almost become septic.
So I'm so, so glad that you brought that up because there are, that the education on that is not, it's just not there.
It's non existent. And so that is, that is so important. So I'm super glad that you brought that up. So what about. So I'm assuming it's going to present the same way in men and women. Correct.
Even in the senior care population. Okay, okay.
[00:38:35] Speaker B: Usually different causes in women, it's usually menopause related vaginal atrophy and tissue loss. And because the distance from the outside world to the inside of a woman's bladder is about 5 centimeters, because the urethra is pretty short, the distance in a man is a lot longer because it's the whole penis, you know, maybe 15, 16 centimeters. But in a man, the issue is that the urine is stuck in the bladder and doesn't get out because the prostate's sitting in the way. And so they get essentially a stagnant bog of urine sitting in there. And like a stagnant pond in the woods, you breed mosquitoes and bugs and that kind of thing. So you need to be able to flush these things out. Well, and the treatment for the man usually is to try and open up the prostate and get things flowing again. If you can fix the plumbing, you're much less likely to get a uti. And probably the most powerful treatment for most urologic problems is in any elderly woman post menopause is topical vaginal estrogen. I cannot think of a single thing that I would basically recommend to everyone under the sun, but I would recommend pretty much every woman get topical vaginal estrogen post menopause. Topical estrogen is very different than systemic estrogen. There are all these fears with this terribly done women's health study many years ago about stroke and breast cancer and that kind of stuff. Topical vaginal estrogen does not get absorbed into the body, does not have those side effects. But because it gives estrogen back to the, to the vagina, you know, that does help from sexual standpoint, lubrication and stuff. But what it really does is it prevents what we call the genitourinary symptom of menopause, which is a long term. That basically means stuff that you feel when it comes to peeing and sex after menopause as a result of vaginal dryness, which can be UTIs, it can, it can be pain, it can be prolapse, or basically things sort of bulging out from the vagina, Lots of different things like that. But it can be easily fixed either with just topical vaginal estrogen or potentially more if it's a more extreme case but very, very commonly prescribed thing for us. It's super helpful.
[00:40:33] Speaker A: So I'm going to use the last question to ask you something personal that has to do with some of my clients. So what are your thoughts on, on the Purewick external female catheter? And yay or nay for that.
[00:40:47] Speaker B: In general, I don't love it, but I like it more than a chronic indwelling Foley catheter.
You know, ideally, you void to completion on your own. That's great. If you don't and the urine has to get out somehow.
Any type of rubber hose in there, whether it's intermittently, which actually is the cleanest but takes the most work, or a chronic foley, which almost 100% will lead to urinary tract infections. Well, at the same time, if you are leaking and you're just sitting in a diaper all the time, you get diaper rash, essentially, fungal infections, excoriations. It's all kind of wet and moist all the time. And so I think for those patients, you know, a pure wick is helpful in that at least it diverts the moisture away from sitting in there all the time. But the biggest thing from a urologist standpoint is if the patient is needing a.
The first thing we should do is ask ourselves, why is she needing a pure wick? What is making her so incontinent? Is it overflow? Is it incomplete emptying? Is it stress? Is it urge? And can we do something to fix the underlying incontinence so that she doesn't need a pure wick? That would be great. But in, you know, as a purely urinary moisture diversion device, it's better than sitting in a diaper all the time. Probably. But we got to fix the real problem in there, I would say.
[00:41:58] Speaker A: Okay, thank you, because I feel the same way.
Dr. Sun, this has been incredibly helpful. Where can viewers find you online to continue the conversation or get more resources?
[00:42:09] Speaker B: Absolutely. So our practice is called Urology Partners of North Texas. We're 33 urologists in DFW, spanning the breadth of every subspecialty of urology. Male, female, everything.
Our website is upnt.com Urology partners of North Texas, and you can find us there. Read some info about different conditions that we treat. Book an appointment with any of us. We also see patients virtually throughout the state of Texas.
[00:42:33] Speaker A: Okay, thank you so much, Dr. Sun. I really appreciate you being on the show today.
[00:42:37] Speaker B: Yeah, thanks for having me. This is great.
[00:42:39] Speaker A: Absolutely. Okay, guys. Well, that wraps up this episode of the Senior Care conversation. If today's discussion struck a chord with you, whether for yourself, a parent, or someone you love, remember, you're not alone. There is help. We're here to keep talking, keep learning, and keep preparing for a better future in senior care. Thank you for joining us. And until next time, take care of yourself and those you love.