Issue Date: June 2, 2002
The Urbans' Renewal
Dr. Tedd makes a house call: Third in a series
Meet three generations with a can-do attitude that won our medical expert's admiration. Prostate cancer, back pain and diabetes may seem daunting -- but this family's story will help you live better, too.
By Tedd Mitchell, M.D.
Joe and Nancy Urban are retired but by no means out of action. They've taken innovative, positive steps to deal with two health issues that can strike Americans of any age: Joe was diagnosed in 1997 with prostate cancer; Nancy suffers with back pain.
They're also concerned about heredity and disease. A son-in-law has diabetes, and Nancy and Joe worry what that means for their grandchildren.
I chose the Urbans, who live in Westminster, Md., for the third family in my five-part "house call" series in USA WEEKEND Magazine because their actions in response to health challenges offer lessons for many families.
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The Urban family
Joe, 60.
Health: Diagnosed with prostate cancer in 1997.
Job: Retired electrical engineer.
Distinction: He and wife Nancy walk daily with their two boxers.
Spare time: Loves the outdoors. Spent May traveling to visit family and friends in the South.
Nancy, 58.
Health: Degenerative
disc disease.
Job: Retired optician.
Distinction: Uses a new elliptical cross-trainer. Credits their strong Lutheran faith with getting them through crises.
Spare time: Loves to garden and travel.
Christine, 37.
Joe and Nancy's eldest child (followed by Nancy-jo, 35, and Joey, 33) is in good health, but her husband, Doug O'Connor, 38, has Type 1 diabetes. The extended family is concerned that Christine's children -- Erin, 10, and Rory, 4 -- will develop the disease.
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Overcoming prostate cancer
Joe was 55 and feeling good when he visited his urologist in 1997. Because of increasing levels of PSA (prostate specific antigen) in his blood, a screening test for prostate cancer, a biopsy was done. It revealed cancer. Surgery and radiation followed. Joe still sees the urologist and a radiation specialist every six months.
Joe's story is like many men's. His father had prostate cancer, but not until his 70s. Joe never had prostate problems, so being diagnosed with the cancer was shocking. But Joe, now 60, is a survivor with an upbeat attitude. He and Nancy, 58, are big believers in complementary medicine (in fact, Joe swears that grapefruit fiber, soy and IP6 supplements have kept his PSA down), and they see an acupuncturist several times a year for stress, back pain and sinus relief.
What can we learn from Joe's situation? For starters, prostate cancer is not just for "old" people. Most cases do occur after age 65, but improved screening techniques make it possible to find cancers in much younger men.
For years, the gold standard of diagnosis was the digital rectal examination (the "finger wave" exam). It's still integral, but the PSA blood test is an increasingly standard part of the health screen for men older than 50. It's widely available and useful in detecting cancer at much earlier stages, when therapy can improve quantity and quality of life. And today's treatments cause fewer side effects.
The American Cancer Society and the American Urological Association recommend annual PSA tests, along with the digital rectal examination, for men over 50 and for high-risk men over 40. Men at particular risk include blacks (who have twice the risk of whites) and those with a family history of prostate cancer.
Although the PSA is a good test, it's not the be-all and end-all. PSA levels can be elevated by other conditions. The "free PSA" specialized test can help distinguish between benign and cancerous elevations. Other maneuvers, such as following how rapidly the PSA changes, also can be informative. That was true in Joe's case. His doctors had been watching a rising PSA level, so they ordered further testing.
If prostate cancer has been diagnosed, the next step is to determine the extent of the disease. A series of tests measure the size of the tumor in the prostate and find whether it has spread to other parts of the body. That helps to direct therapy.
Treatments include surgery, radiation, cryotherapy (freezing tumor cells), chemotherapy/hormonal therapy and newer options, such as brachytherapy and proton therapy.
All are a "good news/ bad news" proposition.
The good news: Therapies are more effective.
The bad news: complications. Side effects have improved significantly, but patients still can have problems with urinary incontinence, impotence, pain and diarrhea (to name a few), depending on the type and extent of their therapy. Accordingly, elderly men who have other health problems sometimes opt to simply monitor this slow-growing cancer. For example, if an older man has extensive heart disease that soon will end his life, it may not be worth putting him through aggressive therapies to treat a small tumor. The bottom line is that treatment of prostate cancer is effective and varied, and it requires informed discussions with a prostate cancer specialist.
Exciting things are on the horizon. New drugs are being evaluated that may kill prostate cancer cells by destroying their blood supply. Additionally, vaccinations are being evaluated to stimulate the immune system to rid itself of potential problem cells.
Our generation may not enjoy the full benefit of this research, but our children very likely will deal with prostate cancer in a completely different way.
Meanwhile, a man's lifestyle can help prevent prostate cancer. High-fat diets have been associated with an increased risk of prostate cancer, while soy protein and tomatoes may reduce the risk. Vitamin E supplements may reduce the risk, too, according to a study conducted at the National Cancer Institute. Go to top
America's No.1 complaint: back pain
Nancy, a retired optician, prefers to spend her time outdoors, in action. Just before our visit, Joe was splitting firewood, and Nancy was carefully stacking it -- while wearing a back brace.
Nancy's concern is her back. "I have always had problems with my back, but more after my kids were born. About six years ago I fell down, hurting my back. Shortly thereafter, I slipped on the ice and re-injured it." Diagnosis: degenerative disc disease, a chronic condition that doesn't require surgery but did call for physical therapy. "I have learned to manage it," Nancy says.
Her story is typical. Back pain is the most common physical complaint of adult Americans. Most of us have had at least one episode of back pain, most often in the lower back. The causes vary, but the outcome is the same: pain. The economic impact is substantial, from diagnosing and treating it, and from absenteeism and decreased productivity.
I urge you to eliminate the things that raise the risk of back pain. Those include:
A sedentary lifestyle. Nancy's professional life as an optician kept her buzzing around on her feet all day, making her an exception to the rule: Most people with back pain are sedentary. This leads to weak back and abdominal muscles, providing less support to the spine. That leads to compression of structures. Inactivity also decreases flexibility, which limits the back's normal range of motion. Finally, inactivity leads to weight gain, placing more stress on the back.
Labor-intense jobs. Heavy lifting, especially with twisting of the torso, increases the risk for back trouble. Many companies have even developed employee training to reduce back injuries.
Inappropriate exercise. Nancy has a great thing going for her: a routine of low-impact exercise (walking). High-impact exercises (such as jogging) may or may not cause problems in healthy backs; the jury is still out. But it seems clear that people with back conditions should avoid high-impact exercises. Even some low-impact activities can aggravate back pain if done intensely. Classic example: Although cycling is a low-impact exercise, it increases the risk for back strain by placing the cyclist in a forward-leaning position for a long time.
Incorrect strength training. Nancy works with weights to keep her back strong. Importantly, her personal trainer makes sure she's lifting the weights correctly. That's great: Incorrect weight training can do more harm than good. I recommend starting a strength-training program under the guidance of a qualified trainer. If that isn't possible, follow guidelines available from organizations such as the American College of Sports Medicine. Take it easy at first.
Smoking. The reason isn't clear, but the association is. Cigarette smoking predisposes you to low-back pain. Smoking may increase the risk of disc degeneration, and it may cause problems by reducing blood flow to the area.
Psychological stress. People with depression, anxiety or very stressful jobs have more back trouble. Watch for physical signs, including headache, sleep disturbances and heartburn. Sometimes, back pain is the only sign.
Backs: What goes wrong
The spine consists of 24 bones (vertebrae) stacked on top of one another, separated by pliable shock absorbers (discs). This structure, the main weight-bearing frame for your body, keeps you upright.
A tunnel (spinal canal) through the vertebrae houses the hard wiring (spinal cord) needed to relay messages between body and brain. That information exchange is made possible by nerves that exit from the spinal cord and branch throughout the body in a way fiber-optic technology can only dream about!
A structure this complex is bound to have weak links. Let's explore the basics:
Spinal alignment and support. Because humans' means of locomotion is two feet, not four, our spines are erect rather than parallel to the floor. This works well as long as we keep the supporting muscles strong. Think of the muscles as "guy wires" for a girder. Our society is becoming increasingly sedentary, overweight and out of shape; our guy wires are getting weaker. Our spines don't get support, which can lead to back problems.
Structural irritation. Each component of the back can become inflamed, causing pain. Vertebrae can develop arthritis, with changes in the bony structure. That can lead to bony spurs that press on nerve endings. Inflammation also occurs in "soft" tissues (ligaments, discs, tendons, muscles), creating a variety of pain syndromes. If the pain is caused by structural abnormalities, a doctor can detect them.
Pain from surrounding structures. Other organs can cause back pain, too. Back pain with urinary symptoms may emanate from the kidneys. Back pain associated with eating might be due to gallbladder problems. Back pain in someone with a history of cancer may indicate spread of the tumor. Back pain around the time of a menstrual cycle may be from the uterus. Pay attention to other symptoms and have them evaluated by a health professional.
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Avoiding diabetes
Doug O'Connor, 38, is married to Joe and Nancy's daughter Christine. They have two children, ages 10 and 4, and the whole family is worried about them.
Doug was diagnosed with diabetes at age 26, and his father developed diabetes at 60. This family history has everyone concerned. Is there a genetic tendency? Are the children at risk?
Before you can understand diabetes, you have to understand what happens when the body functions properly. Humans burn sugar (glucose) as our main fuel. When we eat, digestive processes provide sugar, which enters the bloodstream. The sugar is transported into our cells by insulin (a hormone produced by the pancreas). Once inside each cell, sugar is used to generate energy the body needs. In diabetes, sugar doesn't cross into the cells but instead floods the bloodstream.
There are two main types of diabetes. Type 1 -- most often seen in children (although Doug was a young adult) -- occurs when the pancreas quits producing insulin. If Type 1 diabetics aren't given insulin, the cells make energy in a deranged way; it can be fatal. Doug gets his from an insulin pump, which is considerably easier than injections.
Far more common is Type 2 diabetes, which is what Doug's dad has. It occurs when insulin production and insulin resistance decrease. Some sugar makes it into cells, but most stays in the blood. A coma could result, but more common is damage to the heart, eyes, nerves, kidneys and feet. Additionally, diabetes is a major cause of impotence in men.
So, are Doug's children at increased risk? Yes. There is a genetic link for Type 1 and Type 2 diabetes, but that does not mean all children will develop the illness. Larry Gibbons, the president of the Cooper Clinic, puts it this way: "While genetics may load the gun, environment pulls the trigger."
If you have a family history of diabetes, minimize risks with regular, life-long exercise and a nutritional program to maintain a desirable weight. Lifestyle habits are extremely effective for prevention and treatment.
The legacy of good health
Joe and Nancy, and their children and grandchildren, have a lot going for them: close ties, active lifestyles and a sense of responsibility about their health. Sure, they have chronic illnesses, some serious, but the same can be said for most families. Their response -- medical follow-up, modifying their routines -- should produce the best outcomes.
Good health: What a gift to leave the kids!
During 2002, five USA WEEKEND reader families will get help with common health problems from Contributing Editor Tedd Mitchell, M.D., director of the Wellness Program at the Cooper Clinic in Dallas. You can still read his past House Calls, on heart disease, arthritis, migraines and asthma.
Also:
 Sex and the modern man
Cancer: Progress in detection and treatment
Health Briefs: The latest advances
Past Housecalls from this series:
Housecall #1: Heart disease
Housecall #2: Arthritis. Asthma. Migraines.
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