Dr. Mistry Answers Listener Questions on Prostate Artery Embolization + Ejaculate Quantity/Quality

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour. I am Dr . Mistry, your host, here with my co-host and partner in crime over here, Donna Lee.

Donna Lee: 

That’s right. I’m a bad girl.

Dr. Mistry: 

I’m a board certified urologist, maybe looking for a new partner in crime here shortly if she can’t clean up her mouth, and this is a men’s health show. This show is brought to you by the urology practice that I started in 2007, NAU Urology Specialists and have proudly grown to include some amazing practitioners. We have Dr. Christopher Yang, a board certified prosthetics expert in male erectile dysfunction. We have Dr. Lucas Jacomides, who spent many years, one of the head honchos over at Baylor Scott & White, exceptional at integrative care, and knows a lot about all the different areas of urology. Dr. Stacy Ong–she was for almost a decade the only urologist at Breckenridge. So she knows about trauma and sick patients and really, really terrible disease. And she is just an amazing practitioner, wonderful background to her as well as a wonderful disposition. Then my own practice. I am certified in robotics. I do quite a bit of advanced fertility. We have been doing amazing work when it comes to hormone replacement therapy. We do women’s issues when it is related to sexuality, urinary leakage, kidney stones, prostate cancer, on and on and on and on. And it’s the kind of thing when it comes to your specialty men’s health needs, but really all urologic needs, we’re here to take great care of you.

Donna Lee: 

Yeah, that’s right. We can handle it. What’d you say, from the nipples down?

Dr. Mistry: 

That’s right. Nipples to the knees.

Donna Lee: 

Nipples to the knees.

Dr. Mistry: 

Nipples to the knees. We have an amazing integrative health practitioner. Her name is Shefaly Ravula. She used to be at Austin gastro. She’s a firm believer in food as medicine, and she really walks the walk and, you know , not just talks the talk. She’s an amazing practitioner who’s going to help integrate dietary and supplement kind of trends along with the medicine and surgery that we perform to optimize your health. We have Dustin Fontenot, who’s an amazing physician assistant when it comes to your hormonal health. Leonora Brown, she is a little mini me, a doppelganger of mine. She’s been , she’s been with me for 10 years.

Donna Lee: 

She does not look like you.

Dr. Mistry: 

She doesn’t look like me, but she treats patients like me. And I love that. I love, I love reading her notes and seeing how she’s treating people. And she has smaller hands than I do, so a lot of, a lot of my old timey patients prefer their prostate exam with her. And then we have Jason Ramsdell, he does a lot of work down South. He’s a former 20 year in the coast guard kind of character. He’s been a PA in urology for many, many years, and just the most amazing wheel disposition.

Donna Lee: 

And a big ol’ beard.

Dr. Mistry: 

And a big old beard. And one of our news additions, so we have Heather L enz. She has experience in family practice, a wonderful disposition, and also small fingers.

Donna Lee: 

We talk a lot about small fingers, big fingers.

Dr. Mistry: 

I’ll tell you, it’s funny, it’s funny when people think is important. Yeah. And your questions and your participation with our practice and your coming in to see us are really, really important drivers of what makes this show happen and our practice happened. So , Donna, how do people get ahold of us? And let’s go to some questions.

Donna Lee: 

Sure. You can call us during the week at (512) 238-0762. Our website’s armormenshealth.com and our email address is armormenshealth@gmail.com. First question, discussing prostate artery embolization, also known as PAE. “Dr. Mistry, I’m having PAE by Dr. McWilliams at UCLA. Should I be concerned that my prostate at 160 has a median lobe protruding into the bladder?”

Dr. Mistry: 

What a great question. And so prostate artery embolization is a fairly new, unique, and often underutilized procedure for an enlarged prostate where an interventional radiologist will go into the arteries that feed your prostate and then send little, little beads that will cut off the blood flow. It will shrink, shrink the prostate and it works wonderfully for these humongous prostates . 160 gram prostate is five times larger than a normal prostate.

Donna Lee: 

What’s, what’s the size? Like a walnut?

Dr. Mistry: 

A walnut would be a normal prostate. And this is like a tennis ball. It’s a pretty big prostate. Now in our practice with me, if you were getting treated by me surgically, I would do something called a laparoscopic robotic simple prostatectomy, which is a procedure done through small incisions in your abdomen to go and kind of core out your prostate. It’s a wonderful procedure. I love doing it. It works really well for men. But sometimes men don’t want to go through something as invasive as that and want to try something a little less invasive and a prostate artery embolization is a perfectly acceptable option if you are not in urinary retention or having recurrent urinary tract infections, but just are bothered by symptoms of an enlarged prostate. The procedure takes about a couple of hours. If you don’t want to travel all the way to UCLA , we have exceptional experience, prostate artery embolists here. We use Dr. Howard Sill, Dr. David Wood at Advantage IR. They’re our partners, and we have worked together to really promote this technology. In terms of the anatomic considerations you have, it is virtually very uncommon, virtually impossible to have 160 gram prostate without having a large median lobe protruding into the bladder. It’s, they go hand in hand. So it is the case that men with larger median lobes, which is like kind of a tongue of the prostate going into the bladder that can act like a ball valve on the opening of the prostate–those men don’t do as well with prostate artery embolization, but I’ve had excellent experience in patients whether they have the median lobe or not. Usually when I see a large median lobe and the patient is highly symptomatic, I will encourage them to have that simple prostatectomy procedure performed. It is not like the same surgery that you do for prostate cancer, so does not cause incontinence and impotence and all those things that you’re concerned about. It’s a different procedure, even though some of the words may sound like the prostate cancer procedure. And if you’re out there interested in either prostate artery embolization, or management of especially large prostates, we’d encourage you to give us a call.

Donna Lee: 

That’s right. That was an amazing section on prostate artery embolization. I’m sure people are seeing the commercials too, because I see them on KVUE.

Dr. Mistry: 

Yeah. And we’re going to do webinars about once a month. So for those of you that can visit our site , we’re going to be having information on it. And if you’re interested in just sending us an email, we’ll definitely include you if you’re interested in our next webinar.

Donna Lee: 

Gotcha. We have enough time for another question. “Dr. Mistry, how can I increase the volume of my ejaculate? I’m a 71 years old, fairly fit male.”

Dr. Mistry: 

That’s great. There was another question too, right?

Donna Lee: 

Mhmmm. You want me to get to that, too? Or you’re making me find it?

Dr. Mistry: 

I think they kind of relate to each other.

Donna Lee: 

Ejaculate volume: “Doctor, how can I increase the volume of my ejaculate?”

Dr. Mistry: 

Well, I think that’s the exact same question. There was another question that somebody had, which was a patient with a dry ejaculate.

Donna Lee: 

Oh I’m sorry, yes.

Dr. Mistry: 

And so , just kind of putting all those volume questions together. Let me just say that although a lot of men and a lot of physicians might discount a man’s concern, men come to me every day, concerned about the quality quantity of their evacuation. And when they’re complaining about dry ejaculate, I always worry that people are worried, I was worried that the person’s really concerned about having a poor orgasm. So when you come and see us for these kinds of concerns, we certainly have medications that can increase your ejaculate volume. We can give you explanations of what could be happening medically that could be changing your ejaculate consistency. If you have a dry ejaculate, it could be due to medications, or prior surgery, or a condition called retrograde ejaculation, which happens in response to neurologic issue, injury or issues, prior surgery. It can happen due to medication side effects. So if you’re out there on medicine for your prostate and you have a dry ejaculate, 9 times out of 10, it’s your prostate medicine. So those are some kinds of different interventions that we’re going to take. Medicines that we use traditionally to increase ejaculate volume, we’ve found that HCG has a pretty good impact. Then we look at your medicines and see if you’re on any kind of drying agents. Are you o n oxybutynin? Are you on any medicines that we think might dry up your fluid secretions?

Donna Lee: 

Hmm, never thought about that.

Dr. Mistry: 

And so then we can reverse that. Well, I mean, that’s how you got to think about it. I mean, when somebody comes up, comes to complain about it, the first thing you need to remember is that it used to be different for that guy. And you know, he may not be performing on camera, but for whatever reason, having an adequate ejaculate volume, and they also look at that exactly consistency as a sign, as a sign of prostate health. So if it becomes overly, some men complain about it being overly watery, some people complain about it being changed in color, some people about it being overly thick. And the semen is a product of the prostate. So as the prostate either gets injured or old, or it gets treated with medicine, it can change the product that it’s putting out. And that product is putting out is semen , which has a primary purpose of helping to nourish sperm. Just this week, I had a patient 59 years old, who was very concerned about their ejaculate volume, but also has a severely enlarged prostate that needs to get treated. And unfortunately, a lot of times the treatments that we do for an enlarged prostate are going to affect the ejaculate volume. So whereas in some men, we pick and choose which options are least likely to cause him side effects with, and compare them to the ones most likely to improve his overall urinary complaints, we made his treatment algorithm entirely based on the likelihood of affecting his ejaculate volume. And I think we’re going to make him happy.

Donna Lee: 

Well, I hope so because that’s a really sensitive discussion.

Dr. Mistry: 

It is.

Donna Lee: 

Because you know, women are running away from the ejaculate, but you guys are trying to improve it…

Dr. Mistry: 

Only you, Donna. Oh my lord.

Donna Lee: 

You guys are mind you improve it. Stop that. You can call during the week at (512) 238-0762 , send us these questions. We’ll get them answered right away, or as soon as possible. Armormenshealth@gmail.com. And you can hear our podcast all over the world, Dr. Mistry, for free! And our website is armormenshealth.com, where you can see Dr. Mistry’s smiling, happy face!

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Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour

Any Way You Want “T:” Dr. Mistry On The Tried and True vs. Latest and Greatest Types of Testosterone Supplements

Speaker 1: 

Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here as always with my professional comedian practice manager and cohost, Donna Lee .

Donna Lee: 

You know what died with COVID? Live comedy.

Dr. Mistry: 

Live comedy.

Donna Lee: 

Sad.

Dr. Mistry: 

Well, luckily you can get your fix here.

Donna Lee: 

That’s right.

Dr. Mistry: 

On this very important men’s health show.

Donna Lee: 

The Armor Men’s Health Hour. Funny and full of energy and information.

Dr. Mistry: 

Well, I don’t know .

Donna Lee: 

No?

Dr. Mistry: 

Are you a low energy individual?

Donna Lee: 

No, I am not. I’m up very early in the morning, ready to come to work, to work with you.

Dr. Mistry: 

I will tell you that this practice often gets low energy individuals. In fact, low energy is one of the most common reasons that people come and see us.

Donna Lee: 

Segue!

Dr. Mistry: 

I’m a board certified urologist. This is a men’s health show. Our practice is NAU Urology Specialists. We’ve been in existence since 2007. I graduated from the great Baylor College of Medicine in Houston, Texas, where I also did my residency in urologic surgery. And for those of you that don’t know what a urologist is, they are specially trained sub-specialists of…

Donna Lee: 

Ding-a-lings and Yum-yums.

Dr. Mistry: 

And surgery. And we are, we are a surgeon first kind of mentality. I think you’ll get that in terms of the, really the, the approach that we take to medical conditions and life probably.

Donna Lee: 

And we’ve got a lot of…

Dr. Mistry: 

We like solutions.

Donna Lee: 

That’s right. We want to turn this podcast maybe into a high T podcast instead of a low T podcast .

Dr. Mistry: 

That’s right. That’s right. We should go, we should make goals for ourselves. Donna Lee, tell them about our offices and how to get ahold of us.

Donna Lee: 

That’s right . During the week, you can call us at (512) 238-0762 . Our podcasts are worldwide. Like I joke about that, but they really are. We have this little tool that we can check out and see where people are listening. And Dr. Mistry is super famous in Europe and Asia. So there you go. You can also reach out to us by Gmail: armormenshealth@gmail.com. That’s armormenshealth@gmail.com. Our website is armormenshealth.com. So reach out to us, we’ll answer your questions anonymously. We get so many questions every week, and they’re so much fun!

Dr. Mistry: 

Yeah, I think this week, we got a ton of questions, not only from listeners, but also from patients that came to see us interested in a better form of treatment for testosterone.

Donna Lee: 

Yes, we have a lot of those.

Dr. Mistry: 

You know, I think that some , there are people that get into the quote unquote “testosterone game,” or start getting treated for tested for testosterone in a number of different ways. And we see a lot of them after they’ve been on testosterone and are looking for improvements in what’s happening to them.

Donna Lee: 

Right. And they just want to feel better, and they want to have more sex, and they want to run around the block feeling great.

Dr. Mistry: 

And they want to have better, today I had a really good friend of mine from town who finally came to see me because he was getting more fatigued after his workouts in the morning, not less fatigue. And you know, that’s not really the way that we think about these things. We think about having a lot more energy, a lot more endorphin runs, but he was getting more tired. And so he wants to know if testosterone replacement could be something that could benefit him.

Donna Lee: 

I get tired just thinking about exercising.

Dr. Mistry: 

That is not true.

Donna Lee: 

It is true.

Dr. Mistry: 

You were doing, you were doing barre.

Donna Lee: 

I was doing barre three… well I was. And then after when COVID hit and everybody had to face their mortality, I was like, “Oh, look at the carbs!” So…

Dr. Mistry: 

“Look at the carbs!”

Donna Lee: 

Yeah. And stopped going to barre. I haven’t gained any weight somehow. So there you go.

Dr. Mistry: 

There you go. You’re winning, good job. So testosterone replacement therapy that we do most traditionally are going to include injection therapy and pellet therapy. People often approach us wanting to feel better, but you know, are questioning the types of therapies that are available. So I just thought for a brief review for our listeners, I could talk about each of the most common types of therapies and what are the goods and bads of it. And I love talking about this stuff. It’s stuff that I deal with all day. So I may go a little quick, but you know, it’s still satisfying.

Donna Lee: 

Hey, that’s what she said!

Dr. Mistry: 

So we have ways of treating your testosterone by not giving you testosterone, and that could include both lifestyle and dietary changes as well as supplements that can help increase your natural testosterone. A moderate exercise regimen, building of muscle mass, especially in your lower extremities–those things can naturally boost your testosterone. Then, especially in patients trying to keep their fertility intact, we can use medications like HCG or Clomiphene or Arimidex are going to be the three most common things that we use that more naturally increase your testosterone level without suppressing the function of your testicles. Then we have what we call peptide therapy, and that’s something that we provide prescriptions through our partner in testosterone and men’s health, BioTE. We use a specially designed peptide program. This is where, if you’ve ever heard of growth hormone or Sermorelin or GNRH agonists, if that’s something that you’re interested in pursuing and seeing if you’re a candidate for, then it’s something that we have a lot of interest and understanding of. And Dustin, who is one of our snapshot P A’s for men’s health here will take you through the BioTE peptide program.

Donna Lee: 

That’s right. Dustin Fontenot is one of our PA’s.

Dr. Mistry: 

That’s right. He’s awesome. He’s been with us for how long?

Donna Lee: 

Five, six years? He’s one of those manly men that see all our manly men patients.

Dr. Mistry: 

He can grow, he can grow a beard.

Donna Lee: 

He can grow very long beard and treat all the men in Austin.

Dr. Mistry: 

Then when we start into more traditional testosterone therapies, there is a pill that’s available now. The pill has been available for testosterone replacement in Europe for many years. I’ve been kind of reticent to use it because of my feeling that it may adversely affect the liver, but the FDA approved studies that were done found there was a, not an alarming amount of liver issues. We are starting to use this medicine more commonly it’s called Jatenzo, and if that’s something that you’re interested in looking at because of the other forms of treatment not really appealing to you, it’s something that we can try here in the office.

Donna Lee: 

I was spelling it wrong. Jatenzo.

Dr. Mistry: 

Yeah. J-A-T-E-N-Z-O.

Donna Lee: 

I started with the G yeah .

Dr. Mistry: 

Then there’s a , then we get to the gels and gels are some of my favorite ones, because I think all the gels are the same, but we just put them in different places. Like there’s one gel you put on your scrotum, there’s one gel you put under your arms, one gel you put in your chest. But my favorite one is the one you put in your nose.

Donna Lee: 

Oh, I thought you were saying in your butt.

Dr. Mistry: 

No!

Donna Lee: 

When you say “in your,” the following word’s usually “butt.”

Dr. Mistry: 

For some people. So it goes in your nose are called Natesto is interesting, because although it’s required twice a day, it is one of the only testosterone replacement therapies that has not been shown to really suppress your own native testosterone production. So if you’re still trying to maintain your testicular size, or if you’re interested in maintaining fertility, but the other forms of treatment just aren’t working, then Natesto may be the right treatment option for you.

Donna Lee: 

And there’s a really good looking guy on their website.

Dr. Mistry: 

Oh boy. Then we have, after the gels , then we go to injections and we offer injections, both intramuscularly, we can do it here in the office, although we prefer teaching you how to do it at home or having one of your somebody at home doing it–not just some random person, like somebody you know, though, you know.

Donna Lee: 

Some dude off the street?

Dr. Mistry: 

Some dude off the street. We get our testosterone compounded because we find the one mil vials sometimes hard to use, the ones you get from your pharmacy. We get a 10 mil multidose vial that costs about $66 bucks for three months supply–pretty cheap, comes with the needles, get shipped to your house, very efficient way of getting testosterone. But if you either don’t like how the weekly injections of testosterone make you feel because you feel the highs and lows of the number, a number of our patients do subQ or subcutaneous injections with a smaller needle. They use a smaller volume more commonly done during the week and have excellent outcomes, those outcomes and the effect of the medication is predictable. And so that’s why injections work very well. But absolutely positively the gold crown winner of testosterone therapy is going to be pellet therapy. And the reason that pellets work is that these are very small subcutaneous, little pellets–they look like little tictacs–get put underneath your skin through a very small, just three millimeter incision. I have how many people here almost all 10 of our providers are trained or trained and very experienced in doing a pellet therapy. They can be done virtually with minimal notice and the healing time.

Donna Lee: 

Set it and forget it.

Dr. Mistry: 

That’s right. You set it and forget it. You put them in and we can, based upon your weight and your physical activity level and how you’ve responded to pellets before, give you an excellent sustained level. I mean, many of our patients sustain their level at 900 or 950 for the course of the six months. And then you’ll start feeling it when it’s not working anymore, but we can also get a blood level to just to see where you’re at and then redose you. Our repelleting rate , meaning the satisfaction rate of pellets that leads to men and women getting another pellet is over 90%. And so that means that people really do appreciate the benefits of it. If you start testosterone therapy with me , I usually start you on injections to see if you like the , you know, the outcome of testosterone and then saddle you with a more permanent solution like pellets.

Donna Lee: 

Gotcha. Yeah. I’m on our testosterone therapy at work. And I noticed…

Dr. Mistry: 

It’s probably why you haven’t gained any weight during the COVID.

Donna Lee: 

Oh, is that it? I’m more active that I don’t know about? It was my high number–you were talking about symptoms before–my high number is super high on the lab result and it’s red and it’s like, “Ah, this is way too high!” But then my provider Leonora was like, “No, actually for you, that’s a normal number for where we want you to be.” So I wanted to remind the listeners.

Dr. Mistry: 

There’s no normal, there’s only normal for you.

Donna Lee: 

That’s right. Don’t look at your lab results and go by that number.

Dr. Mistry: 

Or actually be scared either one way or the other, or be convinced that you’re normal or not normal.

Donna Lee: 

Because I’m so normal.

Dr. Mistry: 

Well, I love it. Thanks a lot to all those questions about BioTE and testosterone pellet therapy. And Donna, how do people get ahold of us ?

Donna Lee: 

You can call us during the week, as you all know, (512) 238-0762. You can reach us by email armormenshealth@gmail.com and our podcasts are everywhere. They’re free and they’re amazing.

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The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com

There’s More To Your Pelvic Floor: Dr. Treadway Explains How Both Men and Women Miss The Signs of Pelvic Floor Problems

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Donna Lee: 

Welcome to the Armor Men’s Health Hour. You are hearing a female voice talking about men’s wellness here at the Armor Men’s Health Hour. Dr. Mistry stepped away, but this is Donna Lee. And thanks for listening to our podcasts wherever you listen to podcasts for free. We’re located in Central Texas in Round Rock, North Austin, South Austin, and Dripping Springs. We cover a variety of topics and we have a very special partner of ours who’s been with us for a good while, Dr. Angela Treadway. Welcome back.

Dr. Treadway: 

Hi, good to be here.

Donna Lee: 

So you’ve been with our practice the entire time?

Dr. Treadway: 

13 years.

Donna Lee: 

The 13 years that we’ve been open. So you’re like a pioneer.

Dr. Treadway: 

I am like a pioneer, and feeling the covered wagon every day.

Donna Lee: 

Right before we started recording, we were talking about how something could be so funny that you snort and then we made up a word and it was ” snortable.”

Dr. Treadway: 

Snortable, snortable. Yes, we have a new category of humor. It is snortable.

Donna Lee: 

Well, hopefully one of us snorts in the segment, but I don’t , I don’t know if we will, because I think we’re going to talk about something incredibly fascinating. So during the week you had some interesting patients, of course, as always. But I know you mentioned you had like a commonality between some of the patients tell me about this fascinating topic.

Dr. Treadway: 

I did. I did. One day this week, I had four patients in a row, four men that came in with the identical testicle pain symptoms. And I had to do almost identical interventions on them. And when the fourth one came in and he gave me his complaints, I said, “You are the fourth one today.” And he says, “Well, I got the memo. You know, it was going around.” And you laugh, but I didn’t snort, right?

Donna Lee: 

Oh, well.

Dr. Treadway: 

I refrained.

Donna Lee: 

That’s crazy though, four patients with the same…

Dr. Treadway: 

In a row, in the same day.

Donna Lee: 

And you said one of them was like a sports type person, but he was sitting a lot…

Dr. Treadway: 

Okay. So we have the pain categories can be a range of activity . So I’ve got the secondary ones all the way to the CrossFit, anywhere in between. So it can be too much or too little, like we kind of want to get them in the sweet spot of activity. That would be idea.

Donna Lee: 

And you said, we’ve talked about different types of pains. You wanted to talk about…

Dr. Treadway: 

I wanted to add a couple, because in addition to the guys that came in with the testicle pain , identical situation, also this week, I had a gentleman who had been a bull rider in college and he broke his tailbone. And he is now in his eighties, I think.

Donna Lee: 

Tell me he broke his tailbone bull riding and not like walking down the street.

Dr. Treadway: 

I think the first insult was bull riding and he decided, “Okay, enough.” And then over time in his work, he was more sedentary and ended up sitting a lot, and ended up sitting in a really terrible position. So when you’re sitting up tall and everything’s aligned, you’re on your sit bones, you’re not on your tailbone–everything’s even in the pelvis. But once you get that really bad slumpy posture, all of your weight shifts backwards onto the tailbone. And there it is. If you’ve been injured, now you’re bearing all your weight there and it feels terrible. So people look for pads, or they look for doughnuts , or they look for anything to unweight that area, but continue to sit in this pattern that not only puts all the weight on the tailbone, but shortens the entire pelvic floor. So pelvic floor, I’m the pelvic floor therapist, so let me give you a little idea what that means. Everything you’re sitting on is has a muscular component and that those muscles completely fill the bottom of the pelvis from the pubic bone to the sit bones, to the tailbone–it’s like a diamond. It’s attached front to back. And if you are sitting in upright posture, it’s in good length, length/tension ratio, kind of, you know.

Donna Lee: 

You’re making me sit up a little bit taller.

Dr. Treadway: 

I think you just got taller.

Donna Lee: 

I’m worried for my bottom.

Dr. Treadway: 

But if you’re sitting on your tailbone and you’re in pain and you’re trying to get away from the pain, you might sit tucked and then sit to one side, or sit to the other side. Now your back’s going to hurt, right? Now you’ve got what’s called a , you got a mess going up the kinetic chain. That would be like parking your car with a one wheel on the curb.

Donna Lee: 

Oh , good analogy.

Dr. Treadway: 

Yeah. So what’s going to happen to your suspension? Well ask a mechanic. It’s probably not a good idea. But similar stuff happens to the human body and what ends up happening instead of you going in for, you know, new shocks, you have pain and probably discs falling apart because they’re getting asymmetrical wear and tear. And that’s how it goes up the kinetic chain. But coming back down to that tailbone, so working with tailbone pain, there can be a component of it that causes bowel disruptions. There can be a component that ends up causing a difficulty evacuating, which causes a lot of pushing and straining, which causes hemorrhoids. So now we have double trouble. Pain from all sorts of structures. And then you add to that the fact that the pelvic floor is about 80% voluntary muscles under your control and they run on a nervous system called the somatic nervous system, which is the voluntary muscles. But about 1% is runs on the autonomic nervous system, which has two speeds, fast and slow, or fight or flight, rest and digest. So that part that runs on the autonomic is inside the anal sphincter. It’s the same muscle that makes a puppy’s tail tuck when it’s stressed out. And we have a tail too , and it will tuck when we’re stressed. When you’re stressed, it’s going to tug, guess what, on the tailbone. So anybody who’s in trouble like that, like my bull rider, will feel extra bad if he’s in traffic or driving or has a, you know, a really stressful day at work. And it’s just, it’s a tough bomb to diffuse. You know? What I do with those patients is educate them, number one, on the whole structure function position. Like let’s get this suspension back in alignment here.

Donna Lee: 

Get that wheel off the curb.

Dr. Treadway: 

Get the wheel off the curb, as it were. You know, give them an idea how to fix that. And I do on an awful lot with if, if that bone is still in trouble, if that tailbone is still in trouble, I do go in and fix it. Yeah, I do. But I, you know, I get good rapport first. You know, I don’t buy him dinner…

Donna Lee: 

Buy him flowers.

Dr. Treadway: 

I find a way to slowly, softly break it to them that it’s coming. And then, you know, they’re usually surprised how much better things are.

Donna Lee: 

How severe, I mean, what’s the most severe you’ve seen with patients that have tailbone, this specific issue and with pain in their anus?

Dr. Treadway: 

Well , if there’s an awful lot of tightness in the anal sphincter, what will happen is that it will get so tight and so contracted and never relax, and then there’s not a lot of blood flow in that muscles . So when they try to have a bowel movement, it’ll tear and so they get anal fissures. So when I’m taking a history of somebody says they’ve had anal fissures, I have a good idea what I’m going to find. I’m going to find a lot of muscle tension. So what I’ll do in the evaluation is, you know, observe the area, observe the movement, the flexibility, the lifting, and the dropping that is necessary. And then I will use a biofeedback device, which is an EMG, which measures muscle activity. And I can actually show them how much tensions in that muscle. You know , how much are they holding it in a fist? Is that what’s going on? Just being able to see it and being able to show them how to intervene on that, I’m usually able to get that down in the first visit. That’s usually, as long as the person’s head and pelvic floor talking to each other, you know, if they’ve dissociated than when I might take some time, but you’d be surprised how just getting information about how this happened. It’s not your fault. It’s not forever. You know , there is, there is a plan here that usually helps at least take the tailbone from being so tucked . Right. You know, it gets the puppy tail to stop.

Donna Lee: 

To wag again?

Dr. Treadway: 

Yes, get the tail wagging again.

Donna Lee: 

We talked briefly earlier in the week about a patient and fecal incontinence. And in urology, I don’t guess we, we treat more urinary incontinence, but you can treat both.

Dr. Treadway: 

Right, because of the pelvic rehab provider certification letters after my name.

Donna Lee: 

Because of the the 15 letters you have after your name?

Dr. Treadway: 

The part that doesn’t fit on the business card anymore.

Donna Lee: 

I gave up. I didn’t even put it on your scrubs . I was just like…

Dr. Treadway: 

Thank you for not putting it on my lab coat. No one would ever read my name again, like it’s horrible.

Donna Lee: 

That’s funny. Oh my goodness. Wo what more can you share about the week that you had, what other interesting patient? I know you had a patient who had a baby, and we do treat women here.

Dr. Treadway: 

We do treat women here. Yes, I do postpartum checkups. I do…

Donna Lee: 

Is that the typical, like I had a baby and now I sneeze and tinkle on myself?

Dr. Treadway: 

Yes, I had a baby and my episiotomy scar hurts and everything’s wrong. So I help them. Yeah . And again, it’s education again it’s utilizing the EMG feedback to show them what they’re doing and to educate them as to what’s going on. Now, sometimes there’s a prolapse involved and the strengthening of the pelvic floor muscles can shore up that prolapse because muscles, every muscle everywhere in your body will develop. Just like if you want to develop a bicep and get some girth and some size in it, you can do the same thing to the pelvic floor to allow you to have better control of continence, to allow you to have more support of anything that’s prolapsing, and some of my postpartum patients have fecal incontinence and we can, it’s the same muscle. It’s the same set of muscles. It’s obviously one’s a urethreal sphincter, one’s an anal sphincter, so they are different, but they are on the same swath of muscle. So when the, when the command comes down from the brain to say “shorten,” it should all shorten. Now, if you’re super talented, you can do one and not the other, but I don’t usually teach that.

Donna Lee: 

That’s a whole other class.

Dr. Treadway: 

That’s another class for another place.

Donna Lee: 

Well, thank you so much, dr. Tredway. If you have any more questions or concerns, you can email us at armormenshealth@gmail.com. You can specifically ask for Dr. Treadway and her response, I will get that right over to her. You can check out our podcast for free wherever you listen to podcasts, they’re free everywhere all over the world. I’ve been joking that Dr. Mistry’s Mr. Worldwide, because we see that people are listening in Europe and Asia. And I don’t know what’s that about, but it’s very cool. Our number is (512) 238-0762. And our email address is armormenshealth@gmail.com. Thank you so much, Dr. Treadway.

Dr. Treadway: 

Thank you.

: 

The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com

Euphora Health Explains: Do I Need Insurance With DPC Providers, and Will I Save Money?

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee .

Donna Lee: 

Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee. Dr. Mystery is stepped away and we have our partner, Dr. Lucas Jacomides back with us.

Dr. Jacomides: 

Great to be back again. I stepped away too.

Donna Lee: 

But you came right back.

Dr. Jacomides: 

But I came right back. They just kept pushing me back in the door. I tried and tried to run away.

Donna Lee: 

It was when I said, “Please don’t leave. We don’t have a host.”

Dr. Jacomides: 

I can’t say no to your tears.

Donna Lee: 

That’s right. Sometimes, but only in the office. So we’re located in Central Texas. Dr. Jacomides sees patients now all over at our Round Rock, North Austin, South Austin, Dripping Springs…

Dr. Jacomides: 

I’m a Kung Fu with a white coat and a stethoscope.

Donna Lee: 

You’re on the move. Gosh, you’re all over.

Dr. Jacomides: 

I’m not sure what that means.

Donna Lee: 

That’s for the special patients.

Dr. Jacomides: 

That’s right .

Donna Lee: 

Our website is armor men’s health.com. And this show is brought to you by our founding company, NAU Urology Specialists we started 13 years ago. It was Dr. Mystery, Liz his clinical supervisor and one other person. Three people in one office. And now we’re what? Huge. We’re huge.

Dr. Jacomides: 

North Austin Urology should not let the name fool you. It’s what it stands for. But we, first of all, the first one wasn’t even in Austin. It’s [inaudible] Round Rock.

Donna Lee: 

It’s Round Rock, I know.

Dr. Jacomides: 

…but now we’re everywhere. Now we are at the edges of town. We’re like, we’re everywhere.

Donna Lee: 

We are the second largest urology group in Austin and Dr. Mistry and I always say, “What does that mean? That means we’re a little prettier on the weekends and we push up our boobs just a little bit higher.”

Dr. Jacomides: 

That’s right.

Donna Lee: 

So, there you go.

Dr. Jacomides: 

Yeah, don’t step on number two.

Donna Lee: 

So we have special guests with us. Dr. Lucas Jacomides will introduce our guests.

Speaker 2: 

Yes. Dr. April Calderon and Dr. Chris Larson . You heard them on recent segment that we just gave out. And I–or maybe not, maybe there’s a completely different segment because we lost the first tape, but I’m glad to have you all here today.

Dr. Larson: 

We’re happy to be here.

Dr. Jacomides: 

Tell us again what the name of your company , the name of your group, and then how to reach you so we don’t lose sight of that before.

Dr. Larson: 

Yeah, it’s Euphora Health. Our website is euphorahealth.com. We’ve got two locations, one in Austin, one in Cedar park. Austin phone number is (512) 887-3955, and Cedar park is (737) 215-4525.

Donna Lee: 

That’s right. And you can Google Euphora Health.

Dr. Jacomides: 

And you were direct primary care doctors again, which means you do not accept insurance in the conventional way, correct?

Dr. Calderon: 

Correct. Yeah. We have a monthly membership and we utilize that monthly membership to be able to offer care any time. Our patients text us for small things, for large things, and can reach us after hours if needed.

Dr. Jacomides: 

What happens with your patients that , um, let’s say they, you see them and say, “Great, you sound like you need to have this colonoscopy. And we need to get you to somebody who does this, or even worse, you have a kidney stone and you need to go see Dr. Jacomides.” How do you…that’s not the bad thing. That’s the benefit of the kidney stone, by the way. But, you know , but how do you , how does that translate to people use their insurance with us and not with you, or how do you, how do you tell them what to expect?

Dr. Larson: 

We try to help them navigate that situation, so it was fairly dependent upon kind of what’s in their pocket, as far as that insurance card. Some people, you know, these days have no insurance. And so in that situation, we kind of route them towards the most cost-effective approach to take care of that problem. So if it’s colon cancer screening, there are sites that you can go to, to, you know, even in town, get a colonoscopy for $1,250 cash, if you want to pay cash for that. And we also can, you know , kind of there’s different risk categories and different likelihoods that a positive test means a true positive test, but we can route them towards tests that they might be able to do at home at a much lower price point. And we’ll talk to them about the risks and benefits of doing that.

Dr. Jacomides: 

You know, I had a situation with a friend of mine whose friend lived in Dallas and had no insurance and dropped a kidney stone. And everybody in town wanted to do it for an extremely high price. And he called me up and I said, you know, let me just make a few phone calls. And we were able to do it for half the price of anything he was quoted in Dallas. And it really, so he was willing to drive from Dallas to have surgery and his wife drove him back, you know , and that’s what it really comes down to. Right? Sometimes you just, can’t just be told, “This is the price of healthcare and you’re gonna have to pay it.”

Dr. Larson: 

Yeah, historically, you know, people have traveled outside of the country at times, right, to get joint replacements. And some of these bigger surgeries will now we have kind of bundled price surgical centers, even in town where you can look at the price for the surgery on their website. And often you can get the , get it for less than your deductible with your health insurance plan.

Dr. Jacomides: 

That’s what it comes down to because yes, it is going to be ultimately your payment is what it’s going to be up to a certain level. And then I guess maybe your insurance will kick in. We were talking off air a little bit about access and barriers to care. April, please, if you can try to catch that lightning, catch that dream and bring it back to this radio and listen so our patients can benefit from our fun conversation.

Dr. Calderon: 

Sure. You know, I was just explaining that about eight months ago. And prior to that, I was in a conventional insurance-based practice. And what that means is you get paid a certain amount, a certain percentage of each visit based off of what the insurance will pay you. And then you end up seeing more and more and more patients. Well, then what happens is you don’t get a chance to actually reach out to those patients who need you during the day for something acute or for a refill of a medication. And so you end up doing that at the end of the day. What I found myself doing during that time is practicing what I call it like to call “barrier medicine” now. And I D I had no idea that that was even a thing when I was doing it. But what happens is you protect yourself and you’re seeing patients throughout the day. And then there’s a barrier because the nurse is potentially the first one that talks to someone, or maybe even the front staff, if the nurse is busy. And so I think patients push against that. They want, they want to be heard. They want to get their questions answered. And so in this type of practice where we have more concierge like, and it’s all access, you know, it’s just me and my nurse. And so if somebody calls or somebody texts I can get to that phone call or that text within a five minute period or potentially within a 24 hour period. And so I’m not practicing that barrier medicine. Because right now I’m doing what’s best for my patients.

Dr. Jacomides: 

That’s amazing. You know, one of the things that really was eye opening to visit some of their offices and I’ve been to all of their offices, all the different DPC doctors. And I keep looking for the army of people in the front desk, which , and you know, and I remember just saying, “Oh no, it’s just me for you know, one of your providers . Like, what do you mean? Where’s your front desk person? Where’s your, I was like, literally, she was the only person. And I go, wow, that’s just like, I’m just going to about to hire somebody. But she would have her phone in her ear and answered the phone. So…

Donna Lee: 

That’s why it’s called “direct,” Dr. Jacomides.

Dr. Jacomides: 

That is pretty direct. I mean, there is no barrier. I mean, you are, there is no wall, you know.

Dr. Calderon: 

That’s awesome.

Dr. Jacomides: 

I mean, you know, “You need me on that wall!” No kidding. No, that’s great. What would you say just to distinguish a little bit, cause I even I don’t know. How do you say who’s a concierge doctor and some of the bigger groups like MD VIP or what is the difference? Yeah . What is the difference?

Dr. Larson: 

Yeah, so I would say to kind of paint with a broad brush for concierge medicine, you’re going to sign probably a longer contract. The price point is going to be higher than what we might charge in direct primary care. And traditionally, they’re still going to bill your insurance for the visits.

Donna Lee: 

Oh, they are?

Dr. Larson: 

But in direct primary care, there’s no longterm contract. If for whatever reason you want to leave, you’re done with us in 30 days.

Donna Lee: 

And what was the pricing? We’ve talked about before, but…

Dr. Larson: 

Anywhere from $39 a month to $89 a month, based on your age. And then on top of that, we’re not going to bill your insurance. You know, the model is you pay us that monthly membership and you get access to us, and then we try to give you our discounts on top of that. So anything else we might give you like labs, imaging, we basically just pass our discounts on to you.

Dr. Jacomides: 

That’s cheaper than a gym membership. So the…

Dr. Calderon: 

It’s a Costco membership, the Costco way of doing things.

Dr. Jacomides: 

This is a men’s health show. I would be remiss if our listeners are not wondering, not to offend the ladies out there who care about their healthiness, but tell me how it worked from a men’s health approach. April, we’ll start with you because I know you see a bunch of guys and you say, “Look, I don’t know that I want to see a woman doctor, what are you talking about?” Well , tell me about that. Tell me the truth.

Dr. Calderon: 

Yeah, and I’ve had those questions multiple times. And really it starts with a girlfriend or a wife calling for an appointment for their husband or boyfriend. No I’m just kidding.

Donna Lee: 

I don’t know if you’re kidding.

Dr. Jacomides: 

The discount for the boyfriend.

Dr. Calderon: 

So, I had to explain this the other day, but in WellCare, what we’re doing is we’re trying to find things early on. And a lot of times it may be as simple as a slightly elevated glucose. And if we find it early, we can prevent diabetes. And so what I find is potentially 20% of men haven’t been to the doctor within five years. And then they have these labs and they’re like, “Gosh, I’m so fatigued, and it may be my testosterone.” But you know what? It might be something else. And I start talking about diet, and we start talking about exercise and I’m like, “Well, and she’s been so busy. I don’t exercise and I’m eating more carbohydrates and I just eat more snacks.” And we check their labs and their glucose is slightly elevated. And they’re just shocked because they weren’t ready for that response. They actually wanted it to be their testosterone. But yeah, so we start there and we start with labs and we start with talking about, you know, how has your sleep? The thing that everybody is always amazed at is that I can just say, “Hey, your annual labs are going to be $25. This is your, this is your lab costs.”

Dr. Jacomides: 

Annually $25 for labs?

Dr. Calderon: 

Yeah.

Donna Lee: 

Wow. That’s amazing.

Dr. Jacomides: 

That’s amazing. You know, and we try to think of ourselves as comprehensive practitioners too . When people come to us with a symptom saying my ED, is starting to be a problem, my erectile dysfunction. And then you start going, “Well, gosh, you’re only 40. You know, let me, let’s check some basic labs and see what you’re going on with your heart, or get you to Euphora Health and they’ll do real testing and not just, you know, what I think I’m doing.” But no…

Donna Lee: 

Tell us about your website again, and your phone number.

Dr. Larson: 

Yeha. It’s Euphora Health, euphorahealth.com. We’ve got two clinics. One in Austin, that phone number is (512) 887-3955. And at Cedar park, it’s (737) 215-4529 .

Donna Lee: 

Wonderful.

Dr. Jacomides: 

That’s great. Thank you all for being here, and for being great, and we said the exact same time.

Donna Lee: 

And our phone number is (512) 238-0762. And you can reach out to us any time, Monday through Friday. Thank you guys so much again, we really appreciate it. Thank you.

: 

The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mystery, email him at armor men’s health@gmail.com

“Direct” Primary Care: Meet DPC Providers Dr. Larson and Dr. Calderon of Euphora Health

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Donna Lee: 

Welcome to the Armor Men’s hHealth Hour with Dr. Mistry And Donna Lee. I am Donna Lee, everybody’s favorite because everybody wants more Donna, according to Dr. Mistry. Dr. Mistry is not with us for the next couple of segments or so, but I do have our partner, Dr. Lucas Jacomides.

Dr. Jacomides: 

Hi, Donna. How are you?

Donna Lee: 

I’m good. I know you like to hear yourself on the radio.

Dr. Jacomides: 

I do. It’s so cool. I love the sound of my voice amplified.

Donna Lee: 

Did you set this up at home yet so you can talk to your wife like this?

Dr. Jacomides: 

This is my radio voice that I use only with my wife. I actually have more of a high pitched squeal. Yes, it’s really…

Donna Lee: 

It’s connected to your bed?

Dr. Jacomides: 

It’s more like two octave lower in the bedroom, actually .

Donna Lee: 

Well, Dr. Jacomides is one of our new partners, of course. And before I forget, we are located in Central Texas in Round Rock, North Austin, South Austin, and the super cute Dripping Springs area. Our website is armormenshealth.com and you can reach us at armormenshealth@gmail.com for all those amazing questions and we’ll answer them anonymously on air. Today, though, we have a couple of amazing special guests. I’m going to let Dr. Jacomides introduced them .

Dr. Jacomides: 

Thank you, Donna Lee. I have with me the power couple, husband and wife team of Euphora Health, Dr . Chris Larson and Dr. April Calderon.

Donna Lee: 

Welcome.

Dr. Calderon: 

Hello, thank you for having us.

Dr. Jacomides: 

You two I have known for a while. Dr. Calderon. I’ve known you since the, even maybe before Baylor Scott and White days. You know.

Dr. Calderon: 

That is a long time.

Dr. Jacomides: 

That was a long time ago, but we’re…

Dr. Calderon: 

Just don’t mention my age.

Dr. Jacomides: 

It has aged as poorly to have been there. But generally speaking , I’m glad to see you guys here in our studio. Dr. Larson I’ve interacted with recently, and you are what are called “DPC” doctors. Please tell our listeners what in the world DPC stands for and what is, and what does that even mean?

Dr. Larson: 

Yeah, so DPC stands for direct primary care. So it’s a little bit like concierge medicine in the level of access that somebody might get, but it’s a, it’s a lower price point. And so I like to kind of explain this in two ways: comparing us both to Netflix and comparing us to Costco. So it’s kind of a monthly membership, you know price point being from $39 to $89 a month, depending on your age. And for that, you get all access to us through text , through phone, through telemedicine, and certainly face-to-face when it’s appropriate. You get access to us both office hours, nine to five Monday through Friday, and then after hours. So we’re kind of your doctor, no matter when it is, or no matter where you are in the world. We offer same day, next day appointments for urgent issues. And then we get what we really enjoy, which is longer visits with our patients, which is why we got into primary care to really get to know people, get to know their story.

Donna Lee: 

Wait a minute. I’m paying $800 a month for insurance. You said it was what? $39 and $ 89?

Dr. Larson: 

That’s right. Yeah.

Donna Lee: 

Wow.

Dr. Jacomides: 

But don’t tell them your age.

Dr. Larson: 

It depends, obviously the younger you are the less expensive it is.

Dr. Jacomides: 

That’s right. This is true.

Donna Lee: 

There you go. That is fascinating.

Dr. Jacomides: 

Yeah. And in dog years, how many is that ? Does that count ?

Dr. Larson: 

No, you didn’t tell me we’re going to do math.

Dr. Jacomides: 

So you started this practice when?

Dr. Larson: 

It’s been about six years now, we’ve been open.

Dr. Jacomides: 

Okay. And then Dr. Calderon, you joined this practice recently?

Dr. Calderon: 

Yeah, about eight months ago.

Dr. Jacomides: 

Eight months ago?

Dr. Calderon: 

Eight months ago, from a very traditional kind of medicine tract, medicine and insurance practice. And it has changed my philosophy of medicine. It’s just been amazing.

Dr. Jacomides: 

Really, how so? You mean joining it, not just being in the traditional sense and then joining this practice. Right?

Dr. Calderon: 

Right. So joining it, and then also just being able to practice a different way. So really being able to have that one-on-one care with my patients. And then also having a different relationship. It’s like having a family doctor and what family doctors were back 50 years ago. I’ve gotten paid in eggs and flour .

Donna Lee: 

And goats and pigs?

Dr. Calderon: 

Not that yet. But yeah.

Dr. Jacomides: 

So $39 worth of eggs. You just do the math and say, keep counting your chickens. And bring them out.

Dr. Larson: 

So it’s four eggs [ inaudible]…

Dr. Calderon: 

It’s amazing, because when I have a visit with someone literally the first visit, they’re like, “Wow, I have never spent this much time with my physician. And I have never , I’ve never been able to go over diet, exercise, stress, and you know, all of that.” So it’s amazing. I just, it feels so great to be able to help people on a different level.

Dr. Jacomides: 

You saw Chris doing this for awhile . And you said, “I don’t know this thing’s going to work. You know, someone’s got to make a steady paycheck from insurance companies.”

Donna Lee: 

“I’m tired of buying eggs.”

Dr. Jacomides: 

And tired of buying, yeah. “He keeps bringing these eggs home. How about some bacon?”

Dr. Calderon: 

Exactly.

Dr. Jacomides: 

“Bring the bacon home, Chris.” And then you said, “You know what, it’s time. We’re busy enough.” You grew it, you got busy enough. You said, “I can think of no better person than April to come join me.”

Dr. Larson: 

Yeah. So we were growing, we signed up a larger employer. So we work with individuals. We work with small companies to provide primary care to them. And we work with larger companies who might wrap insurance around us. And so this particular company had employees in central Austin and also kind of North/Northwest Austin. So we needed to grow to support them. And then , you know, we were zealots. And so we want to bring this type of care to all Austinites and all Americans . So expansions are in the plans.

Dr. Jacomides: 

How many of them are you in Austin? I don’t know if that even make grammatical sense, but how many DPC doctors would you say are in the Austin area?

Dr. Larson: 

We’ve got, per capita we may have more than any other city. We have a lot here. So we’ve got about seven or eight in the Austin area.

Dr. Jacomides: 

And I hear it’s hard even people are looking and they can’t even interview people quick enough. So I think it’s certainly interesting to see that. So that was really convenient, I guess. You’re there, you’re at your job, you know ?

Dr. Calderon: 

Yeah. And you know, I was not happy going through 20 to 25 patients a day, not being able to spend time with them. Having to say ” Oh, I’m sorry, I can’t see you for that because you scheduled for this.” And so this has really made a huge difference.

Donna Lee: 

Right. And I think people don’t know with insurance, when you see your doctor, you can only go over one or two things. I mean, and the doctor basically has to kick you out and say , “Sorry, we’ll talk about three and four next time.”

Dr. Jacomides: 

Really?

Dr. Calderon: 

You try, you probably try not to. We try not to, but you know, there’s also that time, like you have to see the next patient and the next patient.

Dr. Jacomides: 

I find it very hard to document on my electronic medical record with one door or hand on the door handle. Is that, is that, is that wrong? No? It’s very hard to point and click. No, I’m kidding of course.

Donna Lee: 

It’s what insurance makes us do sometimes.

Dr. Jacomides: 

No, I think it’s a great point. And you know, I mean, what is your average length of visit? I would say, I mean, and also want to get into the telemedicine stuff here separately, but how long do you spend with your patients on average then?

Dr. Larson: 

Yeah, so often the first visit is an hour or even a little bit more, depending on how many issues the person needs to take care of. And then follow ups 30 minutes or more if necessary, especially for, you know , chronic disease or something where we’re really having to educate for a dietary change or medication. If it’s something acute, cut myself, or, “Hey, I got this dermatology issue,” you know, most of the time we can just take care of that over text. So…

Dr. Jacomides: 

And you mentioned texts and also telemedicine these days, we’re all trying to socially distance and stay away from sick people and places where sick people dwell. There’s no difference in price or anything. You say, “Look, you can call me X number of times after this it’s this many.” Or how do you restructure them to the contact to keep it from being too abusive?

Dr. Calderon: 

Yeah, actually, so it’s a membership model. So you pay so much per month and you get all access to us. You can have one visit or you can have 15 visits. And, you know, in the beginning, what happens is people are so excited, and so we kind of go over all, a lot of issues, maybe take care of them the first, you know , two to three months. And then as we continue to go on and have doctor patient relationship, we start seeing, oh, well, they really don’t need us every, you know , two weeks. It’s more like once a week, or I’m sorry, once month or once every three months. And it’s this relationship that we’re forming. So they can text me and say, “Hey, you know, that issue that I was having before what’s happening again.” And then it’s a shorter conversation and it’s more convenient because we don’t have to go through their whole history. So it’s just, it’s really cool.

Donna Lee: 

Wow. That’s what medicine should be. How do we stray away from that so far?

Dr. Jacomides: 

Well, it’s interesting. You know what I mean? We can get to this rabbit hole of insurance and fee for service and doing, and then just piling people in. And, you know, it’s hard to meet the demand, which is, you know, a lot of times the concerns that you and I have talked about Chris , you know, because if, then it’s a question of limiting sizes of people. And then it’s a question of how many people are gonna be able to take care of all these people? And also if it’s an issue of resources and saying, Well, maybe I don’t have this much free cash to give. I mean , what do you say to that point? You know, is it , you know, when people say, look, what does my insurance get? Does this get me anything? You know, I’m sure you get that question a lot.

Dr. Larson: 

Yeah. That’s, as you can imagine, the most common question is, you know, “Do you take this insurance?” And so that, as you suggested, there’s a rabbit hole there. And so often we can help people get access to care, be it medication or labs, or imaging, many times for lower than what they would pay for their copay , or co-insurance. And so, for those things that are common, relatively expected to happen to anyone within a 5-year/10-year timeframe where you might hurt something and need some imaging. I don’t know that we truly need insurance for that. I mean, I can get an x-ray for $35 and ultrasound many times for less than $100, CT scan for between $100 and $200. So, should we really insure for that kind of cost when you could just pay cash and get those same things that are much affordable price, much more affordable price?

Donna Lee: 

That’s amazing.

Dr. Jacomides: 

Well, that’s the value prop for sure. Tell this audience how we can get ahold of one or both of you. Please give us your website…

Dr. Larson: 

Sure. Yeah, our website is euphorahealth, so kind of “euphoria” without an “I.” euphorahealth.com. We’ve got an office in Austin or Cedar park, and we’re all over social media as well.

Donna Lee: 

And the phone number?

Dr. Larson: 

Phone number in Austin is (512) 887-3955. And in Cedar Park (737) 215-4525.

Donna Lee: 

Perfect. And we’ll get that on our Facebook page as well. So you can learn more about Dr. Caldron , Dr. Larson at their website. You can visit us at armormenshealth@gmail, I’m sorry, that’s our email address. Armormenshealth@gmail.com, where you can send all your incredibly fun and embarrassing questions that we will answer on air anonymously, of course. And our website is armormenshealth.com. Our phone number during the week is (512) 238-0762. And thank you guys so much, and we’ll have you on for another segment very soon.

Dr. Calderon: 

Thank you. Thanks for having us.

: 

The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com

Testosterone for Women: Fear Not Hair Loss/Growth!

Speaker 1: 

Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour. I am Dr. Mistry, your host, here as always with my cohost , the ebullient Donna Lee.

Donna Lee: 

Such a sexy word. Does that mean I’m cute? Bubbly? What does ebullient mean?

Dr. Mistry: 

Donna Lee is our office manager, and walking thesaurus around here .

Donna Lee: 

She kinda doesn’t know what some…I don’t know what a word means… [inaudible] ebullient.

Dr. Mistry: 

I am a board certified urologist. This show is a men’s health show and this show is brought to you by our medical practice that started in 2007 NAU Urology Specialists. A urologist is a surgical subspecialty-trained physician that treats mainly genitourinary conditions for both men and women. And this includes everything from the nipples down .

Donna Lee: 

I’m giggling ebullient.

Dr. Mistry: 

The nipples, the nipples to the knees, we say. That includes the kidneys that includes the ureters, the bladder, the prostate. We do a number of things…

Donna Lee: 

And the yum yums.

Dr. Mistry: 

And the yum yums. I forgot the best part, really. We have, we also treat women for a number of conditions, whether they be incontinence , pelvic floor prolapse. We have a specific expertise in our practice when it comes to the advanced treatment of complex sexual disorders. So for that issue, we have a sex therapist on staff, we have pelvic floor physical therapy, and then I think our biggest contribution to kind of our profession and what we can provide our patients is a more holistic approach. We believe strongly in nutrition and supplements and a more integrative approach to your health. And that’ll affect you, whether you’re getting treated for cancer or stones, or even irritative urinary complaints. And it’s your questions and your participation in this show that really keep it going. I really do talk like this all the time. You have a lovely bedside manner. I appreciate that.

Donna Lee: 

I keep hearing that from patients.

Dr. Mistry: 

I try to use my words nicely.

Donna Lee: 

You should, because you’re on warning with the staff.

Dr. Mistry: 

That’s right. That’s right.

Donna Lee: 

You have to be nice. And by the way, ebullient: cheerful and full of energy. So thank you.

Dr. Mistry: 

See, there you go.

Donna Lee: 

I Googled.

Dr. Mistry: 

Nice, nice, Donna Lee, why don’t you tell people about our practice and how they make an appointment with us?

Donna Lee: 

They can call us during the week at (512) 238-0762. You can send us an email to armormenshealth.com, we can do an inquiry through that website. Or you can send us an email directly to armormenshealth@gmail.com and Dr. Mistry on our website, our little podcast pops right up, they can send in a question right there, they can see your handsome face, they can hit the play button and listen to one of the podcasts for free.

Dr. Mistry: 

I love it.

Donna Lee: 

So go to our website.

Dr. Mistry: 

I hope it counts as a download, because that’s how I measure my value now as a person.

Donna Lee: 

Oh, that’s a good point. I don’t know.

Dr. Mistry: 

It’s how mnay downloads we get.

Donna Lee: 

I don’t know about that, but you can listen to our podcast for free everywhere. And we are podcastable, and dr. Mystery is doctor worldwide. We need a pit bull song.

Dr. Mistry: 

That’s right. Well, it’s like I said, your questions really kind of drive us. Donna Lee, do you have a question?

Donna Lee: 

I do. This one is from a listener and she says, “Hi. I’m listening to your radio show and we’d love to hear more about women taking testosterone. I heard there are negative side effects with losing hair at first, then growing hair and undesirable places. Can you talk a little bit more about the pros and cons of testosterone treatment for women, especially in their fifties? I know it’s a guy show, but I also know there’s plenty of women listening.” ‘Smiley face.’ Thank you for that.

Dr. Mistry: 

I love it. Thank you so much for that question. So I’m going to include testosterone in a, just kind of a slightly broader conversation related to hormone replacement therapy in women. So we’ve been doing hormone replacement therapy for over a decade. We get referred patients from many OB-GYNs around town who don’t feel comfortable. We have to do complicated hormone replacement in women who have had breast cancer diagnosis. And because we worry about why you want the hormones, not just getting the hormones, I think that we really achieve the goal of making people feel better. When people come to us for hormone replacement therapy, they’re usually complaining of symptoms of perimenopause or post-menopause. This can include low sex drive, low energy, changes to their skin, hair, and nails. There can be a substantial decrease in vaginal moisture leading to vaginal dryness and pain during intercourse. And I think that the poor sex drive is one that drives a lot of women to us. And sometimes it’s hard to tell , you know…

Donna Lee: 

If they don’t like their husbands?

Dr. Mistry: 

That’s right. You know, because sometimes just doing the laundry…

Donna Lee: 

It doesn’t do it for her? It does it for me. That’s all I ask: fold the towel.

Dr. Mistry: 

Maybe, maybe…And so , I always think of sexual, like low libido in a woman, it’s a couples’, that’s a couples’ problem, because , if women are playing the role in which they’re more likely to be approached and initiated for sex, then they’re going to be pressured. If the man is the one of low libido, then maybe his wife is happy.

Donna Lee: 

Everything’s fine.

Dr. Mistry: 

But if it’s the woman, you know, the man can feel, you know , frustrated sexually of course. But then more importantly, I think women just kind of get forced into like doing things they don’t want to do. And that’s not fun.

Donna Lee: 

That’s called rape.

Dr. Mistry: 

No, it’s just…

Donna Lee: 

No.

Dr. Mistry: 

Stop that.

Donna Lee: 

I’m sorry. That sounds terrible.

Dr. Mistry: 

It just , it’s just , you’re just kind of like forcing yourself to go into an act that you don’t necessarily feel really that connected with. It’s going to be harder to orgasm. It’s going to be harder to get aroused. And you know, for many couples , when, when you lose that sexual intimacy, it removes a part of that relationship. Now that’s not everybody. You know, some relationships thrive just fine without it. But usually people come to us, not because they themselves are distressed by a low sex drive, but because they feel like they’re letting their partner down. So…

Donna Lee: 

That makes sense.

Dr. Mistry: 

And so testosterone, we know in men is a big driver of sex drive, but it is also the same for women. So sex drive is also promoted with testosterone therapy in women. We have to do a lot lower of a dose and it can be harder to dose women because…

Donna Lee: 

Because we’re so complicated?

Dr. Mistry: 

No, because you don’t need much, and so we use creams for some women, but then some get concerned about transference or maybe it doesn’t absorb right. We use it sub-Q injections in women, which I think a lot of women really like if they’re not averse to kind of injecting themselves, and that’s super cheap. And then we have pellet therapy and the pellet therapy is the best “set it and forget it” kind of therapy. And unlike men who routinely get doses 2000 milligrams, women get a much smaller dose. That dosing is going to be dependent on your physical activity, your own size when you come to see us, and we put those pellets in like 5 minutes.

Donna Lee: 

Like a few minutes.

Dr. Mistry: 

Yeah, just super quick.

Donna Lee: 

Why are the women every three months and the men are every six months for pellets?

Dr. Mistry: 

That’s a great question. So because the dosing of testosterone in women is on the lower end of the range, if you put too much in the beginning, you risk spiking.

Donna Lee: 

Oh, that makes sense.

Dr. Mistry: 

And so, but giving testosterone without giving estrogen and or progesterone, depending on what your reproductive status is and whether you still have your uterus, it often is disappointing if you just give one. And so a lot of women get a better sex drive with just estrogen, and that’s not because estrogen is a big sex drive driver, it’s because you’re going to feel better about yourself. You’re gonna feel better both cosmetically, you’re going to feel better in terms of your vaginal lubrication and arousal. So that’s going to make it easier to get kind of turned on with the estrogen. So we do both, you know, you want the estrogen and the testosterone and in some people progesterone. And people worry a lot about whether something is bio-identical or not. There are some clinics in town that charge people thousands and thousands of dollars for this notion of bio-identical hormones. And I think that there’s , the most important thing when it comes to hormones is being able to test to make sure you’re getting the right amount, and whether it comes from the, you know , bark of a yin-yang tree and…

Donna Lee: 

A ding-a-ling tree?

Dr. Mistry: 

In some ways…and whether there are terms being used that make you feel that something is more naturally derived, I think is less important than making sure that you’re getting the consistent something that we can test for. So I tell people, of course we do bio – identical. I mean, the molecule that we’re giving you is identical to the molecule that you make in your own body.

Donna Lee: 

Thus, bio-identical.

Dr. Mistry: 

Thus bio-identical. And so , and it doesn’t have to be super expensive. And you can just test it out to see if it works well for you. The specific questioner, listener is asking about side effects of testosterone.

Donna Lee: 

And hair .

Dr. Mistry: 

And so the hair , I will tell you is often seen if you’re overdosing people. So I have had a few people that get hair kind of in the area that they’re rubbing the cream onto, which is why we have you rub it onto your calf, because you’re going to be shaving, most women shave that area anyway.

Donna Lee: 

Mhmm. Do they?

Dr. Mistry: 

Yes.

Donna Lee: 

Okay.

Dr. Mistry: 

Sorry, Michael.

Donna Lee: 

Date night.

Dr. Mistry: 

Date night. I guess that’s why you wear pants to work.

Donna Lee: 

That’s right. Once a month I’ll shave my calf.

Dr. Mistry: 

That’s right. So , there’s also the concern of growing facial hair or a hairy lip, and I will say that the complaints have been extremely uncommon for those things. We’re more likely to see a little bit of change in mood , with testosterone. Certainly you can have a better sex drive, and there’s also a concern some patients have of an elevated red blood cell count, but these are things that we check and we monitor, and most of these things are not dangerous to you if they’re well monitored. Overall hormone replacement therapy, if initiated within 10 years of menopause, decreases heart disease, decreases stroke risk, and decreases breast cancer risk, which is things that people don’t know. And so it is something protective to you to maintain a body chemistry that’s more like your younger self. And so we are, you know, when it comes to both men and women, we are big proponents of hormone and wellness.

: 

That’s awesome. What a great answer. What a great question. Huh. Okay. Well, I’m going to send that listener to this podcast and you can listen to all our podcasts for free wherever you listen to podcasts and call us during the week at (512) 238-0762. And send us your emails, armormenshealth@gmail.com. The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail .com

Meet Heather Lenz, PA-C, NAU Urology Specialists’ Newest Provider

Speaker 1: Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: Hello, and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here as always with my exuberant, indispensable office manager and cohost Donna Lee .

Donna Lee: Hey, that’s me. I thought you were going to change it again and say, “Oh, but Donna’s here.”

Dr. Mistry: I’m in a good mood today.

Donna Lee: That’s nice.

Dr. Mistry: I’m appreciative of everybody’s role in my life.

Donna Lee: As you get sometimes with me, I noticed that we can come together, like the Beatles song, and do this show.

Dr. Mistry: Yeah, for the show .

Donna Lee: And act like we love each other again.

Dr. Mistry: That’s right. That’s right. And I think there’s nothing more important than being able to come together for a very, very important thing, like a show on men’s health. I’m a board certified urologist. This show is brought to you by practice that I founded in 2007, NAU Urology Specialists. And we’re so thankful to all the people here at news radio KLBJ 590 AM 99.7 FM, for helping us put on this show and all of our team members here. We really enjoy being able to give you what I believe is state of the art information in regards to men’s health, and really kind of talk about sensitive subjects with men in the same way that I would talk about these subjects in the office.

Donna Lee: Like about their yum yums and ding-a-lings?

Dr. Mistry: And their yum yums and ding-a-lings. This week we have a very special guest.

Donna Lee: We do.

Dr. Mistry: Heather Lenz. Hey, Heather.

Heather Lenz: Hello.

Donna Lee: Yay.

Dr. Mistry: Heather Lenz is the newest addition to Jurassic Park around here. She is a physician assistant, a recent graduate…

Donna Lee: And she’s cuter than a pterodactyl.

Heather Lenz: Thank you, Donna Lee.

Dr. Mistry: She’s a own professional woman, Donna Lee, who deserves more for you.

Donna Lee: She’s a very stunningly sweet and cute and smart person on our team.

Dr. Mistry: Well, she’s an awesome person. We chose her. We had so many PA candidates this time around that we stopped looking at resumes after 40.

Donna Lee: Oh my God. It was so many.

Dr. Mistry: And , you know, the market here in Austin is really hopping for people wanting a job here. And of course, we just were able to pick from the creme de la creme.

Donna Lee: It was awesome.

Dr. Mistry: I mean, not the creme de la creme. She didn’t go to Baylor. But let’s just say, let’s just say if there was a layer above, right below the creme de la creme, it would be UT Southwestern and that’s where she went to school. So, welcome to our practice, Heather.

Heather Lenz: Thank you so much, doctor.

Dr. Mistry: I thought that , um, uh , what we would do is talk a little bit about kind of what is the experience that you’ve had kind of beginning , you know , brand new , of course I’d like to hear what you, what you’d like to talk about, how your training was and, and why our listeners out there, if they do come to see us a lot of times after I see you initially, or even initially if you have an emergency you’re going to see a physician assistant provider, and how important that is to us to maintain what we’re doing. And Donna Lee, I think, you know, that the kind of medicine that we practice here is really amazing. We really think about the whole body approach, a holistic approach. We had several patients this week come to us, just for that approach, knowing that we do nutrition and pelvic floor physical therapy and so many things, so speaking to that. So when people want to come see us, how do they get ahold of us and where do they know our offices are?

Donna Lee: You can just scream really loud outside and I’ll hear it, like telepathically the right word. Or you can call (512) 238-0762. Or you can send us an email to armormenshealth@gmail.com. We answer every one of them. And they’re amazing, every question that we get. And we make sure that it’s anonymous, so we don’t embarrass anybody.

Dr. Mistry: And if you do email us, please ask for a free t-shirt. We just have too many.

Donna Lee: We did get an email that said , “I just want a t-shirt.”

Dr. Mistry: “I just want a t-shirt.” Tha’s right. It worked. It worked.

Donna Lee: I sent it out. So yes, you’re welcome. But also listen to our podcasts , wherever you catch your podcasts for free.

Dr. Mistry: So Heather, a lot of people out there may not know what a physician assistant is, how they work within a team environment, and even what kind of requirements you need to become one. Did you go to college?

Heather Lenz: Of course, I went to college. I went to four years of undergrad.

Dr. Mistry: At?

Heather Lenz: At the University of Texas.

Dr. Mistry: The University of Texas, right here.

Donna Lee: That’s right. Two longhorns sitting here.

Dr. Mistry: That’s right. I got my MBA from there. And you got a bachelor’s degree from there. And then was it your desire to go into medicine early on?

Heather Lenz: I had always wanted to be related to medicine. So yes, the answer is I wanted to be a part of the healthcare field. Initially thought I wanted to be a pharmacist and worked in a pharmacy and just decided, you know, I wanted some more patient contact. I really am passionate about being empathetic and open and vulnerable in a space with a patient. So that’s why I really like urology.

Dr. Mistry: Well, that’s awesome. You spent some time as an eye care technician, you spent some time in a pharmacy, and you spent some time doing dermatology. What’d you do there in dermatology?

Heather Lenz: Yeah, so I was a medical assistant there, which is similar to a nurse that works in an outpatient office. So I assisted in mohs surgery there, so that’s a surgery that removes skin cancer. I did a lot of just basic dermatology, so rashes, acne, all that kind of good stuff.

Dr. Mistry: Then you took that interest in medicine and then you applied for PA school and there’s how many PA schools in Texas, about?

Heather Lenz: I think there’s about, oh gosh, I think I applied to 9 at the time, but I think there’s more now.

Dr. Mistry: So, so there’s somewhere between 9 and 15 PA schools, and your average class size, I guess at Baylor there was about 20. How many, how many at Southwestern?

Heather Lenz: I had 51 when I graduated, started with 55. So yeah, it’s pretty competitive to get into.

Dr. Mistry: So what’s interesting is that there are, you know, fewer PA spots in Texas than medical school spots because you know, the Baylor, you know, Medical School class is 200 people.

Heather Lenz: Yeah, very true.

Dr. Mistry: And it takes how long to get through it?

Heather Lenz: So the whole school , mine was 30 months continuous, so you don’t, you know , you don’t get your summers off or anything like that. I would say the average program is about 27 months.

Dr. Mistry: Well , you know, 27 to 30 months , whereas medical school going formally is going to take you about 43years, but you know, some schools even cut it down to three. You know, here in Austin, the Dell Medical School, one of the years is dedicated to a different kind of experience, which makes in my feeling better doctors, but it’s really a little shorter of dedicated medical education. And then during the course of medical school at Baylor, a lot of the PA’s took classes with the medical students. Is that how it was with you?

Heather Lenz: Yes . So the beginning of my program, I took some physiology and anatomy classes as well as did a cadaver lab with medical students. So similar definitely intro courses. And then of course the rest of the courses are just really concise, but very similar education style to medical students.

Dr. Mistry: And then after we learned the basics, then we go through and go through different rotations where you observe people practicing medicine, really learned the trade. And then after you graduate, you go look for a job. And what’s interesting about a PA, which is different than a physician, is that we are really only specifically trained in one area. So I mean, as much as I may want to go and fix somebody’s broken femur, it would probably be looked down upon. They’re like stick to the one bone that you’re dealing with.

Donna Lee: The one non-bone.

Dr. Mistry: Well, good . You know Heather’s new because she’s still laughing at my jokes .

Donna Lee: That’s right. That’s right.

Dr. Mistry: So then after that, we were really fortunate to get you to join us. And a lot of people out there may think of urology in a certain way. And you’ve now been able to experience kind of urology in a different way. Maybe you could just kind of point out where do you think the big difference is in how you perceive what a urologist does compared to what they, you know , what they routinely see?

Heather Lenz: Yeah. So I definitely think it’s a lot more diverse than I initially thought. You know, we deal with not only bladder conditions, but prostate, you know, definitely penile concerns, and sexual concerns as well as kidney related things. So , and it’s a cross, you know, it’s something that affects both men and women, you know, pretty much at any point in their lifetime. So I definitely think it’s just much more diverse than I ever expected.

Dr. Mistry: Well, what’s really fascinating , uh , about having so many incredible, enthusiastic, and in most cases, younger members of our team is that you’re a lot closer to the basic medical knowledge. So , just this morning we discussed cases in which, you know, the fact that you’re closer to treating hypertension and knowing those initial guidelines, and you’re closer to treating high cholesterol and especially in a practice like ours, where we really care about the whole person. You know, if you come in with fertility issues, but you’re 40 pounds overweight and you have two drug hypertension, you know, we’re going to make sure that all of those things are well-treated and having your expertise and your knowledge just recently out of school…high school? I was about to say high school.

Donna Lee: You almost said high school.

Dr. Mistry: Wow. I’m an old man. Really goes a long way to making sure that we’re providing that top notch care.

Heather Lenz: Right. And I definitely think that, you know, that is what everyone here focuses on is that holistic approach.

Dr. Mistry: Well, that’s great. And , you’re just brand new, I mean, just like 4 weeks into our practice, and we’ve just really enjoyed having you on board. I think all of our patients out there that have been, you know, really trying to get an appointment with us, it’s going to be easier to make those fall appointments and get to see us. Is there, is there a particular area of urology that you found to be, you know , really exciting that you can’t wait to learn a lot more about?

Heather Lenz: Um, I definitely think the sexual side of urology is something that we just don’t learn as much of in PA school, and it’s just kind of new to me. But I do find it super fascinating. Again, it’s one of those vulnerable spaces that I’m interested in and would love to learn more about.

Dr. Mistry: You know, this week we got to see a really interesting case of sexual aversion disorder, and it’s one of those topics that if you were , you know, I think, and I shake my head…if this guy had ended up in almost any other urology practice, he would have been given some pills and sent on his way. And how lucky it is that we have sex therapy onsite, pelvic floor physical therapy onsite , but really a whole group of physicians that know that if you’re a 20, you know, guy in your early twenties coming in and you’re complaining about erectile dysfunction, there’s probably some more there, and you need to really look deeper and make sure you’re really attacking the root of that person’s questions. So we really look forward to you being part of our practice, Heather. So welcome on board . And for those of you out there that are looking for a great practitioner, I know you’re going to find one in Heather. Donna Lee, how do people find us and make an appointment with us?

Speaker 1: You can call us during the week at (512) 238-0762 . You can send us an email to armormenshealth@gmail.com and our website is armormenshealth.com and check out our podcasts. They’re free. They’re magical. They’re amazing. Thanks, Heather.

: The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions, or to schedule an appointment, please call (512) 238-0762 or online at Armour men’s health.com.

Women’s Hormones and Wellness: Dr. Mistry Answers a Female Listener’s Question About Hormone Pellets and Hair Loss

Speaker 1: Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee .

Dr. Mistry: Hello! This is Dr. Mistry, your host of the Armor Men’s Health Hour, joined today by my office manager and cohost, Donna Lee.

Donna Lee: I was wondering what words you were going to choose there.

Dr. Mistry: Yes, I’m trying.

Donna Lee: And it’s practice administrator.

Dr. Mistry: There you go.

Donna Lee: Not office manager.

Dr. Mistry: I’m a big, I’m really big about titles.

Donna Lee: No , you’re not. Because you’ve been calling me your office manager for three years.

Dr. Mistry: That’s correct. Perhaps, perhaps I’ve been a little off, Miss Manager.

Donna Lee: You’re a doctor, a board certified doctor.

Dr. Mistry: That’s right. I’m a board certified urologist. This is a men’s health show. We are the Armour Men’s Health Hour here on news radio KLBJ. Thank you so much to our team here. Donna Lee is my practice administrator and this show is brought to you by our practice NAU Urology Specialists. We have been here established in 2007. We have offices all throughout town and Donna Lee’s going to tell us where those offices are, and I’m going to tell you a little bit about our practice.

Donna Lee: That’s right. You can reach us throughout central Texas. Our main hub is Round Rock, Texas. Do you know there is an actual round rock? Like I Googled it.

Dr. Mistry: Yes.

Donna Lee: What or where is that round rock?

Dr. Mistry: It is in a body of water.

Donna Lee: Oh, okay. Well, I Googled it and I knew that, but I didn’t know where it was. But we are also located in North Austin by the terrible DPS office at Lakeline Mall .

Dr. Mistry: Tickets for all of us.

Donna Lee: That’s right. Oh, sorry about that. We’re also in South Austin and our Dripping Springs location is fabulous.

Dr. Mistry: They love dripping and dripping.

Donna Lee: And dripping. So we don’t love dripping and dripping. We want to fix dripping.

Dr. Mistry: We want to keep you from dripping.

Donna Lee: And dripping. Our number is (512) 238-0762 . And you can send your questions….

Dr. Mistry: That is not our number.

Donna Lee: (512) 238-0762.

Dr. Mistry: Oh, I guess it is. Aren’t you did I say wrong ?

Donna Lee: Our email addresses is armormenshealth@gmail.com and I will respond to everyone of your questions and we will answer them anonymously on air with Dr. Mistry’s brilliant advice.

Dr. Mistry: Our practice is a little unique when it comes to standard urology and even medical practices. We have a team of four physicians. We have a team of five physician assistant and nurse practitioners. We have a functional nutritionist on our staff who through your insurance, we give you amazing integrative medicine type advice. We have two pelvic floor physical therapists because…

Donna Lee: One’s not enough!

Dr. Mistry: …because we believe that a biomechanical cause of many pelvic complaints can be found, and we like to avoid medications when possible. We have a sex therapist on staff who can also treat other , you know , psychiatric or psychological issues. And we have an amazing staff, just an amazing staff, really dedicated to helping you get your appointment as quickly as possible, get your surgeries done as quickly as possible. And you know, all of us are kind of working our butts off to keep you safe in our office, to get you in the operating room in the office when clinically indicated, make sure you’re getting your medicines and getting your care because regardless of what’s going on in the world, it is important to not delay care. When you have a medical condition,

Donna Lee: That’s right. You don’t have to have surgery. It sounded like you were going to take everybody straight to surgery.

Dr. Mistry: Well, you know, I am a surgeon.

Donna Lee: You do like to do surgery.

Dr. Mistry: I do love to operate.

Donna Lee: Well we promise to have a good diagnosis for you and a reason to do surgery.

Dr. Mistry: That’s right. I mean, if your surgeon’s crying because he hates what he does all throughout operating on you, you don’t want that guy. You want the person to be kind of excited about what he’s doing.

Donna Lee: You know, what I like about your vasectomy is that you always have New Order radio station on.

Dr. Mistry: That’s right. That’s right.

Donna Lee: You think the patients know that subliminally? They’re leaving here singing one of the songs?

Dr. Mistry: The patients are always, “Oh, I like your jams.” And then the , the nurse helping me is like, “Not again.”

Donna Lee: That’s right. It’s always the same.

Dr. Mistry: The same radio station.

Donna Lee: You need some variety there.

Dr. Mistry: So Donna Lee, questions really keep this show going. And of course the patients that we want to take care of are so important to keeping our practice going and keeping our ideas fresh. So if you have questions, that’s armormenshealth@gmail.com, armormenshealth@gmail.com is where we send the questions. And do you have a question?

Donna Lee: I do have a question. We had a couple of questions that came in from ladies. Even though this is a men’s wellness program, I did have a patient reach out to us and she said she would like to learn more about the pellet insertion and if it helps women with hair loss.

Dr. Mistry: That’s great. So usually we’re dealing with hormones that people lose as a result of aging, but in women, they also have another unique time where hormone abnormalities can rear their heads and that’s if they’ve had a hysterectomy. And that’s even if you’ve had a hysterectomy where the ovaries were, quote unquote “spared.” Oftentimes the blood supply to the ovaries, a lot of it comes from the ligaments that are come along the ligaments that are cut during the course of a hysterectomy. So even if you think your ovaries are behind or you’ve had a hysterectomy and you thought your ovaries were left behind, you could suffer from hormonal deficit. So hormone deficit in a woman will include three different hormones: progesterone, testosterone, and estrogen. And each of them has a different role to be played when it comes to restoring your health and making you feel good. Now, when it comes to hormone replacement in women, there’s a lot of fear that people have that perhaps it’ll put them at increased risk for heart disease, stroke, or breast cancer. And what the data has shown is that if you are within 10 years of menopause or 10 years of a surgical hysterectomy, then your likelihood of developing cardiovascular side effects or breast cancer is decreased compared to your control population. So it’s really protective in women to be placed on hormone replacement therapy early. And this helps them maintain a lot of the things that you would, if you want to know what hormone replacement therapy will do for you, think about what you naturally would expect to happen to you as you age. You expect to lose elasticity of the skin. You expect to have changes in hair color and changes in hair consistency. You perhaps expect to get hot flashes and not be able to tolerate temperature change as well. Sexual functioning kind of as an expectation of getting older is expected to get lower, you know.

Donna Lee: And it does.

Dr. Mistry: You have no excuse. You’re like 32 years old.

Donna Lee: Yeah, OK.

Dr. Mistry: So then you have vaginal dryness, you have libido, and then there’s energy. And most importantly, I think, is cognitive functioning. This idea that you’re just not as with it–more forgetful, things of that nature. And I see these commercials from these very expensive on, you know, hormone, you know, hormone clinics that advertise, and I don’t want to mention one by name, but you know, you see these expensive ads and people are talking about how much better it makes them and I’m like, “That poor woman just spent $2,000 a month for something that we do for like, you know, $40 a month.” So…

Donna Lee: And if you watch KVUE, it’s the same lady in the same commercial, and she’s like…

Dr. Mistry: She did great! Trust me, she’s really happy with her outfit .

Donna Lee: She’s like, “I can’t keep my hands off my husband!”

Dr. Mistry: ” I can’t keep my hands off my husband!” Greatest, greatest ad ever.

Donna Lee: Because she’s paying $2,000!

Dr. Mistry: The problem with these kinds of centers is that if the hormones don’t work, I say it over and over again on the show: if you go to a place that does one thing, you’re going to get that one thing, regardless of whether you need it or not. So if you go there and you have very low sexual desire and you are a 24 year old woman, somewhere along the way, don’t be surprised if somebody sticks you on some hormones. When in fact some of our other therapeutic options might work much better for you: Vyleesi, Addyi, we use off label Wellbutrin.

Donna Lee: Those are like female Viagras?

Dr. Mistry: These are all like…well, you know, female Viagra is actually Viagra, right ? But what these medicines are, are they’re actual medicines that enhance libido. Like men out there, if you were wondering how come there’s not a drug that increases libido in women, there is, there is, okay? And these have all been FDA approved. They’re safe, effective, and something that we take care of. So when we get somebody who’s in their , let’s say, you know, early forties, who’s still hormonally intact, but complaining of very low libido–first things first. I tell her husband, “Do the laundry, fold a towel.” That’s my, that’s my Donna Lee sexual libido trick. Just go home, just take, unfold a blanket and just fold it right in front of her and say, “You think I’m hot now?”

Donna Lee: Better yet, wash a dish in front of me. Wow. That gets me going!

Dr. Mistry: Man, I feel like your barrier’s pretty low. So if that barrier doesn’t work, though, some of these medicines like an oral pill called Addyi or a little injection called Vyleesi are known and been FDA proven to enhance sexual libido desire and number of intercourse episodes.

Donna Lee: You’ve had some patient testimonials.

Dr. Mistry: Yeah . And it’s an amazing opportunity. So I included that in that hormone wellness kind of question the answer for that, because the purpose shouldn’t be to get hormones, the purpose should be to feel better in a certain way. And you know, your energy can be affected by your thyroid. It could be affected by your weight. It could be affected by so many different things. And so I have an integrative nutritionist on staff that’s going to help you make sure that your diet is not being affected or something you’re eating is not worsening your , the way your gut feels or the way your hair and skin are doing. And then we have, you know , of course, hormones and we do offer hormones in a pellet form: bioTE hormones for women. They run about $300 for three months because the way that women are dosed, the dosing is a little smaller. In men, the same bioTE pellet–well, a different, higher dose pellet–but the same kind of procedure lasts longer, about six months. If you’re going to , we can do pellets both for estrogen and testosterone, and if you still have your uterus, you’ll need to get progesterone as well, which is given through a very tiny oral pill that you take daily and sometimes a little less, less often. But then we also have natural supplements to help with symptoms of menopause if you’re not interested in doing a hormone replacement program. And just a really great program here for helping you deal with aging and menopause and making sure you don’t lose those things that you love. So how do people get ahold of us ?

Donna Lee: You can call us during the week at (512) 238-0762 . Send us questions to armormenshealth@gmail.com. And we’ll be back to the Armor Women’s Health Hour.

: Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour.

Dr. Mistry Answers a Listener Question About Spark Wave Therapy and Its Benefits

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here as always with my cohost and practice administrator, Donna Lee.

Donna Lee: 

I’m going to make sure KLBJ leaves the throat burp in there. Did you drink some soda right before we started recording?

Dr. Mistry: 

Perhaps. Perhaps. I’m not exactly a professional, I was going to say musician.

Donna Lee: 

Oh. Or that.

Dr. Mistry: 

I’m not a professional musician, nor am I a professional radio personality, but I am a board certified urologist. I am the founder of our show’s sponsor, NAU Urology Specialists.

Donna Lee: 

“NAU” stands for North Austin Urology. It’s not “Now” Urology Specialists.

Dr. Mistry: 

It’s a throwback, it’s a throwback to our original, you know, our roots. That’s how we started our first, the name of our first practice and kept it around a little bit. And so it’s a practice that we’re extraordinarily proud of. We’ve built it with a philosophy where patients are first. We go the extra mile to take care of the problems that you have. We really reduce the buffers between you and the providers by giving you access to our email and cell phone number and really encourage, you know, a constant communication. We have an amazing staff whose training that we’re working on every day to improve your experience.

Donna Lee: 

And we have amazing people.

Dr. Mistry: 

Just amazing people. And you know, and we love our patients, too. There’s a patient that we have, who I think for the last five years in a row, one of our MA’s has thrown a birthday party for him.

Donna Lee: 

Oh, that’s right!

Dr. Mistry: 

Just so happy that he made another year.

Donna Lee: 

It’s so sweet. We have balloons and all sorts of things for him, cake.

Dr. Mistry: 

And I had a patient that I saw maybe in my first week of practice 13 years ago that I just saw again this week. I had two of them. So just a longterm relationship that we developed with you, even though it may not seem like keeping a urologist in your life maybe something you’re looking forward to. But it’s not just because we fix a problem that’s causing you pain or distress and then we take care of it and you’re gone, but so many people come to us because they want to feel better about themselves. They want to lose weight, they want to improve their hormones, they want to have a family, and they want to improve their fertility. And then of course, those that are unfortunate enough to have a cancer diagnosis, they become our patients because we follow their cancer diagnosis throughout their life.

Donna Lee: 

That’s right . And on a much lighter note, it’s nice to have a urologist as a friend when you’re getting married in Las Vegas and your husband’s having a kidney stone.

Dr. Mistry: 

Yes.

Donna Lee: 

True story.

Dr. Mistry: 

Unless the husband is so hardheaded, he just won’t follow directions.

Donna Lee: 

Oh, Michael.

Dr. Mistry: 

Oh Michael.

Donna Lee: 

Bless his heart.

Dr. Mistry: 

Well, we are still seeing patients during this era of social distancing. We are doing our best to keep our lobbies clean. We clean them down regularly throughout the day. All the rooms are completely taken care of with a bleach substance where anyone would have touched. Of course our medical equipment has been very thoroughly cleaned in between uses. And then we have masks worn by all the staff, even when they are just with staff, that’s important for you to know that exposure risk is going to be minimal in our office. We will see you by televisit, even if it’s a new patient visit. And we’re, our goal is to see you today. So I had never took pride in being a practitioner who has a long wait list. That just means that I very poorly planned for the future. If it’s going to take 6 weeks to see me, because if you need me, you know, I want to be there for you as soon as possible. And we have practitioners available to see you virtually always the same day or the next day. We encourage you to come and see us. Donna Lee, if people are trying to find this , where are they going to come ?

Donna Lee: 

They’re going to Google us. And they will find us at, in Round Rock, North Austin, South Austin, and Dripping Springs, Texas. You can call us during the week at (512) 238-0762. If you have a radio question, you can even ask for me because I live at the office. I have a little little bed in my office now and I just camp out. That’s why I don’t go home anymore.

Dr. Mistry: 

And that’s why I don’t see you getting anything done during the day.

Donna Lee: 

Yeah, I just sit in there.

Dr. Mistry: 

That’s very nice.

Donna Lee: 

I’m just laying in bed.

Dr. Mistry: 

You know, what’s funny about being a doctor that I didn’t realize is how many outside of the office friendships I would develop. Now they’re all with older men, maybe that sounds kind of weird. But later in life, my kids’ godfather came when I first met him as a patient, and then excellent hunting friends that would go on great hunts, and somebody early on in my practice became a really good friend of mine because he saw a bunch of sailboats. And then just during this quarantine, we finally got him to come out and teach myself and my kids how to sail on boats that he gave us. So that’s wonderful. And you know what? He sent us the last question. So I’d love to share that question, even though we won’t share his name.

Donna Lee: 

Oh, I was gonna say , can we do that? No.

Dr. Mistry: 

No.

Donna Lee: 

I mean, not his name.

Dr. Mistry: 

Keep out that part, but go ahead and do the question.

Donna Lee: 

OK. Well the question’s great. He states, “I’m 57, and while I don’t have much trouble getting an erection, I do have difficulty maintaining one, and it’s not as hard as it was a few years back. I also have a few small knots or lumps that can be felt only with an erection, which might be clots?” He was told in our office about the shockwave therapy that we now call spark wave. “How proven and effective is it, and is it likely to help this type of situation? And if it works, what about the rocket, a similar device available online?”

Dr. Mistry: 

That’s a great question. And it reminds me of a funny story about a sexual aid that I heard about years ago. And if you want to know what it’s like to be very good friends with a urologist, we certainly have talked about this very same thing around the campfire, in a group of other guys. So if you’re having either difficulty getting, but certainly with maintaining an erection, something like what we’re doing when it comes to this sonic or acoustic therapy for erectile dysfunction is a very good option. What’s happening there is that the blood flow into the penis is usually very robust, but the mechanisms that keep the valves closed to keep the erection in the penis are not functioning well. And so what using spark wave in our case or shockwave in other offices or GAINSWave in some other offices you’ll hear, the underlying kind of premise is that you’re going to be using energy to cause microtrauma along the blood vessels and the bodies that hold the blood during an erection and helping to regenerate them so that they’re stronger and work better. And we do that in a lot of different tissues. We have to use a little bit of trauma to make valves work better. And so when it comes to using something–and so, for that, for that, I would say getting better erections that last longer, the spark wave is a wonderful option. But when it comes to the lumps that you’re feeling , that’s, although it’s been a little while since I’ve had my hands on…

Donna Lee: 

On this particular penis?

Dr. Mistry: 

On this particular penis. More than likely bumps underneath the skin are going to be related to Peyronie’s plaques. And this, these are those same, the same disease process that we hear about over and over again on our, on our show, a concern about the curvature is usually the most common one, but these little plaques that form bumps they’re more prominent when you have an erection certainly can be concerning. They’re usually not clots. They’re usually hard scar plaques. They don’t usually respond that well to the shockwave, unless you have pain. If you have pain with an erection, then that pain does seem to respond well to shockwave, but just the, just the breakdown of the actual plaque doesn’t seem to be a big, a big benefit. And then the next question is about the rocket. So , we look online and look at what the rocket is…

Donna Lee: 

What is the rocket?

Dr. Mistry: 

The rocket is like a, because they heard “shockwave therapy,” and then somebody heard that shockwaves are like little piece of energy hitting the penis, so somebody made essentially just a vibrator that you put on the penis.

Donna Lee: 

A penis vibrator?

Dr. Mistry: 

That’s right. It reminds me several years ago, there was a product that was announced for female arousal disorder–so women that couldn’t get aroused.

Donna Lee: 

That’s because they don’t like their husbands.

Dr. Mistry: 

And the instructions were, their instructions were, “Apply to clitoris, rub vigorously for 15 minutes prior to intercourse.” That those are , I’m not kidding.

Donna Lee: 

Stop, no.

Dr. Mistry: 

“Rub vigorously.”

Donna Lee: 

“Rub vigorously .”

Dr. Mistry: 

It was the “vigorously” that I loved, because it wasn’t a FDA approved drug, so they could say whatever they wanted. And I was like, this is an incredible marketing because somebody was like, “Well, it’s not working.” “Well, how long did you rub it in?” “Well, it says 15 minutes. Let’s get to it.”

Donna Lee: 

Let’s add that “vigor” to it.

Dr. Mistry: 

Let’s add “vigor” to it. I pretty if you rub anything on there for 15 minutes, you’re going to turn something on. And so same here. If you’re using a vibrator or some increased kind of vibratory stimulation to the penis, if you just use the vibrator when you have a slightly limp erection, you’re going to get more stimulation of the penis and it’s going to get harder. But that’s not what you’re looking for. You’re not for harder now, you’re looking for harder when you’re not using it and later, and in a more natural, more regenerative way. And so for that, I would say use the real thing. Come in and let us use one of our amazing , very well tested devices that we have for this acoustic therapy of the penis. And we will certainly do our best to try to make your erections both more rigid, which it can achieve, as well as longer lasting. We’ll do that along with our supplement program, which includes sometimes a supplement called L-arginine and an anti-inflammatory supplement called curcumin . What a great question and a great little, you know, softball for us from a, from a good friend.

Donna Lee: 

So what you’re saying is the summary is, “Maybe you should see a doctor.”

Dr. Mistry: 

No. See me, come back.

Donna Lee: 

I mean, Dr. Mistry, and not buy a bunch of crap online.

Dr. Mistry: 

How do people, if people are interested in getting this kind of therapy or learning more about us, how do they get ahold of us?

Donna Lee: 

You can reach out to us at (512) 238-0762 . Send us your amazing, emailed questions to armormenshealth@gmail.com. That’s armormenshealth @gmail. com. Dr. Mistry and I are always so amazed and happy when we see these emails come through. That means somebody is listening. As Sally Fields once said, “They like me. They really like me.”

Dr. Mistry: 

I don’t think that was Sally Fields.

Donna Lee: 

That was Sally Fields.

Dr. Mistry: 

No, I think that was…

Donna Lee: 

No, Sally Fields, swear to god. OK, podcast.

: 

Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour. Men’s health hour

How To Live Longer, Better with Prostate Cancer: Dr. Mistry Explains How Urologists Evaluate and Treat Prostate Cancer

Speaker 1: 

Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee .

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, a board certified urologist, here with my certifiable office manager practice administrator amateur sound engineer, Donna Lee.

Donna Lee: 

Hi. My stomach is growling and then you sat down with food. So thanks.

Dr. Mistry: 

This is very professional.

Donna Lee: 

It’s going to make a great segment.

Dr. Mistry: 

The Armor Men’s Health Hour is brought to you by our practice that we started in 2007, it’s called NAU urology specialists. We are a full service urology specialty organization, and by full service, we mean that we take care of all of you, when it comes to your urologic complaints. We take, you know, our new tagline, it’s going to be, “We put the ‘U’ in urology.” Specialized care individualized to you with a whole host of practitioners that you may not even imagine exists in a urology office. We have sex therapy, pelvic floor physical therapy. We really recognize the importance that sleep apnea plays on a number of urologic conditions, including low testosterone and frequent nighttime urination, so we test for that right out of our office. We have full supplement lines, so that if you’re taking something that you saw on late night television for your prostate, you know that what we have is exactly what we think he should have. We have treatments for…

Donna Lee: 

The ads are cheaper at night, probably.

Dr. Mistry: 

Maybe that’s what it is. Remember that everybody–you’re watching the ads of people that really couldn’t afford the morning ad. We have treatments for premature ejaculation, treatments for erectile dysfunction. We have weight loss programs, and really trying to get you to the next level of your urologic care. So if you’re trying to feel better, you’re trying to pee better, you’re trying to have better sexual relations, this is the place to come. And we also treat cancer: prostate cancer, bladder cancer, kidney cancer. In fact, the bulk of what I do surgically has to do with robotics and advanced endoscopic treatments of kidney stones and enlarged prostate, infertility, and cancer. And if you didn’t know what a urologist does, that’s a little quick little peek into it.

Donna Lee: 

That’s right. They focus on the yum yums and the ding-a-lings.

Dr. Mistry: 

And the ding-a-ling. I mean, that’s a very important part of what we do. We don’t just focus on the men, although you have given us a yum yums and ding-a-lings award.

Donna Lee: 

For 2020.

Dr. Mistry: 

That’s right.

Donna Lee: 

Radio, “excellence in radio,” the award says

Dr. Mistry: 

It would be embarrassing if we had to give an award to another urologist doing a radio show next year. You know what, they’re doing a much better show. We gotta give it to them.

Donna Lee: 

They probably have a better label maker than I do, but I found these awards and they’re legitimate awards. They were given to me in life.

Dr. Mistry: 

OK. We’re putting them on our Facebook page.

Donna Lee: 

We shoud.

Dr. Mistry: 

You can also listen to this as a podcast. It’s a free podcast available wherever you get your podcasts including Apple store, Google play, as well as Spotify and it’s even on your Alexa. So just say, “Play the Armor Men’s Health Hour.”

Donna Lee: 

That’s right. If you’re at home, that’s kind of creepy, but cool. Say, “Play Dr. Mistry and Donna Lee.” Oh my.

Dr. Mistry: 

It be right [inaudible].

Donna Lee: 

One of the awards I have is actually , I was a local host for the local version of The Voice because of my comedy career that I was allowed to be the special guest. So there’s three of us. There’s like a singer, and then this other person…anyway , it was such a low budget thing that, you know in The Voice, when the chairs turned around with the electric chairs that turned around, we had stools and we had to like pitter patter our feet to turn around really quick when we wanted to see who was singing. But anyway, I got that award. Now it’s the ding-a-ling and yum yums award of 2020.

Dr. Mistry: 

I love it. Well from that piece of levity to what is probably a little bit more serious, your questions to our show are really important to us. A lot of the questions that get asked to us are really sensitive, and we do get, try to get to them as quickly as possible. And this was a great question. So Donna, why don’t you share it?

Donna Lee: 

That’s right. We have a weekly listener, so thank you for that. He said, “Dr. Mistry, based on slightly elevated PSA of 4.27, I just received the results from a biopsy of my prostate and received positive results on 4 of the 12 biopsy samples taken. What kind of questions should I ask when I meet with the doctor for the followup? What do I have to worry about? And should I get second opinions on what they found? I’m not experiencing any symptoms so far. Based on the four positive biopsies do I start some kind of treatments or continue to monitor with blood work? Thanks. I listen every week.”

Dr. Mistry: 

What a great question. And this is a dilemma that so many are going to face , virtually 300,000 men are going to face in the United States every year. And so what to do when you are found to have prostate cancer. So what I tell patients is, you want to know how much cancer do you have, and that’s the 4 out of 12 biopsy, of course. How aggressive does it look? And that’s where the Gleason score comes into play. So that’s going to be a number like 3 plus 3 or 3 plus 4, 4 plus 3, or 4 plus 4.

Donna Lee: 

What do you want?

Dr. Mistry: 

You want the lower, the number the better. So you want a Gleason 6 because that’s going to be a little less aggressive for the most part. Then your urologist is going to play a little game and not a bad game, but a good game. So what I do in my office is I input all of your information into a special thing called the prostate cancer nomogram. It’s online at the Memorial Sloan Kettering Cancer Center. It’s called prostate cancer nomogram. And he put in all the information and it tells you what’s the likelihood that with your biopsy, when compared to thousands of other men, that your cancer is likely to have already spread, or is likely to spread in the next 10 years. And 10 years is our marker for when we think we should make a decision about whether to treat a man. So if there’s a high likelihood that the cancer is going to progress or spread in the next 10 years, and the guy in front of us looks like he’s going to live 10 years, then we decided to treat. If the guy in front of us does not look like he’s going to live 10 years, then we might choose not to. Now where there are a lot of error comes into play, is that people live longer sicker than ever before. And so dying of prostate cancer is a bad way to die. So we would prefer you die with it, not of it. So if treating you, you know, in a way that kind of lessens the likelihood of having to die from prostate cancer is an option, that may be something we choose even if you have a few medical conditions. A lot of questions that you should ask, have to do with what do you do, what options do you offer when it comes to treatment of prostate cancer? So, although this may sound insulting to some other urologists, if you don’t do radical prostatectomies doing, using the robot, then perhaps you will be less apt to recommend it. You know , if you don’t have a hammer in your tool belt, you may be less apt to suggest it. If your urologist has a financial interest in a radiation center, then don’t be surprised if they are going to recommend radiation. So what national data has shown is as urologists own more and more radiation centers across the country, that they recommend radiation for patients that they normally would have said, “Watchfully wait.”

Donna Lee: 

That sounds so wrong.

Dr. Mistry: 

Well, I mean, it is, it’s a natural inclination. So in our life we do HIFU or high intensity focused ultrasound. I speak about it. I don’t have an ownership interest in HIFU , but you know, I do get paid for doing it. And so, in our practice, HIFU may be something that gets offered to you. That’s the treatment. Now where we try to focus where you’re going to find not everywhere is what else can you do? Almost everyone asks me, what should I eat? And I can’t even imagine what they say in the other urologist practice. Do they give them a book or what they do? But we have Shefaly Ravula–she’s a integrative health specialist and a nutritionist. She’s a PA, and she’s going to meet with you and through our whole program of what we do nutritionally. Some people may ask, well, what’s going to happen to my erections, to my quality of life, with different forms of treatment. And we’re here to minimize the side effects and maximize the oncologic outcomes. You don’t get enough information just by knowing that it’s 4 of 12 [ inaudible]–you have to know how aggressive the disease is and a lot about you. How long would we expect you with your medical history to reasonably live a good life, and can we offer you a treatment that’s going to help you live a longer life better? Because in prostate cancer, even more than other cancers, you have the issue of lifestyle and quality of life that you have to take into consideration. But no matter how much we try to help guide patients through this decision, something else plays a role. And that’s what I call with my patients, sometimes the decision is more psychology than biology. I meet guys all the time, “I have cancer in me–cut it out, cut it out, cut it out.” I meet guys all the time, “I have cancer. I don’t care. Nothing’s going to kill me. I never want any treatment of any sort.” They’ll say, “I hate radiation.” Some people will say, “I hate surgery.” They’ll come in with a bias. A lot of times, the wives, if the husband says he doesn’t want treatment, t hat wife w ill look side items say, “You’re getting treatment. Y ou k now, you’re definitely getting treatment.” A 45 year old guy with 2 young kids at home, that’s a different consideration. I mean, that f amily i s g oing t o want that guy around. So even if I have to do whatever it takes, you know, I used to make the analogy that you go to MD Anderson, they put a mark across the word cancer, so they’re g oing t o cut you in half to get you cancer-free if they need to, especially if you’re young and they feel that you justify an aggressive treatment. But that may not be your decision. And so we c alled this “shared decision making” when it comes to prostate cancer treatment. So the questions you should ask or make sure you know, what your doctor does themselves, because that may bias their answers, perhaps what their financial incentives could be when it comes to treatment options that they offer. And you should always get a second opinion. If your guy doesn’t do robotic prostatectomy, you should go to a guy that does robotic prostatectomy. If you go to a guy that doesn’t own a radiation machine like us, we don’t own one, and if you come to us and you want to go to a radiation machine or radiation second opinion, you should do that. If you weren’t offered HIFU for your cancer, then you should go to s omebody that offers that. And if you haven’t been offered a nutritional or a more natural approach, you should, you should perhaps try to seek out one of those. And so getting the most out of your care is what we try to do. And if you’ve been diagnosed with prostate cancer, Donna, how do people get a second opinion from u s?

Donna Lee: 

You can call us at (512) 238-0762 and send us an email to armormenshealth@gmail.com.

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Dr. Mistry wants to hear from you! Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour