Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal specific needs. Hello, and welcome to the Doctorpedia podcast. I’m Daniel Lobell and joining me on the phone today is Dr. Steven Gange – one of the world’s leading urologists, and I’m so happy to have you on the line. Thank you for joining the show.

Dr. Steven Gange: (00:36)
Daniel, thank you very much. My pleasure.

Daniel Lobell: (00:38)
I’m fascinated to learn all about urology. Let’s start at the beginning here. What made you get into urology and what made you get into medicine

Dr. Steven Gange: (00:48)
Medicine for me was just kind of the way my educational path directed me. I mean, I liked the idea all along of helping others, but to get to that point, you have to clear some major academic hurdles. I was doing pretty well with those early on and had to continue that academic path. So I got to medical school and, at that point, thought it was gonna be a family doctor because that’s what you do.

Daniel Lobell: (01:11)
The door to door doctors? [Laughs].

Dr. Steven Gange: (01:13)
Yeah. I don’t know about – maybe door to door, but certainly just kind of a little bit of everything and very quickly in medical school, they bombard us with just reams and reams. In those days, it was actual paper – like tons of materials to memorize. I just looked at it and thought, eventually: “this isn’t what I want. I don’t want to know a little bit about a lot of things. I want to be an expert.” And that led me to the path of specialization. And then the urology decision – there’s some really cool things about our specialty that I can share with you. But mostly I just found people in urology that I could identify with. I spent some time with them. I liked what they did. I liked how they conducted themselves. They seemed happy. And that’s ultimately what causes you to pull the trigger and go in a direction of a specialty.

Daniel Lobell: (01:56)
Yeah. I mean, that seems like a good reason. You want to hang out with happy people… Who are the most miserable doctors? Are you allowed to say?

Dr. Steven Gange: (02:05)
[Laughs] That’s doctor to doctor, that’s not by specialty.

Daniel Lobell: (02:08)
[Laughs] It’s not like one specialty?

Dr. Steven Gange: (02:08)
I know there’s specialties that would make me miserable, but I don’t think all the people in specialties like that are miserable. I just found something that worked for me. And, you know, I didn’t really know because it was just beginning to sort of get a glimpse of it. But as I’ve gone through years now – almost three decades, I feel very sure that I made the right decision for me.

Daniel Lobell: (02:31)
Are you still challenged by it? Do you still find things that you’re like, “wow, I don’t know what to do” and is there some excitement to that?

Dr. Steven Gange: (02:37)
If we were just talking day to day, seeing the average patients that come through – most of that is almost rote. But there’s always those sort of straightforward consultations, there are still challenges. Like “how do I get along with this person well enough for this person to understand what I’m trying to encourage them to do?” The knowledge is pretty stable at this point. But working with people is a challenge and to get them to be in a trusting environment with someone they’ve never met, that really requires a lot of skill and a little bit of luck.

Daniel Lobell: (03:13)
Is there something you do specifically that is your go-to for disarming the patient to make them feel comfortable?

Dr. Steven Gange: (03:20)
I wish I did something every time that worked every time. I try at the beginning of any consultation with patients to listen to them, but I also read their body language. By the way, that was so much easier before masks. I really feel like, “wow I might as well be on the other side of the curtain, listening to this person,” because I can’t read eyes and I don’t think anyone can. People make their facial gestures below the mask line. I’m finding medicine in the COVID era to be particularly challenging just from the interpersonal aspects of it.

Daniel Lobell: (03:54)
It’s even broader than that. I think just even interacting socially has become – when they talk about social distancing. It’s never been easier than when you can’t tell if the person smiling when you’re talking to them, right?

Dr. Steven Gange: (04:06)
Yeah. We’re losing contact with one another. We don’t trust anyone. It’s a sad, sad fallout from this – obviously this concerning virus, but the social impact, sociological impacts – I don’t know how we ever come back from it.

Daniel Lobell: (04:23)
Yeah. Between what’s going on politically and what’s going on medically, everybody seems to be skeptical of everybody else. We don’t trust each other’s news, we don’t trust each other’s views and we don’t trust each other’s something else that rhymes with those – snooze? I don’t know. [Laughs]

Dr. Steven Gange: (04:40)
[Laughs] We don’t trust the person walking toward us in the grocery store, so we make sure we take an extra wide berth with your stupid carts. It is pervasive and the mistrust that COVID and what we’ve had to do to react to it – the mistrust is… I don’t know how it’s ever going to come back. It’s like now we have TSA that resulted from 9-11. Are we going to have masks now forever? I don’t even know how it’s going to ever end.

Daniel Lobell: (05:08)
I hope not. And I can’t imagine that would be a healthy choice, either. I don’t know, but I think it’s probably not. Mentally healthy – for sure not, but I think – and as a non-doctor I don’t really have a basis for this – but I have to imagine that breathing into a mask all the time is not as good as breathing air freely.

Dr. Steven Gange: (05:28)
Sure. Yeah, I agree.

Daniel Lobell: (05:30)
They’ve put everybody’s mentality that everyone you meet is a potential killer.

Dr. Steven Gange: (05:34)
That’s the problem. There’s so much mistrust and we don’t even look at people. The fact is we can’t read eyes, but it doesn’t even matter because when you walk by a person, really all you’re doing is admiring the choice of mask. We look at each other’s masks and we stay wide apart as we’re walking towards one another – it’s the saddest thing ever.

Daniel Lobell: (05:52)
Yeah. And I never even thought about how it would impact you or any doctor-patient relationship.

Dr. Steven Gange: (05:58)
I’ll tell you. We see mostly men. I see men, that’s principally my aspect of urology and I miss shaking hands. I honestly think a handshake tells a lot about a person. I read into a handshake and I deliver parts of me through a handshake and there’s no handshakes. We’re doing these stupid elbow bumps. I can’t even stand them. What are we actually doing? I think clearly, there’s huge societal impact, but in my day to day, trying to bring people over to my way of thinking about their situation is really, really hard in masks.

Daniel Lobell: (06:32)
I feel you and I’m with you. I wonder if we’ll ever get to a point where somebody says, “you know, you could tell a lot about a person by the way they elbow bump you.” [Laughs]

Dr. Steven Gange: (06:40)
[Laughs] Exactly. I hope not.

Daniel Lobell: (06:43)
What is urology?

Dr. Steven Gange: (06:45)
We are the human plumbers. We take care of the whole situation that begins with the production of urine by the kidneys, travels down these little tubes called ureters stored in the bladder and passes out through the urethra and in the case of men, a prostate that wraps around the urethra. All of the elements of that urinary production and expulsion relate to our specialty, including cancers, for example, in the kidney or in the bladder cancer, the prostate. We see kidney stones. We do lots of work with infections from top to bottom. In men, we are also the reproductive specialists. We are, in essence, the gynecologists of men. We take care of the fertility, ability to make sperm, the testicles, their production of the sperm, but also the production of the hormone testosterone. We deal with a lot of things in men that are beyond our scope in women. But ultimately, as I said, we’re plumbers.

Daniel Lobell: (07:44)
Yeah. I wonder if you have any of the same tools, but like converted to medical.

Dr. Steven Gange: (07:50)
[Laughs] They’re more delicate, but exactly the same.

Daniel Lobell: (07:53)
I actually heard a podcast this week – it was not a medical podcast, but it was a podcast where they tell inspiring stories and one of them had to do with kidney stones. Somebody had gone in for kidney stones and because of the kidney stones, they found a cancer in the prostate. Is it the prostate? When you go in for a – what the heck is it called–

Dr. Steven Gange: (08:21)
You might be thinking like a colonoscopy.

Daniel Lobell: (08:24)
Colon! Right, in the colon.

Dr. Steven Gange: (08:24)
They go right past the prostate – the prostate is just on the other side of the rectum and that is the organ unique to men.

Daniel Lobell: (08:32)
So it was in the colon, forgive me. They found a cancer in the colon because of the kidney stones.

Dr. Steven Gange: (08:38)
Yeah. Probably because of the imaging. We do CAT scans and then something comes up that way.

Daniel Lobell: (08:42)
And the inspiring story was that the doctor said, “had you not come in with these kidney stones, they saved your life essentially because this cancer would have progressed to a point where it would have been that you wouldn’t have able to come back from it, but we caught it in time because of the kidney stone.” And as I listened to that, I was thinking to myself, “isn’t there something we can… Like with all the apps, shouldn’t there be one that sends you an alert when some cancer is growing in your body at this point? Are we anywhere near that?

Dr. Steven Gange: (09:12)
Well, there are places where you can go and get a total body CAT scan. Not ordered by your doctor, ordered by your checkbook and find things that you might not otherwise have found. And that’s an interesting idea, except some of these things don’t need to be found. So we’ve been seeing more and more incidental kidney tumors when people are having CAT scans for things like kidney stones than we would ever have detected that and maybe they would never have become a problem. But what happens when you do these broad sweeping diagnostic tests is we find things and feel the need to react to them and really at that point, you almost don’t have a choice. You have to respond to the diagnosis, but maybe too much is too much. Like we don’t need to know everything that’s going on in our bodies at this point.

Daniel Lobell: (09:59)
Hm. That’s such an interesting perspective. Maybe it’s too neurotic, but there must be something where if it’s something that could be removed and save your life… some indicator. Do you find when you’re working on people, as a urologist, do you often find cancers that you didn’t set out to find and how common would that be?

Dr. Steven Gange: (10:25)
Well, we specifically look for cancers. In our specialty, principally, prostate cancer is something that’s very, very quiet. It doesn’t cause symptoms until it’s widespread and it’s too late to fix. In some cases you’ll relate to the idea of a mammogram for a woman or a colonoscopy for a man or a woman. These are screening tools that allow us to find things while they are fixable. I’m not really arguing against those. In fact, we have to do those things to find some of the worst cancers, but I am arguing that a total body scan or a little thing that looks like a cell phone that you can beep over your body and find little early problems might just be overkill and perhaps open a can of worms that doesn’t have to be opened.

Daniel Lobell: (11:10)
How important is a colonoscopy or a prostate exam?

Dr. Steven Gange: (11:15)
I confused you. A colonoscopy is for colon cancer and is performed by gastrointestinal doctors. Urologists do other types of oscopies, but the way we find prostate cancer has to do with a blood test called the PSA and the finger exam -the digital exam, it’s not really digital, it’s still a finger – we just take a feel of the prostate. We can do that right through the rectum, because as we said, the prostate is just on the other side of the wall of the rectum, but very, very reachable with the finger. We’re looking for abnormalities in the blood test, but also abnormalities in the texture, the symmetry, even the size of the prostate. Between those two tests, we’re very good at detecting early prostate cancer. That’s not the diagnosis, but those are the tools that lead us to the other tools that can help us diagnose the disease.

Daniel Lobell: (12:05)
At what age should you get one done and how often?

Dr. Steven Gange: (12:12)
Generally recommended to have a man of age 50 get an annual PSA blood test and prostate exam. Continue that through about age 70 or 75, because much older than that, if the cancer was to be detected, it probably would be a very slow growing disease. In men who have a family history – dad had it, grandpa had it, etc. – those folks need to get started earlier with the screening. It’s recommended they start at about age 40. Similarly, African-American men, who have higher incidence not only of cancer, but of bad cancer, they should be started in their screening processes about age 40 as well.

Daniel Lobell: (12:49)
Oh, wow. You mentioned that you guys do some other kinds of oscocopies and I was probably a little embarrassed to cut in, but I shouldn’t be, I’m not a medical expert. What is an oscopy? I’m curious.

Dr. Steven Gange: (13:01)
Oscopy – scope is the middle part of that term. It involves some sort of scope and we use a scope. GI doctors use the scope when they examine the colon and we use the scopes to examine the urinary tract – depending on the situation, different scopes. When we’re looking at the prostate for its size and its impact on urination, we use a little flexible tube called a cystoscope. Cyst refers to the bladder. That’s one of the names that the bladder goes by, if you will. So we’re scoping the bladder – cystoscope.

Daniel Lobell: (13:38)
Hey, different scopes for different folks, huh?

Dr. Steven Gange: (13:40)
Yeah. Like you mentioned the kidney stones – we have even tinier scopes that we can go all the way up to those little tiny tubes that drain the kidneys into the bladder and we can use these delicate instruments to, to identify and treat stones.

Daniel Lobell: (13:54)
How do stones… how are they formed in people and is there anything you could do to avoid them?

Dr. Steven Gange: (14:00)
In all of us there’s components of our urine that could crystallize and create problems in the formation of a stone. So first of all, we minimize the crystals and we minimize the crystals by certain dietary choices. People who like brown beverages (coffee, cola, and tea), lots of chocolate or even dark green vegetables have in their urine a lot of oxalates and calcium, which is in everybody’s urine, complexes with these oxalates to form these crystals that can lead to stones. So, number one, when we’re trying to prevent stones or just trying to avoid them all together, minimize the crystals. Number two, dilute the crystals out by drinking lots of water. The more water we put it into the system, the farther apart the little crystal molecules are and it therefore is a little more challenging to have them complex together to form stones. So really it’s a matter of proper hydration and minimizing things that can lead to stone formation.

Daniel Lobell: (14:56)
Isn’t it a little frustrating that these stones aren’t worth anything? Like in an oyster they’re worth a fortune!

Dr. Steven Gange: (15:02)
[Laughs] Yeah. Well, I do have people who want to take them home and I don’t know what they’re doing with them. I haven’t seen any stone jewelry.

Daniel Lobell: (15:09)
That would be an interesting Etsy site. I don’t know that I’d want it. You performed the very first UroLift procedure in North America in 2011 and you’ve performed a large series of in-office UroLift procedures under local anesthesia in the world. Can you explain what the procedure does, please?

Dr. Steven Gange: (15:31)
Every man has a prostate. Until he’s an adolescent, it’s a tiny little thing. As soon as testosterone starts flowing through our bloodstream, the prostate gland starts growing. It grows bigger and it grows tighter and it essentially wraps around the urethra tube that you urinate through, and sits beneath the bladder. So as urine is expelled from the bladder, it has to pass through this little channel in the prostate gland to make it to the outside world. As prostates get bigger in size, but also bigger internally causing a squeeze on that urethra, men start having some very annoying urinary symptoms. My hope is, by the way, that I catch it when it’s still just annoying, because if a man doesn’t respond to those symptoms, puts off the visits that are probably important, by the time we see them, sometimes men can’t urinate at all. They’ve let it go so long that they’re unable to pass any urine at all through the urethra that’s within the prostate. That’s when we get into doing things like placing tubes called catheters and talking about procedures. But again, the ideal arrangement would be that as soon as a man starts to really notice these symptoms, that he comes in and lets us sort that out with him. Some of the symptoms: an urge to go all of a sudden, sometimes not even making it to the bathroom (we call that urge incontinence frequency), more trips during both the day and night – nocturia is nighttime urination. Frequency and urgency we’ve mentioned. Then there’s the other sort of flip side of the coin where a man will stand at the toilet and not be able to urinate at all or it comes very slowly or it comes in spurts instead of a nice stream. When that all culminates, that’s when men start retaining urine and sometimes they retain it and they don’t feel it, but believe me, when someone has it and they can’t urinate, it’s a crisis.

Daniel Lobell: (17:22)
This makes me think of several questions, I’ll focus on one. One thing I used to – and I know I have a WebMD question for you because I know you’re the urology guy on WebMD – but as a young neurotic, I used to go on WebMD all the time thinking I was coming down with different things and in the process learned a bunch of symptoms for different things that thankfully I do not have. One of them was diabetes and I saw that one of the symptoms was constantly needing to urinate. What’s the connection there?

Dr. Steven Gange: (18:00)
When there’s a lot of sugar in the urine – which is what happens to diabetics when they’ve not yet been treated, especially – the body tries to counterbalance that concentrated urine with the production of more water in the urine to dilute it out and that results in more frequent trips because there’s more urine to expel. I’ve made the diagnosis of diabetes more than a handful of times when a patient came in thinking it was a prostate issue and then we look under the microscope, but we also do a test called a dipstick and we can identify sugar in the urine and, again, that sometimes explains everything. Oftentimes it’s just one of the problems, but in some rare cases that can be an issue.

Daniel Lobell: (18:43)
That’s interesting that it shows the same symptoms in a way.

Dr. Steven Gange: (18:47)
That’s the challenge of medicine. One symptom does not equal one diagnosis. We call it a differential diagnosis – we work our way down from the most common to the least common. That’s kind of what we learned in medical school. We’ve really refined our understanding, so if there’s a bump on the skin, maybe it’s melanoma and maybe it’s just a little cyst under the skin. We have to be able to work through all that and that’s why we go to school.

Daniel Lobell: (19:14)
Right, right. Let’s jump into the WebMD topic because we have a good segue to it. So you basically are instrumental in the entire creation of the urology section on WebMD. How did that come about?

Dr. Steven Gange: (19:31)
That might be an overstatement. When WebMD was very new, I’d heard about them. I love to teach, I love to talk, but I also love to write. Early on I made a connection and they offered me an opportunity to write for them. For a year or more, I would submit little segments and I used to look for them – I don’t know if they’re there anymore. They’ve changed their focus at WebMD, so there’s not a lot of doctor interaction. It’s just more interactive with our educational panels. So I found that to be a little – over time – a little disappointing. Frankly, this is kind of what inspires me about Doctorpedia. It’s kind of going back to what I think WebMD wanted to be early on. I think it’s going to be better. It’s going to be a better product in the end.

Daniel Lobell: (20:19)
Yeah. I think hopefully we’re going to fill that void in the market and I’m excited about that as well. You mentioned earlier and I touched upon it that there are some exciting new technologies in your field. What are they and how are they changing things for you?

Dr. Steven Gange: (20:35)
Yeah. Let me go back to your question about your UroLift, which I consider one of the most exciting technologies I’ve seen in urology since 1985. We have – in urology – been leaders in developing things like shockwave therapies – we’ve done that for kidney stones for years and now we’re doing it for erectile dysfunction. We have lasers for every indication. Lots of cool little devices that help surgeons cause less trauma and less bleeding. UroLift has solved a big problem in urology. As men age, inevitably their prostates are going to enlarge and tighten. The condition that refers to that scenario is called BPH or Benign Prostatic Hyperplasia. And when it progresses–

Daniel Lobell: (21:25)
–Sure, everyone knows that. [Laughs].

Dr. Steven Gange: (21:25)
[Laughs] It needs some intervention. The very first successful interventions occurred in like the 1930s, where a urologist figured out how to go up inside the tube and hollow out the prostate using cautery, electricity – and of course it’s all done under anesthesia. The procedure to this day is still conducted very similarly to the way it was conducted in the 1930s. It’s a procedure called a TURP – TransUrethral Resection of the Prostate and colloquially is more called the “roto rooter” because that’s what our guys tell each other that they had. That’s an operation that’s time-honored, it’s effective, it does open up the channel, but it has too many side effects. Number one, it requires a general anesthetic, can cause bleeding, requires that tube called a catheter that nobody’s a fan of, and can result in some serious scar tissue issues, and sexual phenomenon that occurs a little bit are really bothersome to men. For example, 70% of men who have that surgery can never, ever ejaculate again. So there won’t be any fluid and often the quality of the orgasm also is impacted.

Daniel Lobell: (22:28)
Count me out for that one.

Dr. Steven Gange: (22:28)
Yeah, count you out. You and a lot of folks. There have been a number of efforts to try to improve upon that procedure. There have been medications that have been in vogue now for almost 30 years, which make men feel better, but they don’t really stop the progress that’s still gonna result in this sort of end-stage difficulty with urination. Men go on the pills because they don’t want to have that TURP surgery. Then probably half a dozen things have come and gone, but Uro-Lift has come and stayed. UroLift is a little tiny and ingenious device placed inside the urethra, still through a scope, still with some sort of numbing agent, but not formal anesthesia, necessarily. It’s a series of these little things that you can imagine if you’re going to hang a mirror on the wall, you’d use a wall anchor, you put something in, it would turn sideways, you use a screwdriver and then you put a good squeeze on the wall. That’s why a mirror hangs on the wall. So in the prostate, a very similar, much more delicate analogy exists when we apply your lift implants. In essence, we’re squeezing the prostate open and this is accomplished in sometimes a matter of as few as five minutes, maybe ten. Having done (I think) more than anybody in the country and possibly the world, this is a very big part of my practice and quite honestly, it’s been the best thing I’ve ever done in urology. There are lots of things we do that make men’s lives better, but not quite as minimally invasive as this and with as much predictability as this. With this procedure, men get better very quickly, almost never require a catheter and have zero sexual side effects. That’s a huge divide between Uro-Lift and TURP – besides the fact that we don’t do it in the operating room, it doesn’t cause bleeding, doesn’t result in scarring, and there’s no sexual side effects. Where you said, “count me out of that one” – if you needed something, you’d count yourself in on this one,

Daniel Lobell: (24:19)
Doctor, you sell it so well that I want one and I don’t even need one. [Laughs]

Dr. Steven Gange: (24:27)
[Laughs]

Daniel Lobell: (24:27)
That is pretty cool. And that sounds like a major breakthrough, from what you described. Are there any things on par with that that are on the horizon that you’re excited about now?

Dr. Steven Gange: (24:41)
Sure. I mean, there are a lot of efforts to replicate the success and the minimally invasive approach to what UroLift has accomplished. UroLift really was the first procedure to be performed in the prostate in this way to achieve this level of success, so everybody was chasing after it, I would say. A couple of things that are already out there through the FDA, one is called Resume. Resume is the installation of steam in the prostate. I did the first of both Resume and UroLift in North America, and I did more Resume procedures in the clinical trial than anyone else. Honestly, I just can’t bring myself to it. It’s just too uncomfortable and because steam is heat, heat causes swelling, every man who has this procedure requires a catheter. If we ask men who are approaching urological procedures, “what are your priorities?” All of them would say “first, I don’t want that tube sticking out of me” and that’s, again, something required of that procedure. The procedure actually – as you get further away from the date of the procedure – the procedure looks pretty good. Resume works but it’s just a very hard patient experience and the recovery can last months, where UroLift’s recovery is really more days to a week or so,

Daniel Lobell: (25:58)
Man, this UroLift sounds better and better. Sign me up for three of them! [Laughs] No, hopefully not. What is it like to perform the first one on somebody? Is it daunting?

Dr. Steven Gange: (26:13)
I’ve been involved in clinical research since 1998 and I’ve been the first to do things before. This one was unique because it involves an instrument that I’d never put my hands before. You have to understand the inner workings of the device. Clearly there was some training, so I didn’t walk in cold and just start firing UroLift implants. But by the time I was ready to do that, the two engineers who invented the procedure were in my procedure room. I had support from the people who brought it forth, and so it wasn’t overly daunting. They had done some of these procedures in Australia. It’s just that when we started the procedures as part of the clinical trial in 2011, we did it in awake patients and that was probably the more daunting aspect. The mechanics of the procedure, I got familiar with pretty quickly, but my patient was awake. I had done some things to the prostate historically with awake patients that I really regretted. It just caused too much pain. But I’ve found with the inventor’s guidance, actually, that we could do this procedure under strictly local anesthesia, just putting some numbing jelly inside that urethra and letting it sit for a bit. We embarked on the clinical trial and it went beautifully and although there were some initial hesitations, they all went away pretty quickly.

Daniel Lobell: (27:32)
Pretty incredible that you could do that with local anesthesia. I’m impressed that I could get a dental cleaning and it doesn’t hurt. [Laughs]

Dr. Steven Gange: (27:37)
[Laughs] Exactly.

Daniel Lobell: (27:40)
I found this interesting: in 2001, you founded the Utah Healthy Living Foundation, a nonprofit dedicated to improving the quality of life in Utah through health education and screenings. Can you talk a little bit about what the foundation does and also why it’s so important?

Dr. Steven Gange: (27:56)
Yeah. I was working with the American Cancer Society back in 1998 and we had this idea that men needed some better education than what was being delivered to them and we thought we’d do it in a way that men might respond to. We rented our second largest sports arena here in town and we filled the floor with all kinds of adventures, skiing, hiking, boating – everything that might draw a guy in. Then we had simultaneously planned to have a bunch of educational talks–

Daniel Lobell: (28:33)
–You’d trick people! [Laughs].

Dr. Steven Gange: (28:33)
Yeah, trick them. “Come on in and then sit down for a minute.” Honestly, at the time Bob Dole had just come out talking about his erectile dysfunction and Viagra. So we got Pfizer involved as a sponsor and we got Bob Dole to come in and give it a keynote. Maybe today that doesn’t seem such a big deal, but back then it was really a big deal. We gathered about 2000 people in the course of a day. Not quite what I envisioned – I was thinking more like five times that number – but it had never been done before. We called this the Men’s Health and Fitness Expo and we were thinking we might do this every year. What we found is that working with American Cancer Society, they have some requirements about fundraising and the long and short is that of the money, every dollar that I was able to raise, they needed 30 cents to come back to them. It was really a struggle to get this thing up and running. Bob Dole’s honorarium was like $50,000 at the time. When the event went off – and it went off well, but kind of gave me a lot of headaches along the way – we decided we would form something, a vehicle through which we could raise money and provide education without that middleman. So we founded the Utah Healthy Living Foundation. Since that time, we haven’t repeated the Men’s Health Expo, but we have become accredited to provide medical education. We can educate doctors and every year our organization sponsors the Utah Urological Society meeting, there’s a huge meeting every year. We also have become sponsors of something called Zero, which is a big program nationwide that is addressing the concerns of prostate cancer in men. It’s very educational, there’s these fun runs and walks and all kinds of good things. Then we’ve also done a lot of health education for a variety of conditions – most of them have been urological just because I’m the founder and the president and it’s in my wheelhouse – but we’ve gone a little beyond that. Our hope is that one way or another we’ll take advantage of opportunities to meet educational needs, whether they’re consumer directed or provider directed. I think we’re doing a pretty good job given that we don’t pay anybody any money – it’s a volunteer organization – and we maintain our accreditation at our own costs. I’m happy that we have it. It’s become an opportunity, it’s given us opportunities to do some exciting things.

Daniel Lobell: (31:04)
Yeah, that sounds amazing. This is probably the least interesting thing out of everything you said, but what was Bob Dole like?

Dr. Steven Gange: (31:13)
I didn’t know what to expect, but because I was running the program, I got 40 minutes in the green room with just Bob Dole and I came out a different person. That guy inspired me in a way that I never would have guessed. I mean, you see somebody on TV or in a little commercial clip or whatever – or even delivering a talk. One-on-one he was so interested in what I was up to and he expressed himself in a way that I felt like it was really genuine. Then he was very much an open book about “look, Bob – Senator Dole, how did you get into this educational effort?” One thing after another, it was like layers of impressed-ness. I couldn’t get over what a really fine individual I was getting to sit down and talk to. Then he got up and did the most amazing talk, directed at every man and how to better take care of their own health and taking advantage of all the resources around them. All in all, that was one of the most powerful meetings I’ve ever had in my life.

Daniel Lobell: (32:26)
Now I’m really glad I asked the question. I thought it was kind of a stupid question, but I’m amazed by the answer.

Dr. Steven Gange: (32:31)
No, he’s something else.

Daniel Lobell: (32:33)
Wow. That’s not what I expected to hear. Maybe I’ll go on YouTube and revisit Bob Dole. What are the most important facets, in your opinion, of the doctor-patient relationship?

Dr. Steven Gange: (32:51)
I think trust and honesty, and I think it works both ways. I think the patient has to put him or herself in our hands in a way when he walks into our exam rooms allows us to get down to the most personal of matters. There’s got to be a general level of trust. If either one of us in the equation deviates from honesty, we fail each other. I have to trust the person I’m exposing myself to in some ways as well. When they’re talking to me, I need to know the real story and they need to know the real truth. I have never shied away when it’s something serious from telling patients it’s something serious. I think rather than beat around the bush or give false hope. You’ve got to understand that in urology, we don’t have a lot of people dying of the diseases that we take care of. By the time a man with prostate cancer, which is our most common cancer and it does kill a lot of men and respectfully, it’s a real significant disease, but by the time that’s happening, usually a urologist is way in the backseat. Oncologists are involved and hospice care and what have you. But nonetheless, we make diagnoses day in and day out – diagnoses of prostate cancer. From the very beginning, patients have to know that we’re treating them honestly. What I mean by that is I think there are – in any walk of life – there are people grinding their own axes. I shudder to think that some folks diagnosed with a disease that might be fine untreated – because there are certainly a large group of patients with prostate cancer who don’t need treatment – that they might be talked into doing something because the doctor wants to do something. No accusation to any one specific individual or specialty or anything else. We’re all potentially victims or our own self-interests. But I personally can’t let that ever get in the way. I need to tell a patient literally, what would I do if I were in your position? If I’m not able to say that as I’ve finished counseling a patient, then I let them down and frankly, I let me and my entire specialty down.

Daniel Lobell: (35:09)
That’s always – that’s, first of all, great to hear – but I would say probably only good advice if the person saying it would do something good for themselves. “What would I do if I was in your situation? I’d jump out a window” might not be the best guidance. [Laughs].

Dr. Steven Gange: (35:25)
But that’s what I think balance finds its way in every one of these conversations. We don’t ever want to kind of go down an extreme path unless it’s an extreme circumstance. Certainly there are things in medicine, even in urology: a guy can’t go to the bathroom, he’s laying on the gurney in the emergency room, but he doesn’t want me to put a tube in. Well, it’s an extreme situation and it’s time to put the tube in. But beyond that, there’s a lot of opportunity to ask and answer and go back and forth and educate and help people down a path that’s least traumatic. We never want to deliver care where the treatment is worse than the disease, but I think we see that a lot. We see it some in urology, we see a lot in medicine.

Daniel Lobell: (36:10)
I read a book recently written by a doctor – a nutrition book – but he was saying that a lot of the times, surgeries wind up causing more problems than the thing you were trying to fix.

Dr. Steven Gange: (36:23)
Well, right. But if you walk through life thinking that and your appendix bursts but you think surgery is scary and you go to GNC and buy some supplements… Again, I respect where people come from. I certainly know that there are a lot of people who don’t trust modern medicine. Maybe they prefer Eastern medicine. Maybe they prefer things they brew on their own stoves.

Daniel Lobell: (36:47)
I like modern medicine better than old fashioned medicine.

Dr. Steven Gange: (36:50)
Well, yeah, maybe, but we do a lot of things that seem invasive and I think it’s important for the patient to trust me enough to allow me to tell him what I would do and to be honest in every aspect of that communication. Then we go down a path where there’s no regrets. If a person chooses – based on good information and good balanced discussion – they choose a type of treatment and I support it, then we’re both in this. If something doesn’t go perfectly well, I give it my best effort, you made your best decision. Again, urology isn’t that kind of specialty so much because our things do go well and I specifically focus on minimally invasive procedures. I want a patient to experience it, whatever it is, the way that I would choose to experience it. I think there’s room for improvement in medicine, in this area, and I think about it everyday when I’m talking to people.

Daniel Lobell: (37:47)
That’s great. If I ever need the urologist – and I hope I don’t – I hope to have somebody with that attitude, if not you yourself. I’ve never heard a doctor, by the way, say that they like maximally invasive surgeries.

Dr. Steven Gange: (38:01)
Well, no, not necessarily, but some of us train long and hard. A cardiovascular surgeon has probably gone through, I don’t know, 15 years of training beyond high school. So you go through medical school and then residency and then fellowship and by the time the person’s there, they know how to do the hardest things. They welcome difficult problems because that’s what they were trained to do. I would – more than guess, I know for certain – that some of the highest, most educated surgical-trained physicians – they love the hardest things. I don’t think everybody thinks minimally invasive. I think minimally invasive because I don’t want hard things done to me. I think the way I would want it done. But I don’t have some of those major skills. I had cardiac surgery because of my heart valve that was broken at birth. It is a really big deal and it’s a good thing I found somebody who loves to replace aortic valves.

Daniel Lobell: (39:02)
Wow. When did you do that?

Dr. Steven Gange: (39:04)
Two and a half years ago.

Daniel Lobell: (39:07)
It’s been broken since you were born and you were able to get away with it until two years ago?

Dr. Steven Gange: (39:12)
I had a little heart murmur sometime ago and nobody ever looked into it. I started going to primary care doctors when I was 40, I’m now in my late fifties. Nobody ever listened to my chest at all with the stethoscope, for what that’s worth. My wife and I were watching a movie one day. She put her head on my chest and she heard what sounded like a blue whale blowing through his spout. I had a heart valve – an aortic valve – that was to have three leaflets, mine only has two. Mine was this two leaflet valve called a bicuspid valve and over time they calcify. When they calcify, they don’t work well. I didn’t realize it, but I was in a condition called congestive heart failure. I was having trouble breathing. We’d gone on a dive trip and I couldn’t dive, something was wrong with me. Anyway, I had a broken heart valve and I had a tremendous team of surgeons and quite honestly, I owe them my life. So thankfully not everyone thinks minimally invasive.

Daniel Lobell: (40:04)
Wow. Yeah. Broken heart valve sounds like a country song. [Sings] I had a broken heart valve.

Dr. Steven Gange: (40:13)
[Laughs] Exactly. Good grief.

Daniel Lobell: (40:21)
[Laughs] What would you say is the biggest compliment that a patient could give you?

Dr. Steven Gange: (40:27)
When I hear a thank you, I don’t need it to be elaborate. I don’t need a gift or a chicken or whatever – all I really need is a genuine thank you. I feel like when I get those – and I get them probably 10 times a day, quite honestly – it fuels me for the next day. This is why I do what I do because I’m in a unique position where, because of my education and experience, I actually improve the quality of somebody’s life. When they look at me and they say, “thank you” – it fills my chest. It’s why I do it.

Daniel Lobell: (41:01)
Well as long as it’s not due to the heart failure. [Laughs]

Dr. Steven Gange: (41:04)
[Laughs] Yeah, that’s done now.

Daniel Lobell: (41:08)
[Laughs] Well, that’s beautiful.

Dr. Steven Gange: (41:10)
Thanks.

Daniel Lobell: (41:10)
You mentioned drinking a lot of water can help prevent kidney stones. Is there anything else that you would give advice to people to keep us away from your office?

Dr. Steven Gange: (41:22)
That’s interesting. I do think if there was one piece of advice, it would be to drink plenty of water. I have a sign on my desk, actually, at the office that says that. It’s just kidney stones, it helps against the fight against infection, it helps us gauge the effectiveness of our urinary habits, if you will. So as a guy gets older, let’s say he goes too often and he starts backing off drinking because he’s going too often. Sometimes the going too often is a cue that there’s a problem and dehydration is a terrible way to solve such problems. If you always go through the day thinking that water is the most important nutrient, in essence, that we can give ourselves – you take vitamins and supplements until the cows come home, but if you don’t drink enough water, bad things happen in the urinary tract. Not just the urinary tract. As people get older, that urinary infection becomes much more serious. If they’re dehydrated, people die. Then the question is how much water is it? Eight glasses? Well, it might be glasses for one particular person on a particular day, but mostly we can’t predict the amount of fluid that it takes to keep the urinary tract happy and the body happy. What I mostly tell my patients, particularly kidney stone patients, but this relates to everybody: if when you’re urinating, it’s really smelly and yellow, you’re dehydrated – drink more water. Trying to keep the urine itself kind of a pale yellow is a good general health measure and eight glasses, again, doesn’t pertain to anybody specifically.

Daniel Lobell: (42:58)
You may have said it and I missed it, but being dehydrated – how does that negatively affect you?

Dr. Steven Gange: (43:06)
It leads to the kidney stones and can cause infection. Being dehydrated can cause your blood pressure to go down and your heart can fail. People can literally die of dehydration and it’s not because they got a kidney stone, it’s because they didn’t support their own metabolism and burdened their heart the way that they did.

Daniel Lobell: (43:24)
Wow, it really is that important. That’s incredible.

Dr. Steven Gange: (43:26)
Yeah. Water is a really important thing.

Daniel Lobell: (43:29)
Huh. I just started taking vitamins. I never took them because I had heard that maybe they don’t really work or whatever. What is your opinion on vitamins? Because you mentioned them a second ago.

Dr. Steven Gange: (43:41)
Yeah. I’m fortunate. I have a really good friend who is at the University of Michigan, who’s the nutrition supplement guru – really nationally and in some ways internationally – named Mark Moyad. Right within my arm’s reach here is his supplement handbook. He’s had a number of additions of this thing and he really is considered a thought leader. I hear a lot of his lectures. I sit down and listen, and he’s got all of these things to say about a lot of different things. But every single time after one of these talks, for the past five years or so, I’ve said, “Mark, okay, what do I do now? What, what should I be taking?” And he looks at me and he says, “Centrum Silver.” Because so much of what we think is important and we gorge on – we take huge amounts of supplement A or B – never even make it into our bloodstream. They just get pushed out through the colon. A lot of the decisions are random. Number one, random to choose this supplement or that supplement. And then we just don’t have enough science to guide us when we’re shopping at the GNC to decide which supplement and how much of a supplement to take. When my good friend who’s devoted his entire career to nutrition and supplements looks at me and says, “Centrum Silver” – I think, “alright, that’s what I’m going to do.” Now, there may be times where certain supplements make sense, but more often than not – as I’ve, again, heard many of his talks – the science supporting supplement usages is really disappointing.

Daniel Lobell: (45:05)
Yeah. Like I said, I couldn’t find any conclusive. As a consumer and patient trying to stay healthy, it’s hard to decide what’s real.

Dr. Steven Gange: (45:14)
Yeah, it’s really hard.

Daniel Lobell: (45:14)
Going back to our question of what’s real, what’s fake, and how do we trust anybody anymore?

Dr. Steven Gange: (45:21)
Wait, are you talking politics or are you talking supplements? [Laughs]

Daniel Lobell: (45:23)
Oh, I just meant in general, it’s a bigger problem. Where do you get your news and how do you know and what do you trust? It bleeds into health and everything, especially now during COVID times, when you hear “listen to Dr. Fauci, don’t listen to Dr. Fauci, the CDC is right, the World Health Organization is wrong.” Whatever it is, it’s confusing as hell. Nobody really knows what to do.

Dr. Steven Gange: (45:47)
Yeah. Absolutely true.

Daniel Lobell: (45:47)
But I do get a good feeling talking to you because first of all, I know what an accomplished doctor you are. And also you have such great confidence when you talk. And you’re very reassuring, which I think are great, great qualities to have in somebody in the medical profession. You have a great website, also. I wanted to talk about it a little bit. It has great information on it about your services, news, patient reviews, and a lot more stuff. And you also have very active social media accounts to provide useful information to people. How important do you think it is for doctors to utilize the online health space nowadays?

Dr. Steven Gange: (46:27)
I think there are plenty of doctors who are successful without that. I belong to a large group of doctors and I would say the minority are involved in any kind of social media presence. When I started doing UroLift, specifically, I was the first in the country and the first in North America, I felt like I needed to start bolstering my experience with a little bit of a presence and that’s what led to the creation of that uroliftdrgange.com page, but as you can tell browsing through there, there’s a lot more information. Over time – I’m kind of web savvy anyway – I just have started to build a little bit more education, bit by bit into that page. The company that I’ve worked with for some SEO (search engine optimization) has also guided me down the path of things like Facebook and Twitter, etc. It at this point wasn’t entirely volitional. Some of it has kind of rolled in towards my shoreline. It just seems like, “okay, I’m doing this, maybe I should do this”. I do, from my webpage, probably get a new patient request every day. I’ve as a result of the page recruited patients, if you will, for UroLift from all over the country and from four other countries. People do look and I may not be, because of my medical background, I don’t feel like I need to go searching a medical condition online, but I know that more and more often patients who’ve come to see me have done just that. And it’s not just the 20-30 techie guys, I see guys in their seventies and even eighties who tell me what they found on the internet and found me on the internet. At this point for me, it’s mandatory. It doesn’t mean it has to happen for every other doctor, but this platform gave me the springboard into Doctorpedia, which I again think is going to be a superior interactive experience for consumers and for physicians. I think it’s going to accomplish things that my little page never would have.

Daniel Lobell: (48:32)
I think that’s a good lead in for me to ask you about Doctorpedia and what do you think Doctorpedia is doing and what can they be doing to assist the online health space that people should know about?

Dr. Steven Gange: (48:45)
I think that there’s more honesty and less hype than I see on most pages. I feel like by involving accomplished and honest physicians, people who really do care about how the interaction leads to improvement of quality of health and how the relationship has become so very important to us with our patients. We are (people involved in this page) very much interested in good quality, high-end and very accessible education. I want people to – when they come to the men’s health page, specifically – to understand that they’re approaching a kind of room full of a lot of expert people can provide some guidance and it will be honest guidance. No one is grinding an ax. We are here to just give the best health information available. I think people will like navigating the page. I think it’s got a lot of visually intriguing and stimulating platforms. I just think it’s going to be, because of the way it’s been created, it’s going to be the most visible medical education space on the internet.

Daniel Lobell: (50:03)
Yeah, I agree. You mentioned the visuals and I think it’s just a stunning website just to look at before you even dive into the incredible wealth of knowledge that’s within it that you can personally benefit from. I’m glad you brought that up. I like to ask the doctors about hobbies, as we round off the interview. Do you have any hobbies in your life?

Dr. Steven Gange: (50:28)
This is a shortcoming. I love to golf. I don’t do it very often. I love to ski in winter. I don’t do it very often. I travel a lot, but most of it’s for teaching. I just finished teaching UroLift in my 47th state when I was in Alaska last week. My hobbies are more, “what do I do at the end of the day when I put my feet up?” I need to develop some hobbies that have gotten less attention. I play bass guitar. I’ve played it since I was a kid. I’ve just created a music studio in my house and a buddy of mine who plays guitar and I will be getting together more often. That’s a great hobby. I also want to play cello before the bucket list is complete. Music, regardless of whether I’m playing or listening, music is absolutely a hobby.

Daniel Lobell: (51:19)
I’m staring at a clarinet that I’ve had for two years, that I’m waiting to teach myself or get lessons in.

Dr. Steven Gange: (51:24)
[Laughs] That’s awesome.

Daniel Lobell: (51:24)
As we speak, I’m looking at it and thinking, “man, I’ve got to get on that too.” Maybe if you start merging your hobbies that you want to do with your teaching, you could maybe teach UroLift on a ski lift or something. [Laughs]

Dr. Steven Gange: (51:38)
[Laughs] Exactly.

Daniel Lobell: (51:41)
Do you have any apps that you use? We were talking about apps earlier. Do you have any apps that you use to track your own health?

Dr. Steven Gange: (51:48)
I’ve used My Fitness Pal in the past. I also had a procedure. I had a gastric sleeve about a year and a few months ago. I was a hundred pounds heavier than I am now. Now I’m more normal, but still a little on the heavier side. That platform, that app was very helpful. Now I’ve started just paying better attention to it.

Daniel Lobell: (52:13)
I’m on the heavier side. Do you recommend it? The gastric sleeve?

Dr. Steven Gange: (52:17)
Well, I was 330 and I lost a hundred pounds with almost no effort. Yeah. If you are in that category, absolutely. It’s a miracle. Quite honestly, it’s as transformative as the heart valve that saved my life.

Daniel Lobell: (52:33)
Do you still have the sleeve on or do they remove it at the end?

Dr. Steven Gange: (52:37)
[Laughs] Yeah. The sleeve is a misnomer. They just amputate half your stomach. The stomach is shaped like an apostrophe and you just chop off the outer half, leaving you a very small stomach. The small stomach doesn’t have a lot of room, so you get full with ridiculously small quantities of food. That’s why it’s not any work. I just eat until I’m full and I don’t eat two hamburgers. I can barely eat a Wendy’s junior bacon cheeseburger without feeling full. So things like that. It’s because of the way it’s designed, it just makes it impossible to stay that heavy. There were days where I was just watching the scale go down five pounds at a time. If you’ve struggled, like I have, Daniel–

Daniel Lobell: (53:24)
–I have, yes.

Dr. Steven Gange: (53:24)
Weight loss is just a horrible game because you go on a diet and you lose 10 pounds and you stop the diet and you gain 12. It’s like there’s no way to sustain that effort – at least there wasn’t for me. I would be happy to talk to you offline about this sometime. I think gastric sleeve by the doctor who took care of me, you couldn’t do better.

Daniel Lobell: (53:44)
I’d love to hear more about that another time.

Dr. Steven Gange: (53:46)
Sure.

Daniel Lobell: (53:47)
I round off every interview with this question and I’m going to ask you (and we touched upon it just now) but what do you do these days to stay healthy?

Dr. Steven Gange: (53:58)
I think the thing that I need to do most consistently to stay healthy is get adequate sleep. I know this because when I’ve traveled in the past 10 days to three different states and a couple of red eyes, I’m not the same person. I can’t fire on all cylinders. And it’s not just wakefulness. It’s how sleeplessness affects so many other functions of our bodies. In treating patients with prostate problems, one of the big problems is being awakened at night to urinate. Some of these are working guys who have to get up the next morning and head off and sit in the boardroom and fall asleep. It is a vicious cycle. For me, besides hydration, which we covered – water and sleep, I think are the two biggest recommendations.

Daniel Lobell: (54:43)
I think those are great recommendations for everybody and I appreciate you sharing them with me and with the audience. Thank you so much for taking the time out to do the show.

Dr. Steven Gange: (54:53)
Thank you, Daniel. Nice to chat with you.

Daniel Lobell: (54:55)
Likewise, this podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique, please consult your healthcare professional for any personal or specific needs.

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