Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well-being. And now here are Ron Aaron and Dr. Tamika Perry.

RON AARON
Thank you so much for joining us today on the award winning Docs in a Pod. I'm Ron Aaron. Our podcast is available wherever you get your podcasts. We also come to you on several radio stations in Texas and Florida as well. Today we're going to take up a topic following up on last week when we talked in honor of Breast Cancer Awareness Month about women and breast cancer, but men can get it as well. Dr. Tamika Perry, our co-host, is here and she will talk with us about that. Dr. Perry is an associate medical director for WellMed. As associate medical director, she supports providers in a number of WellMed clinics. She's been with WellMed for over 10 years. Dr. Perry earned her undergraduate degree from Prairie View A&M University. She then went on to graduate from Philadelphia College of Osteopathic Medicine, where she was National Health Service Corps Scholar. Next, she completed her family medicine residency at Methodist Charlton Medical Center, where she served as chief resident. She's board certified by the American Board of Family Physicians. She earned a master's in public health, and she also was a diplomat of the American Board of Obesity Medicine. Dr. Perry and her daughter live in Dallas. In her free time, they love to travel all over the world. Hey, Dr. Perry, thanks for joining us again.

DR. TAMIKA PERRY
Well, thank you. Thank you for having me. I am so excited to talk about today's topic because I don't think it gets the due attention.

RON AARON
The assumption is breast cancer is a woman's problem.

DR. TAMIKA PERRY
Right. Men have breast, too, believe it or not. Although of all breast cancer, men only account for 1%, men still do get breast cancer. So, what does this mean for my male population? It means that you should be in tune with your body just like a woman should be in tune. Self-breast exams are recommended. Maybe not on the cadence of a woman. A woman does it once a month. But most certainly, if you see any tissue texture changes to your breast, any nipple discharge, and when I say tissue texture changes, what I mean is does the surface feel different? Does it feel like the peel of an orange now, as opposed to it being smooth before? Is there any discharge from the nipple? Has the color of the breast changed? Has the size of the breast changed? These are things that men should look for in addition to women.

RON AARON
Now, in my case, I was feeling the right side. I have a pacemaker, so it's hard to feel the other side because the pacemaker gets in the way.

DR. TAMIKA PERRY
Yeah. So, what you're going to do, Ron, is you're going to learn what's normal for you. If we do have an index of suspicion, there are imaging modalities that we can do, like an ultrasound, that can go around the pacemaker.

RON AARON
What does modalities mean?

DR. TAMIKA PERRY
Different ways. We have different ways in which we can image your breast if we need to if we really feel like there's something there.

RON AARON
So, men can get mammograms?

DR. TAMIKA PERRY
Men can get mammograms. It may be a little bit problematic because of the size of the breast, but depending on the actual male itself, you can get a mammogram. What a better study may be is an ultrasound for a man because the probe is just on the chest wall and examining the tissue themselves. Believe it or not, men can also carry the breast cancer gene. When I say breast cancer gene or breast cancer genes, those are the BRCA genes. BRCA stands for breast cancer susceptibility genes. It's a group of genes that if you inherit, you're more likely to get breast cancer.

RON AARON
Can you be tested for the BRCA gene?

DR. TAMIKA PERRY
Absolutely. If you have a family history, generally, even if you're a guy, insurances will at least pay for a portion of that BRCA testing. So, if your sisters had breast cancer, your mother had breast cancer, your maternal aunt had breast cancer, I probably would encourage you as your PCP to go and get that BRCA testing. Because at this point, the governing bodies like the American Cancer Society says if you have that BRCA gene, then you should get breast cancer screening as a male on a regular cadence.

RON AARON
And that screening would be x-ray exams?

DR. TAMIKA PERRY
If your breasts were of size, it could be a mammogram. If a mammogram is not applicable, an MRI or an ultrasound, because we're looking for that abnormality in that breast tissue.

RON AARON
For men who are your patients, do you talk with them about breast exams?

DR. TAMIKA PERRY
I do. I think that everyone should be in tune with their entire body, so you know what's normal and abnormal for you. If there's ever any question, that's where you should go to your PCP and say, is this right for me? Is this little lump or bump supposed to be there? The only way you're going to even know if it's there is if you're in tune with you. Like we talked about on an earlier show, if you're diabetic, you should always look at the bottom of your feet. If you have breasts, examine them. If you have testicles, examine them. I encourage you to get a mirror and look in places you traditionally would not look because you need to be aware of you.

RON AARON
We're going to pick that up in just a moment. I want to let folks now who may have just joined us, you're listening to the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. We're also on the radio in several markets in Texas and Florida. Docs in a Pod comes to you every week with a look at a variety of health issues that affect men and women over the age of 65 and younger. I'm Ron Aaron and our co-host, Dr. Tamika Perry is with us. You can find her at WellMed at Redbird Square in Dallas. Dr. Perry, you mentioned testicular cancer. Checking out your gonads. I don't ever remember my PCP saying to me, and I'm 83 years old, so that's a lot of years with a PCP or another one. I never had one say, you need to check yourself out.

DR. TAMIKA PERRY
You know why it's important to check yourself out? Because the most common presenting sign for testicular cancer is a painless mass or lump. Of course, if you have pain, you're definitely going to get that mirror to see what's going on down there or try to palpate to figure out what's going on. But it's a painless situation. So, that's why it's important for you to feel and say, hey, what's going on? Most of my guys I've had in my practice who have found their own testicular cancer is because they were doing self-exams. One guy said, I was under the impression I was only supposed to have two masses there, not three. And he was correct. He's only supposed to have two. So, from that point on, we did an ultrasound, and we found out what was going on. Now, interestingly enough, when you're looking as a clinician for testicular cancer, one of the blood tests that we may draw is an HCG test. HCG is the human chorionic gonadotropin hormone. It's actually a pregnancy test hormone. So, I've actually had insurances and some nurses go, why did you do a pregnancy test on this guy? I promise I have a real degree, and I did well in school, but the reason we do that is because some of these tumors produce an HCG like hormone, and we can actually monitor the progression of the tumor and responsiveness to treatment by measuring that pregnancy hormone in a guy. Most of them are what's called germ cell tumors, and germ cell tumors are tumors that arise from cells that are either going to become ovaries or sperm. In this case, definitely become sperm.

RON AARON
Now, is that a regular test that should be done periodically? How does that compare to a PSA test?

DR. TAMIKA PERRY
No, it's not a regular test you should be doing. I'm not doing a pregnancy test once a year in certain populations like I'm doing PSA. I'm only doing that test if either I have found a testicular mass or my patient has found one and I'm concerned. So, if I do find a testicular mass, I do an HCG, do an ultrasound and maybe even to a new to urologist. That's part of the initial workup for this testicular mass. What is it? What's going on? A PSA, the prostate specific antigen, is an antigen that is made and released in the blood by the prostate. It normally makes a small amount of it. Less than four is the cutoff point that we look at. Honestly, it depends on your ethnic background. If you're a man of color, then less than 2.5 so says some literature is your cutoff point. But the point is that if that race starts to race, we start to get concern. Is the prostate inflamed or infected? Because you can have prostatitis. Or is the prostate producing too much of this antigen because there's a mass on it, i.e. a tumor on it, causing this antigen to rise in the blood? So, what we do is at that point, we will refer you to a specialist either for biopsy or we do a prostate exam to see if we can palpate a mass. But we're just going to refer you out so we can discern does a biopsy need to be done? What is the further workup? Do we need to do an ultrasound? What do we need to do from there to make sure this prostate isn't cancerous?

RON AARON
Now, PSAÕs can give a false positive.

DR. TAMIKA PERRY
Yeah. So, if you have an infection like prostatitis, most certainly you can get a false positive. What we want to look at is its trends and symptoms. I like to tell the students that come into to the office and even the patients, we don't treat test, we treat people. So, I also think of a false positive. But I'm going to actually ask the, if your PSA is elevated, are you having nocturnal symptoms. Are you urinating a lot at night? Are you what's called dribbling? ThatÕs when you have this sensation of joy when you get to the bathroom just a little bit comes out. Do you have a sense of urgency all the time? Because if we remember where the prostate sits, it's an organ that sits right underneath the bladder, and the urethra of the penis goes right through the prostate. So, if that prostate is getting bigger, it squeezes on that urethra, which gives you these urinary symptoms. So, if you have these urinary complaints and your PSA is itching up and you're of a certain age, we might give you the diagnosis of prostatitis before we jump to prostate cancer. But if you're a gentleman of color, and that PSA went from 1 to 4 within a year or even doubled from 1 to 2, you don't have these symptoms that I'm talking about. Now we're saying, why is this happening? Is this prostate cancer? I don't want anybody to misconstrue it. Any man can get prostate cancer, but some disease states are more prevalent in certain populations.

RON AARON
Do you still do digital exams during an annual physical?

DR. TAMIKA PERRY
Yeah, we do. However, I get a lot of pushbacks from my guys. That's not always their preferred exam for the digital rectal exam, but it does give us a lot of good information. When we do the digital rectal exam, what we're feeling is the actual prostate. So, when the finger goes into the rectum, at the end of the fingers about where the prostate is. The tissue that's right underneath your thumb, if you press that, that is what it's supposed to feel like. Kind of smooth there. A little bit soft, not really hard. But if I feel that prostate and it's rough and bumpy and that tissue is hard, then I'm really concerned.

RON AARON
Hold that thought. We're going to get right back to you. I was always curious about how you train that finger to know what it's feeling. I'm Ron Aaron along with Dr. Tamika Perry. You're listening to the award winning Docs in a Pod. We're talking about men and breast cancer, prostate cancer, testicular cancer and a whole lot more. Thanks for being with us.

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RON AARON
We are learning a great deal about men and breast cancer, testicular cancer and prostate cancer on Docs in a Pod. I'm Ron Aaron, and our co-host, Dr. Tamika Perry is with us. Dr. Perry and I have been talking about what men ought to be concerned about, and one of the big things we emphasized, and Dr. Perry, let's come back to it, is know your body. Self-exams.

DR. TAMIKA PERRY
Absolutely. Testicular cancer is a cancer that typically the window is between 15 and 35. Like we talked about earlier, it's a painless lump. If it's painless, you won't necessarily have a trigger to look or to do a self-exam. That's why it's important to do that self-exam so we can catch this. It's a very treatable cancer. Remember, 15 to 35, and not to say that a guy who's older than 35 can't get to testicular cancer because they can, but that's typically our window. Just like our window for prostate cancer is usually fourth, fifth plus decade of life and beyond. The same thing for breast cancer, it's a little bit in the older gentleman if they are going to get it.

RON AARON
While we talk about breast cancer a week ago here on the award winning Docs in a Pod, we didn't mention, and you mentioned it for men with prostate and testicular cancer, that African Americans are more at risk. That's true with breast cancer, too. Black women are at higher risk.

DR. TAMIKA PERRY
ThatÕs true. Black women are at a higher risk of breast cancer for a couple reasons. When we look at what does higher risk really mean, one of the stipulations in that statement is somewhat social. Black women are usually late to care and some of it is stigma against getting a mammogram. Some of it is not being recommended in a timely manner. Then when they do get care, sometimes it's not the standard of care. So, the outcomes are not as great. Some of that is social as opposed to something like DNA. Some of it is genetics. It's multifactorial why does that happen in this country with people of color.

RON AARON
Now, you got a master's in public health, which arms you with a lot more information and understanding of these numbers.

DR. TAMIKA PERRY
Yes. I think it's my job as a primary care physician to inform the public and let them know why certain things happen and to really make that an encouraging platform to get some of these screening exams. Like we talked about before, these exams save lives. Mammograms save lives. Digital rectal exams potentially save lives. Self-testicular exams save lives. It's not a moneymaking scheme. It's to save life. ThereÕs not a pyramid anywhere. This is to save a life.

RON AARON
Do you have people accusing you of that? Hey, you're only doing this to make more money.

DR. TAMIKA PERRY
Well, they don't accuse me, per se, but they accuse the industry. I've had lots of my women and my men, if I find elevated PSA, do we need to follow up on that? Because screening exams with a lot of insurance and payers is little to no cost with those. So, you have a screening exam like a screening mammogram is low to no cost. But now when it turns into a diagnostic mammogram, there is a cost associated with that. I always encourage my men and women if you need that diagnostic study, that secondary study, get it because I promise you it's going to be a lot more or less expensive in the treatment of cancer down the road. So, please get it. Early detection saves lives. Please, please, please get that secondary study if someone's telling you that we didn't quite see what we wanted to see on the first one. There may be something going on there. Get the second study.

RON AARON
What are the questions that you ought to bring to your PCP as a man if you think you found something?

DR. TAMIKA PERRY
First of all, it depends on what that something is. If you found a testicular mass, this is what I'm going to ask you. Any pain with sex. Any penile discharge. Are you bleeding anywhere? Has there been any weight loss lately? These are signs that something else is going on. If you found a mass there, it could be very well just an abscess. If you found a mass there, it could be a lymph node in the area thatÕs swelling up. Maybe it's not a testicular mass. Maybe it's not on the testes. But the point is, you need to let your PCP know or your physician know, so that can be discerned. What do we need to worry about and what do we not so much need to worry about?

RON AARON
With the risk for prostate cancer, what would a man feel?

DR. TAMIKA PERRY
He may not feel anything to be quite honest. It depends on how early or how new the prostate cancer is. That's why, once again, that yearly check with that PCP is important because that PCP is going to recommend the digital rectal exam, and at some point, if you don't want that, they may even recommend the PSA.

RON AARON
Is there an age beyond which they no longer do those digital rectal exams or testicle exams that even if you get it, it won't kill you. Either you'll either outlive the cancer, or you'll die first.

DR. TAMIKA PERRY
Most certainly. Usually around 70 years of age is where we discuss it with the patient if we want to really screen in that direction. Depending on the type in stage, it's not that horribly fast growing. So, at 70, depending on your health status itself, we may not even want to screen you. If you're a person who has advanced congestive heart failure and you've smoked and your diabetes is really, really bad, how well are we going to fare with treatment that may include chemo radiation surgery. But if you're 70 but you look 50 and you've been vegan your whole life, and you drink 22 bottles of water a day and you're super-duper healthy, then you might want to be screened until youÕre 90. Your life expectancy is a little bit different. We also want to not only talk about how long you're going to live, but how many good years are we going to have? Are your years going to be riddled being in and out of the hospital due to complications of treatment or due to the treatment themselves, or are you going to have good years?

RON AARON
You told the story last time when we talked about breast cancer about your grandmother who found a lump and chose to do nothing but sit on the porch, drink beer, and eat pecans which she was doing anyhow.

DR. TAMIKA PERRY
That's what she was doing anyhow. She didn't want any surgery.

RON AARON
No invasive treatment.

DR. TAMIKA PERRY
No invasive treatment whatsoever. Along with invasive treatment, there's always a chance that she could have gotten an infection. She could have had complications from surgery, complications from chemotherapy, radiation, but she didn't want any of that. She was like, that's not what I want to do. It was my job as her granddaughter and physician to inform her with the information and allow her to make a sound decision on our own. She made an informed decision that worked out very well for her. She lived 10 years after we found out she had breast cancer without new treatment on her own terms. Even up until Thanksgiving before she passed away, she made her own Thanksgiving meal. These are things you really have to discuss with your patient. What terms do you want to live on?

RON AARON
As a physician, are you comfortable with that?

DR. TAMIKA PERRY
I am.

RON AARON
Even though you know there could be a cure.

DR. TAMIKA PERRY
I am because once again, I've always thought it was my job to disseminate proper information. Then to make a decision with the family that's based on the best interest of that patient. If that's what you decide, I am 100% okay with it.

RON AARON
Now, there's not a lot of publicity around men in breast cancer, and yet it does occur as you said. Do we need to talk about it more so men are aware?

DR. TAMIKA PERRY
We do need to talk about it more, so men are aware because we don't any man, even if it's only 1% of all of breast cancer, to succumb to anything that is preventable and treatable. Most breast cancer in this country is something called invasive ductal carcinoma. All those big words just mean that the actual ducts in the surrounding glands have cancer in them, but depending on the stage, they have a really good survival rate.

RON AARON
Are treatments better today than they were 10 years ago?

DR. TAMIKA PERRY
Absolutely. We can do localized radiation. We don't necessarily have to go straight to a double mastectomy. So, absolutely better. Even chemotherapy is a little gentler than it was in the past. The way that chemo works is it attacks rapidly growing cells, and cancer cells are rapidly growing, but it also attacks any other cells that are rapidly growing, like your hair, the lining of your gut. This is what leads to a lot of the side effects, the weight loss, the nausea, the hair loss that comes along with it. However, that stuff grows back. What you don't want to grow back is cancer. So, early detection is our key with any cancer. Adequate follow up is our key and appropriate treatment is our key. It starts with you knowing yourself and having a great relationship with your PCP.

RON AARON
So, you kill the cancer cells, and you've also killed hair cells and what have you but the hair that comes back. Why doesn't the cancer come back?

DR. TAMIKA PERRY
Because the chemotherapy is targeted at certain parts of the cancer. So, it's targeted at like the nucleus, the receptors on the cells. Those receptors are not on the hair cells.

RON AARON
And that kills it off.

DR. TAMIKA PERRY
Yes, sir.

RON AARON
Before we leave, for men who are listening and for their loved ones, because as we know, Dr. Perry, men are the last ones to actually go see the doctor. What should she or their significant other look for and ask him.

DR. TAMIKA PERRY
Honey, have you seen any new lumps or bumps on your breast? On your testicle? Has there been any changes in your urinary symptoms?

RON AARON
Sounds easy, but I think that's probably tough.

DR. TAMIKA PERRY
We're going to keep working on you guys, Ron. That's what we're here for.

RON AARON
Well, maybe we get men to listen to this show.

DR. TAMIKA PERRY
Absolutely.

RON AARON
Dr. Perry, as you think about the men that you have treated over the years, did you have some who discovered testicular cancer?

DR. TAMIKA PERRY
I did. I actually had two patients and one really good friend who discovered testicular cancer. It was through self-exams, and they were a little bit outside of that window. They were in the 40 years of age range. They were outside of that 15 to 35 range, but both of them were doing fine. They all have children, and it didn't change reproduction or anything like that.

RON AARON
And they were treated, obviously successfully.

DR. TAMIKA PERRY
Successfully. But had they not recognized that, I would have been telling a different story.

RON AARON
Yeah, you would have been going to memorial services.

DR. TAMIKA PERRY
That's right.

RON AARON
What about breast cancer patients? Any males?

DR. TAMIKA PERRY
Oh, absolutely. They, too, were on their health, and one of them had a strong family history and has been treated successfully.

RON AARON
That's good news. Dr. Tamika Perry, thank you. Appreciate your time. Very interesting. We encourage you to share with your friends. Give us a Yelp review because when you do that, you get others to listen. I'm Ron Aaron. This has been a Docs in a Pod program, and we're delighted to have you with us. Join us next time for Docs in a Pod right here on your friendly local radio station or on a podcast.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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