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Shrinking Your Prostate Naturally And Avoiding Urination Troubles · Intellectual Medicine

• 0:00
  Good news. Your prostate got big.
• 0:02
  Congratulations, you lived a long time.
• 0:05
  Here's hoping it gets bigger. You live longer, and here's
• 0:09
  hoping. I know this sounds weird, that
• 0:13
  at some point you're going to develop cancer cells in the
• 0:16
  prostate gland because that is inevitable if you live long
• 0:21
  enough. And they'll just stay there and
• 0:24
  they won't bother you as long as you don't disturb them.
• 0:27
  So a large prostate, it's a reward for long living managing
• 0:32
  it. Yeah, you could do that.
• 0:34
  And some of those supplements I mentioned, start them early.
• 0:37
  It just makes sense. Like, what's you're not going to
• 0:39
  hurt yourself taking tomatoes three times a week unless you're
• 0:43
  allergic to them. Every man will experience
• 0:49
  gradual enlarging of the prostate gland over the span of
• 0:52
  their lives. In some cases, it can get to a
• 0:56
  point that it becomes symptomatic.
• 0:58
  Now the good news is, hey, you live long enough to have it
• 1:02
  happen. One way to avoid that is to die
• 1:04
  young, which I don't recommend. But when does it become worthy
• 1:09
  of attention? This, folks, is strictly A
• 1:13
  functional question. There is nothing about a big
• 1:17
  prostate that is injurious to your health unless it affects
• 1:22
  urinary flow and function. So the size of it is not always
• 1:27
  the most important variable, but rather where it's gotten bigger.
• 1:31
  So think of the prostate gland like Mickey Mouse ears.
• 1:35
  The outer lobes, if they grow outward, it's not likely to
• 1:39
  impair bladder function so much as if the inner lobes are now
• 1:43
  pinching the urethra. And how can you tell this is all
• 1:47
  happening? I mean, there's a ton of imaging
• 1:50
  studies that are available, but the biggest factor to consider
• 1:56
  is your function. Can you pee yes or no?
• 2:00
  Can you pee in a manner that enables you to empty the bladder
• 2:04
  to your satisfaction? It's not critical to have the
• 2:08
  same flow that you had when you were 30 at 60.
• 2:12
  That's unlikely, but keeping a good urine flow such that you
• 2:17
  can function without having to worry about where's the bathroom
• 2:21
  all the time or will not having to wake up with such frequency
• 2:27
  that it affects your daytime energy.
• 2:30
  Waking up at night is not injurious to your health as long
• 2:35
  as you can fall back asleep and you get adequate sleep to be
• 2:39
  restorative. At some point, that adequacy can
• 2:43
  be impaired by frequency. At some point, problems can
• 2:47
  arise due to poor flow volume, poor speed of urinary flow,
• 2:53
  recurrent infections and other problems can happen.
• 2:56
  So what should a man do? Or I suppose, a question worth
• 2:58
  asking, Why does it happen? Well, we're not sure.
• 3:03
  There may be genetic connections.
• 3:05
  Age is a factor. And here's one thing that's not
• 3:08
  a factor, folks. Testosterone, gentlemen, do not
• 3:13
  blame your testosterone on your prostate getting bigger.
• 3:17
  In fact, it gets bigger as testosterone levels decline.
• 3:21
  Such as? Makes no sense.
• 3:23
  And if you want to go on testosterone therapy, have at
• 3:27
  it. There's no good evidence that
• 3:30
  taking testosterone therapy will accelerate growth of the
• 3:35
  prostate gland. It just happens to correlate in
• 3:38
  some men. But in my experience, and I've
• 3:40
  been doing it for 20 years now, it's not a direct correlation
• 3:44
  and theoretically it may be a benefit.
• 3:47
  So how do you know you need a, you need it addressed?
• 3:49
  Simple. It's bugging you.
• 3:52
  You're not happy with the way urine is flowing.
• 3:54
  You want to get it addressed. You start with the very basic
• 3:59
  things to support the prostate itself to perhaps to perhaps
• 4:04
  shrink it and improve the flow without surgery and without
• 4:09
  procedures. I'll be talking about procedures
• 4:12
  in a moment, but keep those on a back burner.
• 4:16
  Guys. Be patient.
• 4:19
  You know, this takes some time and by all means, when you get
• 4:22
  this evaluated, do not let them scare you because your PSA is
• 4:27
  elevated. You have a large prostate, your
• 4:30
  PSA is going to be elevated. Those two things go hand in
• 4:33
  hand. It doesn't mean you need a
• 4:36
  biopsy. Never do I want to see men get
• 4:40
  needles stuck in a prostate gland.
• 4:42
  Go back to my original podcast on that.
• 4:44
  So that should never enter the conversation, right?
• 4:48
  But how do you know if it's cancer?
• 4:50
  Saith the man or saith the urologist, right?
• 4:54
  They like sticking needles in you.
• 4:56
  It's objective evidence of something.
• 5:00
  The best way to distinguish between benign prostatic
• 5:04
  hypertrophy or BPH and prostate cancer is monitoring the
• 5:09
  condition over time. There is not a single study on
• 5:14
  the planet, not even a biopsy, that can absolutely declare your
• 5:19
  condition. The biometrics, the PSA, the
• 5:23
  prostate health index, the urinary studies are coming out
• 5:25
  with more advanced testing all the time.
• 5:28
  The problem they all have is that they're not reliably
• 5:33
  diagnostic. They just kind of help tilt the
• 5:37
  averages. What matters the most?
• 5:40
  Sequential assessment, and I still like APSA.
• 5:44
  It's not diagnostic for prostate cancer, but observing its
• 5:48
  pattern over months and years can be helpful.
• 5:51
  It should, and it will go up slowly and gradually.
• 5:55
  Does not mean you need a biopsy. For God's sakes, you never need
• 5:58
  a biopsy. But you may want to intervene to
• 6:02
  help the prostate to shrink. So what things can you do?
• 6:06
  The prostate gland responds to inflammation.
• 6:10
  I've had men go on a flight and after they got to their
• 6:14
  destination, went into complete urinary obstruction, couldn't be
• 6:17
  at all needed a catheter, had to go to the emergency room.
• 6:19
  What happened? The flight exposes you to
• 6:23
  ultraviolet radiation, which instigates free radical
• 6:27
  overload. So if you're in a circumstance
• 6:30
  where you're free radicals are amplified, you're going on a
• 6:33
  flight, you're under mental or physical duress, you're battling
• 6:37
  an illness. Bump up your antioxidants, chief
• 6:41
  among them vitamin C 2000 milligrams every day is totally
• 6:46
  safe and it can be done couple times a day if needed.
• 6:51
  I don't recommend taking above 2000 milligrams at once.
• 6:54
  The body can only absorb so much and the blood levels will be
• 6:58
  plateaued. So vitamin C when you're under
• 7:01
  duress, watch inflammation. The other thing that can help if
• 7:05
  you're in a position of trying to protect your prostate against
• 7:08
  an acute increase in its inflammation, actually non
• 7:12
  steroidal anti-inflammatory drugs over the counter ibuprofen
• 7:16
  400 milligrams as a preventative.
• 7:20
  If you're going on a flight and you have a prostate's a little
• 7:23
  bit twitchy, some men will take it at dinner and we'll note
• 7:28
  better urinary flow or less nighttime urination that can
• 7:32
  also occur. What about things in the
• 7:36
  supplement world, in the nutritional world?
• 7:39
  In the supplement world, it seems like blends our best.
• 7:44
  There's not a singular supplement that has been shown
• 7:47
  to solve the problem. However, they can be helpful.
• 7:52
  And if you're going to use supplements, gentlemen, stick
• 7:55
  with it. You need six months to judge an
• 7:58
  impact. It's going to be slow.
• 8:00
  It took you years to grow that prostate.
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  It's not shrinking overnight, right?
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  Saw Palmetto helps to lower dihydrotestosterone or DHT
• 8:11
  levels. Combine it with a few others.
• 8:14
  I'm going to read these off. These are the ingredients that I
• 8:16
  like to see and you can find these in over the counter
• 8:19
  supplements. There's beta cytosterol, pie,
• 8:22
  gym, africanum, stinging nettle and lycopene from tomatoes.
• 8:29
  Also, zinc. Keep your zinc knot greater than
• 8:32
  30 milligrams a day by the way. Too much can be bad.
• 8:36
  Lycopene is the stuff that's in tomatoes.
• 8:40
  In fact, a tomato is a better source than a supplement because
• 8:45
  it has other things in it besides the lycopene that may be
• 8:48
  effective. I recommend 3 servings a week of
• 8:52
  a dark red tomato. Plum tomatoes are the best.
• 8:55
  They have the most lycopene. Cherry tomatoes can work as
• 8:59
  well. Hey, if you don't tolerate
• 9:01
  tomatoes, a supplement is totally cool.
• 9:03
  But be patient. These take time.
• 9:06
  They take time functionally. What else can you do?
• 9:09
  Mean the obvious stuff, not drinking before bed, etcetera.
• 9:13
  But none of those things are going to shrink the gland.
• 9:16
  Supplements may help do that. What about in the
• 9:19
  pharmacological realm? I mean, there's some things that
• 9:22
  I love. I love tadalafil for my
• 9:25
  patients. Cialis yes, the same drug menus
• 9:29
  to enhance erections can help urinary flow. 5 milligrams a
• 9:33
  day, every day. You don't take this just when
• 9:35
  you're going to have sex or just when the prostate doesn't appear
• 9:39
  to be functioning well. Take it every day.
• 9:42
  It's safe. Needs to be physician prescribed
• 9:45
  of course, but it also has correlated with decrease
• 9:49
  incidence of heart attack, stroke and dementia.
• 9:54
  I mean think about it, better urine flow, better erections,
• 9:57
  less heart attack, stroke and dementia.
• 9:58
  What's not to like? Dose extraordinarily safe,
• 10:02
  typically 5 milligrams up to 20. There are a couple of drugs that
• 10:07
  have been FDA approved to help shrink prostate gland.
• 10:10
  One of them is finasteride, the other one is dutasteride.
• 10:14
  They both work by blocking DHT or dihydrotestosterone.
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  DHT is one of the metabolites of testosterone that does correlate
• 10:26
  with gradual enlargement of the prostate gland.
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  Taking either one of these drugs over months can slowly shrink
• 10:35
  the gland. Side effects In some cases, men
• 10:39
  experience impairment of their sex drive or their erections.
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  The incidence of this is hard to know.
• 10:47
  You know, you read the package inserts, they'll say it's maybe
• 10:50
  1 or 2%. You talk to men at large and it
• 10:53
  seems maybe more than that. I can tell you it's variable.
• 10:58
  And there are many men who have absolutely no impact on their
• 11:01
  sex drive nor their erections when they're on these agents.
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  They take months to work. Tadalafil or Cialis, that can
• 11:09
  work more quickly. Now we're talking about
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  improving the flow, maybe shrinking the gland.
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  The other thing that can help, though, I'm not crazy about it,
• 11:18
  it's tamsulosin or Flomax. Tamsulosin works by relaxing the
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  sphincter muscle of the urethra, enabling urine to pass more
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  freely. Thing I don't like about it can
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  cause Lightheadedness, and it can cause retrograde
• 11:31
  ejaculation. When you have a climax, nothing
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  comes out. It goes backward.
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  Not quite as satisfying as a normal ejaculation, but if
• 11:44
  you're in a position where there's an acute demand, you're
• 11:47
  at risk of having total obstruction.
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  It's reasonable to consider while you're on the other drugs
• 11:54
  that are shrinking the gland or the and or the supplements that
• 11:58
  are shrinking the gland. You can combine these things.
• 12:01
  Supplement plus prescription. How do you know how things are
• 12:05
  working? Well, you simply determine how
• 12:08
  you feel. How long can you go between
• 12:10
  urinating during the day? How about at night?
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  I was waking up four times a night.
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  Now you're down to two. That's progress.
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  You can do what's called a pre and post void residual.
• 12:21
  The doctor can do an ultrasound of your bladder, see how much
• 12:24
  urine is there. Then you'll go empty the bladder
• 12:27
  and we'll repeat the study and see how much is leftover.
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  A large post void residual is indicative of impaired flow of
• 12:38
  the urine that may be starting to become clinically relevant.
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  So the enlargement of the prostate is affected, affects
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  the bladder by making it work harder.
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  Your bladder has to push with greater force to get the urine
• 12:53
  through a tighter space. That leads to detrusor
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  enlargement. That is, the bladder gets
• 12:59
  thicker, it's a muscle, and when it's exercised like that, it
• 13:04
  gets bigger and more forceful. That accounts for that sense of
• 13:09
  urgency men get, right? One moment, you're feeling fine.
• 13:12
  The next moment, holy cow, you feel like you got to get to a
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  bathroom right away or you may pee your pants.
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  That's urgency. That's a sign of the prostate
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  impairing the flow and the bladder itself trying to
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  compensate by pushing harder. These conditions can be improved
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  by the pharmacologic and the supplement regimen I just shared
• 13:36
  with you. Be patient.
• 13:39
  Do not rush for a surgical remedy.
• 13:42
  They hurt. They have complications,
• 13:45
  although in the right setting with the right hands they can be
• 13:49
  life enhancing and quite valuable.
• 13:52
  So let's touch base upon those. The old standard is a trans
• 13:57
  urethral resection of the prostate, the terp where you go
• 14:00
  in there typically with a Electro desiccation device, just
• 14:05
  cutting away shaving if you will, whistling back pieces of
• 14:09
  the of the prostate gland to help open up the space.
• 14:14
  Problem with that is potential scarring, stiffening of the
• 14:17
  urethra post procedural failures.
• 14:21
  I would say that that procedure is given way to newer
• 14:24
  interventions. 1 which is very effective is called the holop
• 14:29
  HOLEP. That is the holium laser
• 14:33
  nucleation procedure. As the name implies, it involves
• 14:37
  going in the urethra and then with a laser, carving out large
• 14:43
  chunks of the prostate gland that are encroaching on the
• 14:46
  urethra. Those large chunks are actually
• 14:50
  pushed back into the bladder, and then they use a special
• 14:53
  device to break them up and suck them all out again.
• 14:58
  What's good about this? I like the fact that they're
• 15:01
  using the laser because one of the questions comes up
• 15:04
  frequently. If you do a procedure like that,
• 15:08
  is it going to increase your risk of metastatic cancer in the
• 15:11
  event cancer cells are subsequently found to be
• 15:14
  present? So the tissue they carve out,
• 15:17
  they're going to analyze it. And if they turn out that they
• 15:20
  find cancer cells there, the whole up procedure because as
• 15:24
  the laser is cutting, it's also cauterizing.
• 15:27
  So in my opinion, based upon how the procedure is done, it's much
• 15:32
  less likely to create dissemination of cancer cells
• 15:36
  than, for instance, a prostate biopsy or some other surgical
• 15:39
  procedure. This procedure is one of the
• 15:43
  more successful ones if you count success by not needing
• 15:48
  something else later in life. It's been around long enough so
• 15:52
  that we know some of its potential downfalls.
• 15:54
  And one of those retrograde ejaculation men, you ejaculate,
• 15:59
  nothing comes out. So I had one patient jokingly
• 16:02
  say to his wife, well, honey, it won't be so much to clean up,
• 16:05
  right? If that type of an outcome is
• 16:08
  not disturbing to you and you have a particularly large
• 16:11
  prostate, this may be the procedure of choice.
• 16:14
  It works well almost regardless of the size of the prostate.
• 16:19
  That's not true for all the other procedures.
• 16:22
  Now, here's an important caveat for the whole for really any
• 16:26
  procedural intervention in medicine period, but
• 16:30
  particularly in your prostate. Guys, you got one shot to get
• 16:33
  this right. Do not, do not buy at the first
• 16:37
  store you shop in, right? Get a couple of opinions and I
• 16:41
  advocate that one of those opinions should be at a tertiary
• 16:46
  care, high level academic institution that does lots and
• 16:51
  lots of the procedure. You may have a lot of respect
• 16:54
  for your neighborhood urologist and and she may be excellent.
• 16:58
  He may be excellent, but I'm biased in favor of centers that
• 17:03
  just do this type of thing all the time.
• 17:06
  I've seen very different outcomes for my patients.
• 17:09
  I had a patient flew to the Mayo Clinic to have his resume
• 17:13
  procedure done. Man he had a fabulous outcome
• 17:17
  compared to another patient who had it done locally.
• 17:20
  Struggled. Now could be the individual
• 17:22
  variables, but I like the specialty centers so Holip gets
• 17:27
  my endorsement. If you need something and you're
• 17:30
  really symptomatic and right, be patient.
• 17:33
  The six months of non surgical treatment didn't quite work.
• 17:37
  How about resume REZUM? No it doesn't stand for
• 17:41
  anything. It's a trade name they made-up
• 17:44
  like Kleenex or something, right?
• 17:46
  So the resume procedure uses hot water in essence to kind of burn
• 17:51
  away through opening up the path, the pathway.
• 17:55
  What's good about it? Very little to no effect on
• 17:59
  sexual function. And it it's, it's easy to do
• 18:03
  relative to the others, right? It's often times it's a same day
• 18:07
  procedure, the whole up. Sometimes it's an overnight stay
• 18:11
  with anesthesia required resume. Doesn't necessarily need the
• 18:15
  same amount of anesthesia. Can be done locally.
• 18:18
  It'll take it longer to be effective, several weeks perhaps
• 18:21
  longer for gradual improvement to occur, and it's not great if
• 18:26
  you have a very large prostate. There is a size cut off that you
• 18:31
  want to be mindful about, but it does not 'cause retrograde
• 18:34
  ejaculation. It will not interfere with
• 18:36
  urinary flow or erectile function.
• 18:39
  A nice choice, but choose wisely, go to the places that do
• 18:44
  it all the time. So we talked about hold up, we
• 18:47
  talked about resume. How about the euro lift?
• 18:53
  The euro lift, All right, I don't like it.
• 18:55
  It's like, why don't I like it 'cause they're putting stuff in
• 18:59
  you. They put a a plastic device that
• 19:01
  is intended to lift the prostate out of the way of the urethra.
• 19:08
  It sounds good on paper. I can't tell you though how many
• 19:12
  of these put plastic device in. The procedures end up five and
• 19:17
  ten years later becoming a major pain in the neck.
• 19:21
  Plastic devices can fail. The device can corrode through
• 19:26
  tissue. It can become anitis for
• 19:29
  infection. It's foreign material.
• 19:31
  It has no blood flow. Bacteria love to grow around
• 19:35
  such items, so I just don't see it's merit.
• 19:40
  Use the resume. Use a euro lift.
• 19:43
  I'm sorry, not your lift. Use the the Hulk or the resume.
• 19:48
  I don't like your lift. I would not recommend it.
• 19:52
  Anything that puts a device in your body got to be you got to
• 19:56
  think three times, you know? Do you guys remember?
• 20:00
  Probably not that donut the gastric banding they used to do.
• 20:04
  Like they thought that'd be a good idea.
• 20:06
  Those horrible things started corroding through people's
• 20:09
  anatomy. Not good.
• 20:11
  Avoid putting junk in the body if you can, particularly because
• 20:16
  you got better options. There's also prostate artery
• 20:21
  embolization. In this procedure, an invasive
• 20:24
  radiologist goes into the artery and then uses plastic beads,
• 20:29
  typically to block off the arteries feeding the prostate
• 20:33
  gland, thereby in essence killing it, having the cells die
• 20:39
  off so that they gradually shrink.
• 20:43
  Very operator dependent. Very operator dependent.
• 20:47
  You know, no two docs are going to be the same at this.
• 20:51
  I have concerns about its risk because it is difficult to tell
• 20:56
  from the literature since every doctor will have a different
• 21:00
  level of skill. And if you're contemplating
• 21:03
  this, you most certainly want to scrutinize the person behind the
• 21:08
  procedure. So I'm a little reticent.
• 21:12
  The good thing about it is less disruption of cellular material
• 21:18
  can shrink the prostate gland kind of globally, but there's a
• 21:22
  risk of needing repeat procedure kind of like the hole up a
• 21:26
  little bit better than the than the prostate artery
• 21:30
  embolization. So some of the key things
• 21:34
  regarding it, the procedure that is you want to be mindful about
• 21:38
  what you value. If the idea of retrograde
• 21:41
  ejaculation is disturbing, think twice about hold up.
• 21:46
  If the risk of a relapse procedure is disturbing, think
• 21:50
  twice about resume because of the potential for relapse is
• 21:54
  greater with that. The same thing with the arterial
• 21:57
  embolization. Think 10 times about the euro
• 22:01
  lift. Look, some people out there
• 22:03
  going to brag about how great it is.
• 22:05
  I don't trust it yet. I want to wait 10 years and then
• 22:09
  do a look back and you know, see what's going on.
• 22:11
  And again, when you have better, not better, but you have
• 22:15
  alternatives that don't require that, so much the better.
• 22:19
  How about in the functional world?
• 22:20
  What else can we consider? Methylene blue is getting some
• 22:24
  play. Methylene blue is an
• 22:26
  anti-inflammatory. It neutralizes free radical
• 22:28
  overload and as such might it impart a benefit to the prostate
• 22:33
  gland? It might, but there's just not
• 22:37
  enough clinical experience with it, nor enough research evidence
• 22:42
  to give it a hearty recommendation.
• 22:44
  If you're inclined to try it, make sure it comes from a
• 22:47
  compounding pharmacy, not from a supplement supply store, but I
• 22:52
  don't really endorse it for that purpose, even though on paper it
• 22:56
  looks like it may make some sense.
• 22:58
  Another tip that I'll occasionally use for my patients
• 23:03
  who are having nighttime urination in particular is an A
• 23:08
  hormone called desmopressin. It's a prescription drug DDAVP.
• 23:14
  It is an anti diuretic. It's a hormone that cuts down
• 23:19
  the amount of urine that the kidney makes, thereby compelling
• 23:24
  you to pee less at night. This drug is sometimes used for
• 23:29
  young for children, young boys in particular, to help prevent
• 23:34
  bed wetting. And it has the same effect on
• 23:37
  old men who are now peeing a lot at night by virtue of lowering
• 23:41
  the amount of urine produced, potentially give them a better
• 23:45
  sleep cycle. It's an off label use.
• 23:47
  You can ask your doctor about its capital.
• 23:50
  All capital DDAVP or desmopressin, A hormone used at
• 23:55
  night. The ibuprofen idea I mentioned,
• 23:58
  worth trying as well. What happens if you do nothing
• 24:02
  about enlarged prostate? Nothing.
• 24:06
  It'll perhaps keep getting larger and at some point you may
• 24:10
  choose to do something about it, but it's very much your
• 24:15
  prerogative driven based on how you're feeling, how the symptoms
• 24:19
  are affecting you. If you get sick, if you get
• 24:23
  infected, the prostate can become temporarily enlarged.
• 24:27
  Prostatitis is a form of prostatic inflammation can
• 24:32
  happen from infection. It can happen secondarily to
• 24:35
  infections. Elsewhere we mentioned the
• 24:38
  flight getting the flu. Anything that will inflamed you
• 24:42
  systemically can have an effect on the prostate gland itself.
• 24:46
  Although it's intriguing, ozone suppositories are unproven.
• 24:52
  So an ozone Suppository these are gel suppositories go in the
• 24:56
  rectum ozone has anti-inflammatory value and
• 25:01
  these ozone suppositories you can Google them OZONE, ozone you
• 25:06
  could purchase them online they're extraordinarily safe.
• 25:08
  They have to keep refrigerated. I think it's reasonable to try
• 25:13
  because of its potential benefit, anti-inflammatory, it's
• 25:17
  benign, the action of putting a sponsor up the rectum.
• 25:22
  It's not everybody's idea of a great moment, but it's quick and
• 25:25
  easy. So you have my support if you
• 25:28
  want to try that at some point. I would suggest if you're going
• 25:32
  to try it, give it a three month cycle and then do a look back
• 25:36
  and if you notice benefit, you can maintain the course.
• 25:40
  Well, if folks, good news, your prostate got big,
• 25:44
  congratulations, you lived a long time.
• 25:47
  Here's hoping it gets bigger. You live longer, and here's
• 25:51
  hoping. I know this sounds weird, that
• 25:54
  at some point you're going to develop cancer cells in the
• 25:57
  prostate gland, because that is inevitable if you live long
• 26:02
  enough. And they'll just stay there and
• 26:05
  they won't bother you as long as you don't disturb them.
• 26:09
  So in large prostate, it's a reward for long living managing
• 26:13
  it. Yeah, you could do that.
• 26:15
  And some of those supplements I mentioned, start them early.
• 26:18
  It just makes sense. Like what's you're not going to
• 26:20
  hurt yourself taking tomatoes three times a week unless you're
• 26:24
  allergic to them. Well, folks, wishing you guys
• 26:27
  smooth sailing, easy urination. No, you're not going to write
• 26:31
  your name in the snow anymore, but you should be able to get
• 26:34
  through your life just fine with minimal intervention.
• 26:37
  And if if the moment comes that a procedure is needed, heed my
• 26:42
  advice. Don't buy at the first store.
• 26:46
  Shop around. Don't be afraid to make a
• 26:48
  regional trip. This is the one and done you
• 26:51
  want to make sure you get the best care available.
• 26:54
  Thanks for tuning in. We'll talk to you next time.