♪ >> eric: time for sunday house call. >> jamie: it is. >> eric: and joining us always is dr. marc siegel aproessociat professor of medicine at nyu langone medical center and author of "the inner pulse". >> jamie: but, wait, there's more, dr. david samadi, vice chairman of the department of urology, chief of robotics at the mt. sinai medical center with awesome topics this morning. great to have you here. first, there is new hope for millions of patients because federal regulators are speeding up the approval of new experimental cancer drugs. including some for breast cancer. dr. siegel, let's let you comment on this first. >> i'm very excited about this, usually it takes 12 to 15 years and i mean years for a new drug to be approved, a billion

dollars and by the time it is out, it may be obsolete. but what is actually happening now is we are entering a brave new world of cancer treatment because in the past we tried to poison the cancer and as we were poisoning the cancer we poisoned our own rapidly growing cells and now we are doing something called targeted therapy and we noticed a genetic difference and devise a drug for the genetic difference for the abnormal protein and tarring it. or, we bolster our own immune system to attack the cancer, this is such exciting lines of treatment we have to get it out there earlier and the fda is noticing in certain aggressive cancers and breast cancer, we call them triple-negative and they don't respond to estrogen or progesterone or herceptin, and, we may want to treat before we operate on the patient and in order to do that need fast track approval and i'm excited about this. >> jamie: i'm curious, that is why they call it targeted therapy, what you described. is there money for this, though,

to get these drugs through, if a number of drugs are fast-tracked? will they be affordable for patients. >> yes. they will be and one of the reasons why the costs of the medications have been astronomical is because of what marc mentioned. the years that goes into it and the investment of the companies, they put in billions of dollars before they actually see it and, it is great news for patients with cancer out there, the fact it was a bipartisan approval in the senate and it happened in may and the new guidelines are going to be coming to medicine, it is great news, the truth is the fda has to look for safety an efficacy of these medications and as they look at the magnitude of how great these are they look for what they call survival benefits and is the medication going to make people live longer or -- and that is the process we always look at but now, through the new guidelines, a lot of great medications, and also smaller companies that have like great innovation, is going to come out and bring this.

the truth is, that medicine is changing and, marc is absolutely right. in prostate cancer, the field i work with, we are using immune system of your own body to fight the cancer, same with breast cancer, all these new targeted therapies, smart drugs, they need to come out and go through a faster pipeline and get rid of the roadblocks. great news. >> eric: when can we go to our doctor and say, i want this. >> 20 to 30 are coming out this year, more than ever before. >> eric: happening now. >> right now and, they do something, progress-free sur rival and you want to make sure the tumor is not getting worse when you are under treatment for it and that you survive. >> there was a report of the shortage of the cancer medications, we even reported on that, here and that raised a lot of red flags and this is the good results. >> eric: great news. >> jamie: fda doing their job. >> eric: have a busy life, who doesn't? and you probably feel tired at times but there is a difference

between just, you know, feeling tired and chronic fatigue. dr. samadi, how do you know when you get chronic fatigue, do you want to take a nap or stay in bed and keep on pushing the alarm. >> jamie: it could be depression. >> a lot of things and i'm happy to have the topic on house call, sundays because a lot of people ask this kind of question. look, it affects 1 to 4 million americans and unfortunately it is more affecting women than men, you have to have it six months, why they call it chronic. and, the truth is, that a lot of 21st century lifestyles we have, lack of sleep, night shift, the jobs, stress, depression, jamie mentioned affects us. also the processed food we have talked about, the heavy metals in the toxins we get into our food, all of that affects it and nobody talked about the bed being comfortable and making sure you don't have a heavy meal at night but this is a diagnosis of exclusion, you have to rule out other things, other things are important, one, rule out heart disease. if the pump is not getting

oxygen to the rest of your body, guess what? you will be tired and if you have anemia, blood loss from the menstrual cycle, old age, ulcer, check your blood tests an vitamin b12, and they are all possibilities of anemia and, perhaps there is a sub-clinical infection and pneumonia, you don't have to have full-blown fever or phlegm, it may be self-clinical. urinary tract infection and look for those and you have to talk to your doctor, you can't go on and address it without looking all right endocrine system and thyroid, gaining weight, losing hair, fatigued all the time, check your thyroid levels and there is something hoshimoto... don't worry about the names, i like it because it is popular but cortisone levels is the engine of your body. >> eric: what if you feel tired

and you are exhausted and go to your doctor and say, i'm pooped. >> when they come to see me, an internist and you are feeling tired, first thing i try to do is rule out the underlying medical causes. thyroid disease is extremely common. one in five women have it, and are you postpartum, do you have a problem with your heart, lyme disease, hepatitis, diabetes? undiagnosed diabetes can cause it. depression. anxiety. once i've looked at underlying causes, and i've ruled them out, and it continues for more than 6 months, if you are also having problems with your muscles, stiff, a sore throat, lymph node swellings, other things we find, i might consider the diagnose, chronic fatigue syndrome and we thought it was associated with epstein-barr virus and now we think it has to do with the immune system not regulating properly. we don't know causes it and we can treat it with

anti-depressants and nonsteroidal medications and, exercise works well and separating out your tasks, not doing them all at once. >> that is critical. drinking water, what you said, simple things, getting 7 hours of sleep and also, sticking to medication and yoga, getting rid of the stress, simple solutions. >> eric: a long list this morning, so if you have this or think you do, go to your doctor and talk to him about it. the advice. >> jamie: and if you get it checked out you will get a lot of answers. great. each year thousands of people undergo angio plasties, and now doctors say, only a small percentage of these were even necessary, the doctors will weigh in on the findings, more sunday house call, coming up.

>> jamie: welcome back, we talked talk a lot on the show about heart disease, a study came out and showed 1 out of 7 patients that get angry yioplas for clearing their heart didn't even need the procedure. is it certain parts of the country or do we all have to worry about this? night is worse, because the study showed one out of two got an unnecessary stent and it comes back to a message we have talked about a lot on the show. you need the proper guy or girl, that is actually treating you, a proper cardiologist to make a decision and not have a knee-jerk reaction where someone has a symptom and bam, right to an angiogram. and it's not one certified or another, it is who is really good and who is not overreacting. there is a huge study that came out in '07 that showed this dramatically. here's the deal, if you are

really sick and go into the emergency room and are having a heart attack or on the risk of one. then you need it and have to have an angiogram and might need a stent or surgery and if you are well or stable, i believe and i treat a lot of patients for this, medication should be tried first. beta blockers and other medications to take the pressure often the heart and have a stress test and calcium scoring test and so many tests you can do before you thread the heart, the coronary arteries are narrow and we want them to be open but once you do an invasive procedure, you are there and you say, well it is blocked... >> jamie: you're on anesthesia and you cannot weigh in, don't give me a stent, i want to try plavix. >> you better believe it and they use a drug to close the stent and you end up on plavix for years and that has side effects, everything in smn

should be done carefully without overreacting and david and i talked about this. some of it is about a discussion we had on this already. >> i think it is a very interesting study. nobody has really looked at all of the hospitals to see whether the procedures are appropriate or not. what this doctor has done from the university, he has compared, the surgery for bypass and for stent, 8,000 and they found 90% of the procedures were appropriate and cardiac stent only 36% of them are appropriate. a lot of them, had to kind of -- all the contraindications and 40% were not indicated and it is raising a big red flag and, they are looking into it. so the message is if you have angina or chest pain at rest, and unstable heart disease, if you have long history of heart attacks, then you should -- don't have the chance you have to go along with what the doctor recommends. but, there are some asymptomatic

heart disease you have the chance and you want a 2nd and 3rd opinion and find out the medical therapies and way to go rather than getting this... >> eric: you used the term "cabbage." what is that. >> a cardiac bypass and it is basically they open the chest and use vessels from the lower extremities or legs to bypass the areas... >> jamie: last resort. let me ask you before we go. people are sitting at home with stents in their body and heart and think, goodness, what if i didn't need them, can you check to make sure you still need them? they come out. >> you will not remove the stent, once it is there it is there and as marc mentioned these -- you need go on medication, such as plavix. but, look over a million of the procedures are being done, this is the most procedures we are seeing, in health care. and because it is such a big spike in this and over 7 billion dollar industry it is raising a little alarm and flag. ask your doctor, do i really need this -- >> you don't want to scare people who had it already.

right. right. >> jamie: i'm glad. a lot of topics to get to. >> eric: time for e-mail now, we talk a lot about the benefits of fish oil, this person says. i read reports taking fish oil can increase your risk for developing aggressive prostate cancer, i take one capsule, 1,000 milligram, every other day, should i adjust my intake? you are the prostate expert and you hear of take fish oil, is there a problem with your prostate. >> thanks for the e-mail and we enjoy reading them. it is very, very helpful, it has omega-3 fatty acid and it is wonderful, a great benefit for the and lowers triglycerides and the benefits of it for hearts is already established, don't need to go there. when it comes to prostate cancer it is controversial and the jury is out. there is a study from ucla last year that showed taking fish oil, 1,000 milligrams lowers inflammation but most studies

show, there is really no association between taking fish oil and prostate cancer and, what i tell this person, it is really -- you can take fish oil without being worried, unless you really have a strong family of prostate cancer and unless your psa is going up and if there are any issues you are concerned about, see your urologist and make sure he really tests you before you go on this. what i don't like about fish oil, and i used to take it myself. heartburn really stopped me from taking it and i know a lot of times there is a risk of bleeding from fish oil. so, if you are -- talk to your medical doctor before you take it. >> and just to add to david's point. i actually, if you don't have a problem with bleeding and it doesn't cause you heartburn i tend to like fish oil, a lot. because it has been shown to improve thinking. decrease risks of depression. help the heart out. decrease blood pressure. it decreases risks of certain kinds of cancer, and, you may get enough from the fish you eat, though. the american heart association

is all for fish oil as a supplement, look and see how much fish you are eating and if not, i would consider a supplement especially if your doctor is trying to lower cholesterol. >> eric: thumbs up on fish oil. >> and there is a prescription for it you can take if you are concerned about getting toxins from fish you can take the prescription one and it will help. >> eric: and maybe baby aspirin, check with your doctor, dr. rosenfeld said fish oil and baby aspirin. >> jamie: new information on who may be susceptible to vertigo. have you ever had it? the doctors that he have latest on symptoms an treatments for a condition that affects millions of us. we'll be right back. [ truck beeping ]

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♪ >> jamie: feeling dizzy and light aheaded are two of the symptoms millions of us suffer from when we have vertigo. dr. siegel who is at risk and xxa -- what, exactly is it. >> it scares us, the room is spinning and when the room or world around you is spinning, that is vertigo and people get frightened about that and i want to give you a tip off the bat. if it is position that is causing you and you move to cause it, that is less worrisome

and it comes on you when you are doing nothing, call your doctor right away and go to the emergency room. if you have weakness associated with it or some kind of facial problems, problems with sensation, i worry about a risk of a stroke, better get into the emergency room but if it is positional, and comes and goes, and is associated with dizziness it could be medication, could be alcohol, it could be drugs, it could be an infection, or it might be, if associated with hearing, something called meniere's disease. >> you have to distinguish between vertigo as marc mentioned and as you said in the introduction, lightheadedness, lightheadedness, it is about the inner ear and the canal with the fluid and the hair cells and receptors and any change in the

fluid shift, will give you the concern, and whether a formation of crystals in there -- and there are epleys, exercises you can do to get rid of the vertigo and with migraine you may see it and, talk to your doctor and make sure. >> jamie: you know there is hope. >> eric: if you move around, don't worry so much. >> jamie: all of us, eric included are trying to get or bodies ready for swimsuit season and the summer and it means more than just toning up. we are going to tell you the foods that can actually help you fight that battle of the bulge. you don't want to miss that. we'll be right back. c'mon dad! i'm here to unleash my inner cowboy. instead i g heartburn.

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>> eric: and back now with the doctors, summer's coming up. while no one food can help get you slim. there are some foods that can reduce bloat and get your stomach andure your body ready for the beach. do tell? >> okay. so the list is going to be up. but my favorite one is really the ones that have a lot of water, watermelon is great because 90% is water, fills you up, great source of vitamin "c," cucumber has a lot of vitamins and water. have you to make sure you drink 7 glasses a day and make sure you are not dehidrailted. but there are other things to get rid of the weight. there are grapes, which are

excellent. it fills you up. you are know hungry. for breakfast, getting egg white in your system is a great source of protein and prevents hunger or carbohydrates, so stick to fruits and vegetables. look at the dish, as long as it's a rainbow color, if you see charcoal, barbecue, it's no good itch the key is substitutes. what are you doing wrong that you can do that are tasty? i like to barbecue zucchini because maybe it will replace the macaroni salad. before the show, eric has greek yogurt. it's great for you. it has a lot of protein, it doesn't have a lot of sugar or fat -- probiotics. watermelon fills you up with water, it's got vitamin "c," use fruits instead of high-calorie desserts. >> you have challenged eric to show off his 6-pack next week. >> eric: i have no