Fecal Incontinence: Dr. Mistry Talks Treatment Options For Men and Women Experiencing Leakage or Urgency

Speaker 1: 

Welcome back to the Armour men’s health hour with dr. Mystery and Donnelley I’m desperate mystery . Your host here’s all was with my cohost, the effervescent of brilliant and person learning new words all the time on camera .

Speaker 2: 

Brilliant. What is it ? Does a brilliant mean lovely and thoughtful.

Speaker 1: 

If you know what these words mean, and I use them wrong, please not come up .

Speaker 2: 

Booleans I am a Boolean today.

Speaker 1: 

Donna is our practice manager at our urology practice. I’m a board certified urologist. Uh, I started, I started our practice NAU urology specialists in 2007, and we have grown to a magnificent great . We are the second largest, second largest urology group in Austin by default. But yes we are. That’s right. You know , as a general rule, we can’t say certain things in our office. We can never say semi-rigid we can never say re you know, smaller rejuvenation. That’s right. It’s gotta be, we gotta use the terms that talk about growth and ,

Speaker 2: 

And girth. You know, we got a lot of questions about that time. Dr. Dellinger was on talking about girth and fillers.

Speaker 1: 

We are doing so much penile enhancement and so much penile enhancement work. It is absolutely incredible for those of you that are looking for information on growth enhancement or any other kind of genital reconstructive work that you’d like to see done. We have amazing partners. I do a lot of the work along with a number of plastic surgeons in town. Dr. Dellinger is a great partner of ours at lesion and plastic surgery. And , uh , you know, especially if it’s a topic that had been bothering you and you don’t know who to talk to. I mean, it’s a , it’s a wonderful opportunity to talk to us.

Speaker 2: 

And I think there was some confusion because we talk about girth and length, and those are two different things. So I hope the guy knows that about his own PP .

Speaker 1: 

Well that’s okay. Well, we can talk to him .

Speaker 2: 

We can do both through dr. Yourself.

Speaker 1: 

That’s right. We’ll , we’ll, we’ll do our best to make, make your dreams come true. Uh, you know, this is a sensitive subject for a lot of guys. They’re like, I don’t know why I care. And then there are other guys that are like, well, my wife told me that the other guy was bigger. The old boy,

Speaker 2: 

I remember a story about that. Didn’t know why I say I’ve had bigger. So he went right out and got bigger. It’s going to cost me money. I just run from it.

Speaker 1: 

No . And so we’re here to help make those , uh, those kinds of , uh , which is of yours , at least be addressed, if not completely, you know , to your expectation

Speaker 2: 

Disney world for sex, we’re here to make your wishes come true.

Speaker 1: 

The most of the most common things that we do are in relation to men’s health is really to help optimize your function, whether it be urinary function, sexual function, hormonal function, how you’re feeling general fatigue. We want to make sure that we’re helping with your weight loss goals. And we do so many things that people wouldn’t necessarily associate with a traditional urologist office. And that’s because we are not a traditional urologist office. We are here to take care of you from the top of your head, to the bottom of your toes, in terms of making sure that you’re getting the right consultants that are helping to take care of you, the right medical test to help diagnose you. And then of course, you know, treat your kidney stones, treat your prostate cancer, treat your bladder cancer, put your bladder stones or fix your hormones, or for any of the number of reasons that people refer to us.

Speaker 2: 

Oh gosh. And we get so many referrals from all these amazing primary care physicians in town.

Speaker 1: 

That’s right. I mean , our relationship with your primary care doctor is really important. We also see a number of patients that have a previous urologist. I would say that probably half of the patients that I see as new patient consultations have been with another urologist and come to seek us out for second opinions or kind of a upgrade in their care. And that’s what you get with us when you’re big enough to be able to provide more services, but small enough to treat you like a person.

Speaker 2: 

And they’re probably just dig your name, mystery

Speaker 1: 

Dr. Mystery. It’s a real name. That’s right . We are seeing patients in a safe, socially distance and fully masked way here at a number of our offices all throughout town. And we’d love to see you. We are taking a new patient visits via telemedicine. And if it’s really a second opinion you’re looking for and putting hands on you and examining you may not be a critical part of that consultation than a telemedicine appointment is a wonderful way to get somebody to review your records. It’s covered by insurance. You know, I’ll give you kind of exactly the kind of treatment that I would give anyone who was a patient of mine primarily. I mean, you really get exactly in-person or on the phone where you’re getting on the radio, which, you know, hopefully you’ll like,

Speaker 2: 

I think so. I think I know we have a lot of patients who call because they listened to the show. So we appreciate that.

Speaker 1: 

Donna, why don’t you tell people how to get ahold of us and we’re off?

Speaker 2: 

Yep . You can call us during the week (512) 238-0762. You can Google us. Dr . Mysteries, a website is Armour men’s health.com. Well , our website, I guess, and you can send us questions to Armour men’s health@gmail.com. I’ll respond to all of them. We’ll send you free podcasts . If you don’t catch the show on the weekend on Saturday or Sunday on KLBJ and we have more questions, dr. Mystery. Awesome. Well hit us . This one kind of, I was a little worried, but when this wife Synthes in, so her husband’s a patient of hers . She says dr . Mystery, my husband has been in your program for a few months. Now he has refused to tell the doctor about his incontinence and says he doesn’t want to, or need to. I’m concerned he doesn’t have insurance. And she goes on about paying his office visits. I guess she’s paying his bills. He can’t keep a job because he can’t stop going to the bathroom all day. Basically he has to shower and change clothes to go back to work. That’s upsetting. She said, this has been going on since the nineties. He has a, he has had his gallbladder removed within the last few years. So that adds to the problem. She said, listening to your program, it seems there is a medication or therapy he can do to fix the pooping problem. Oh, it’s a pooping problem. Since he won’t tell the doctor and is just taking injections every week, it doesn’t seem to be helping his other problems. He has no intention of telling the doctor about this issue at our clinic. She wants to know what she should do. Well, what a great question. So he’s probably embarrassed.

Speaker 1: 

So, you know, when you, when you look at the question and I apologize if I don’t address exactly what was addressed or intended here, but what I’m going to talk to you about is something called fecal incontinence. So it sounds like that this, this listeners husband could be experiencing leakage of stool throughout the day unexpectedly. So that fecal urgency can be either just like urinary urgency or low loss or incontinence can be from either urgency or sphincteric dysfunction, where it just kind of comes out when you cough and sneeze. So can to leakage from the rectum or anus for fecal soilage. When it comes to fecal solos in a man, we get very concerned about underlying neurologic disease. You know, we recently had a patient who had a , uh, called an anal fissure or an anal abscess that had to be lanced on anal fistula had to be lanced that caused damage to their external sphincter that caused them to have a leakage. And there are fixes. You can actually do slings, just like you do slings for the bladder. You can do slings for the rectum. We have amazing colorectal surgeon partners that help with that. There are, there’s a big dietary component to helping with fecal incontinence as well. And men , particularly in women, fecal incontinence is often due to the same type of pelvic floor prolapse or pelvic floor Oregon’s falling that causes the bladder to fall or the uterus to fall, or any of those things that happened to women, especially if they’ve given birth to multiple children, that incontinence is due to just kind of a weakness of those, of those tissues in a man. We worry a little bit more about , uh , neurologic issues. And when it comes to diet, we really want to make sure that they’re on a diet that promotes really good quality, you know, fully formed stools. So not greasy hamburger diet. Well, I mean, if your gut can’t take a greasy hamburger, all of that greasy hamburgers ,

Speaker 2: 

That was pretty good diet . What about Indian ?

Speaker 1: 

You know what, that’s enough about you ? You know, I guess you’ve got a double wrap your underwear, you’re going to have to do that kind of stuff, but really it’s identifying foods that are not good for you when it comes to holding solid stools. And so our integrative nutritionist Shefali Ruvolo , who’s a physician assistant will work with you to give you advice on supplements on additives, to your food that can bulk up and make it a more high residue diets that you are able to get more fully formed stools without getting constipated. That’s great, making sure that the flora in your guts appropriate so that your , your colon is breaking down the, you know , materials in your stool properly, making sure that your, your small bowel and things aren’t, aren’t working. So where the gallbladder thing comes into it is that sometimes when the gallbladder comes out, the bile that’s supposed to be released by it doesn’t, it causes a more kind of greasy stool to come out. And so that can be effected or that can be adjusted diet without dietary.

Speaker 2: 

Where’s the gallbladder, what is the Galway or no ,

Speaker 1: 

It’s right under the liver and it functions in our digestive tract. Gotcha. And so then you have, what do you do with people with fecal urgency? There are medicines that can help decrease fecal urgency. And there’s also a neuromodulation, you know, how we use that Axonics to help people with bladder incontinence, right ? That these are like little leads put into the nerves that go to the bladder that act like a pacemaker for the bladder to kind of calm it down, right ? The same thing put in a slightly different place can be used for fecal urgency incontinence. So I know a lot of these things sound like they cost a lot of money. Pelvic floor physical therapy is another thing that we offer that will really help fecal incontinence, both in men and women and it’s topic. Nobody likes to talk about, right . I agree. It’s a , for many patients and embarrassing topic, but,

Speaker 2: 

But there’s a fixed maybe for sure.

Speaker 1: 

There’s definitely like steps that can be made to help make you feel better and feel more confident. And even if nobody can smell anything, you feel like you’re , you know, something, you feel like very uncomfortable in public when you’ve kind of staying in your pants. And , uh, we would love to be there as a resource to help make , um, you know, that part of your life much better. And sounds like for this particular person in, I could feel like fixing this issue is going to help their life improve

Speaker 2: 

And yeah . Help his wife not be angry. Cause she was not happy about paying.

Speaker 1: 

Well, trying to wake you up and make your wife happy all the time. It was really a goal that sometimes,

Speaker 2: 

Oh , my people get ahold of us. How do people ask questions? Send us your questions. We’ll answer them right here on air anonymously, Armour men’s health@gmail.com or you can call us during the week (512) 238-0762. And thank you so much for these amazing questions. Thanks back to the day , the armor men’s health hour. We’ll be right back. If you have questions for dr. Mystery, email him at Armour men’s health, ed gmail.com

Eating For Cancer: Shefaly Ravula On Anti-Inflammatory Foods and Therapeutic Diets For Cancer Patients

Speaker 1: 

Welcome back to the armor men’s health hour with dr. Mystery and Donna Lee . Hello and welcome to the armor men’s health. I’m dr. Mr . Your host here with my bubbly effervescent wonderfully. Can’t do without a bolt office manager.

Speaker 2: 

That’s me. Hello. Hello. So effervescence . Hello. Everyone’s lovely.

Speaker 1: 

Many thanks to KLBJ news radio and all of our wonderful staff here for helping us put on this show. This is a men’s health show. I’m a board certified urologist and a , that is a doctor or a surgeon who treats , uh , genital urinary conditions of the prostate kidney, kidney stones, low testosterone, hormones, wellness. We do so much great stuff here, right? Donna [inaudible] . And so , um , one of the big reasons that we’ve decided to bring this show to the community is to really highlight a different way of thinking about your health, thinking about how even a surgeon and, you know, maybe in the community, you may not know, but in the medical profession, the internal medicine doctors are considered the smart ones who are just, you know, more honest about, and the surgeons are just cutters, you know? Right. But as a urologist, I get to thread that needle because I’m, you know, do both, both the genius and ,

Speaker 2: 

And I got her and cut it and get to cut people. And that’s not a teenage dysfunction thing that is an actual surgeon.

Speaker 1: 

Uh, one of the great things about our practice is how incredibly diverse it is. And I think that you would rarely find as intensive a nutrition program in a medical practice, forget about just a surgical practice. And what we really strive to achieve is a whole body approach to different , uh , medical conditions. And today we are joined by , uh , Shefali Roula . She is a physician assistant and she is our functional nutrition provider here at our practice. And thank you for joining us.

Speaker 2: 

Thank you for having me. I’m super excited and slightly nervous.

Speaker 1: 

Well, no reason, no reason to be nervous. Shefali is a humongous addition to our practice. Not only is she a food writer for the Austin American statesman, she does cooking shows and is a trained medical provider. So someone who really understands the connection between nutrition and health and wellness,

Speaker 2: 

Thank you for having me. And I used to write for the statesman I don’t anymore, but I dabble here and there. It’s got the street cred. You said huge, but she’s super skinny and very fast . She is tiny, which might be challenging for our patients. So believe me.

Speaker 1: 

So, you know, it is very easy to talk to people and for them to accept on a superficial level, that what we put in our body can affect our health. Like people that’s easy for people to believe, but somehow it’s hard for people to believe that if they, what they’re putting in their body, that it can affect their body system. And so Shefali, why don’t you tell me what are some of the triggers that really inspire somebody to change the way they’re eating or their lifestyle?

Speaker 2: 

Well, certainly in the medical world, a new diagnosis, you know, a new diagnosis is like a pain point. It’s a new pain point, especially if it’s a chronic illness. So to me, you know, if , if you don’t have a pain point or really just a pain point, then you’re going to have a really hard time being motivated and coached by anybody, including yourself to make those things .

Speaker 1: 

Because transition points are really an opportunity for you to really re-examine what you’ve done. So, you know, smokers often don’t stop smoking until they get a bad illness. You know, people who are overweight often will wait until they have some kind of chronic illness, which is really a shame because sometimes you’ve waited too long. Okay .

Speaker 2: 

Absolutely. I mean, another example is just from, in my prior experience with fatty liver patients, you know, until they’ve been told they have fatty liver or even cirrhosis is when they either first hear about alcohol reduction or they’ve heard all along, but that’s when they actually do .

Speaker 1: 

And so it is a real struggle to get people, to make lifestyle changes when they’re not having a specific pain point, unless you’re particularly motivated that way. But, you know, as a medical professional, I have to give out pain points every day. I’ve got to tell people they have low testosterone. I’ve got to tell people that they have interstitial cystitis. And then of course, cancer diagnosis are a big part of our everyday here.

Speaker 2: 

Yeah, absolutely. So, you know, bandaid medicine is, you know, it’s not what I want to call what we do in the medical field. I mean, we need this Western approach, this evidence based medicine. And we have a role of course, for this kind of medical care, but I’d like us to see in this country a better approach to chronic disease and chronic illness, which takes a lot of work. It’s a work on a provider and more work for the patient .

Speaker 1: 

I’m a big believer in philosophy guiding practices. So if you were just to kind of generalize the nutritional approach to cancer diagnoses , and nobody here is talking about not doing traditional therapy, you know, if you have prostate cancer, take your doctor’s advice. But every single one of my patients, literally the second I diagnosed them, the first question they ask is what should I eat? Like it’s on the very forefront of their minds . So how would you explain kind of your philosophy or your approach to cancer nutrition? Okay.

Speaker 2: 

So it sounds like a lot. Yeah. There’s a lot. There’s a lot there. And I, I, you know, you can generalize diets for the masses, but it would be hard. Everybody knows to eat clean and eat vegetables for the most part. If you look at all the diets out there, paleo vegetarian, vegan, Kito , I mean, most of them don’t disagree on vegetable.

Speaker 1: 

Right, right. And clean foods. We’re really talking about things that are minimally processed, whole foods,

Speaker 2: 

Food . So not like a broccoli chip, but just broccoli please, or you know, all those kinds of things out there. So the reason your patients are going to ask you first and foremost, what can I eat is because patients need to feel empowered. They’ve been given a diagnosis by somebody else it’s totally out of their control. This goes for everything, cancer, heart disease, diabetes, whatnot. So they are going to ask their doctor because who else can they ask ? They don’t, you don’t go to a nutritionist as a, for a well-check you go to your doctor. So they’re going to ask you. And so luckily now medical stools, mega medical stools. I mean , that’s all right . We have medical stools around the clinic thinking GI . Um, luckily now, you know, incorporate culinary , uh, cooking classes, culinary medicine, into their programs, more and more. But certainly when you and I went, when I went to PA school, when you went to med school, nutrition was like two hours of your education, nothing. So

Speaker 1: 

A lot of reasons for it, you know, you know how doctors are paid, what we know, and then how much can we really try to turn the patient’s viewpoint? So, you know, when somebody comes to me with an enlarged prostate, I know that I can recommend 10 times out of 10 prostate surgery is going to help you be better. And I’m going to feel very confident that’s going to work, but I’m not as confident that if I send somebody for weight loss counseling that they’re going to follow through. And I think it’s people being disappointed with our patients follow through that, discourages us to keep going, but that’s never been my philosophy. I’m always a big fan of the one person that decides to go through the therapy. And when it comes to cancer, eating, a lot of them are very motivated to lose weight prior to surgery, but it’s the maintenance of some kind of lifestyle. And if it’s too drastic, they, a lot of people can’t stick with it. So maybe site like some guiding principles that are, that people can easily kind of think about when they approach a cancer diet.

Speaker 2: 

Sure. So I think the first thing I would say, you can say this the moment you see them in the offices start eating cruciferous vegetables every single day. That’s a big word. Yes. So they’re a part of the brassica family and they just all cruciferous vegetables. So this is kale, broccoli, cauliflower, bok choy, a rugala , I’m missing a big one here, couple other ones in that class. If you can eat that every day, a good handful or two servings, just put that we should all be doing this. This is preventative anti-cancer therapy truly. So I would suggest, you know, just tell your patients start, you want to , you want to do something you want, you want some power empowerment. Do you want to take charge and put me in control a little bit. Start eating blueberries and broccoli every single day. Huh ? Can you make me a salad ? Blueberries , blueberries broccoli. Well, there you go. And so that’s another thought of, you know, where I love to think about it .

Speaker 1: 

It’s healthy for you. I really can’t tell you .

Speaker 2: 

That’s the one I was thinking of guys hate Brussels browser . I love Brussels sprouts . Have you had them at

Speaker 1: 

Just , it just takes me back to my childhood.

Speaker 2: 

And the idea is that you’re reducing inflammation. So antiinflammatory diet is huge.

Speaker 1: 

And I think that that is, you know, if I had to really encapsulate what our approach is to so many disease processes, it’s this idea that inflammation is a central core component of many things, cancer, heart disease, high cholesterol weight. And by reducing the inflammatory response in our body, I think that we can reduce rashes, irritable, bowel, cancer, diagnosis, and progression. And so I I’m really proud of the approach that , that we’re taking together when it comes to nutrition. And I think that if you’re out there and you’ve been diagnosed with a cancer, whether it be prostate cancer, kidney cancer, or another type of cancer, and you haven’t been given guidance on what to put in your body because you know what we put on our body has to have some impact and what’s going on with us in terms of our health. Even if it’s cancer, it’s not just always just bad luck, right? And so if you’ve, if you’ve been diagnosed and you want some guidance, we would highly encourage you to come in and visit with us. You don’t have to have a urologic condition per se, to be able to visit which visit with Shefali or, or a team. And she can see you directly. She’s a physician assistant. She has incredible medical training. [inaudible] worked in GI medicine, and now

Speaker 3: 

We’re happy to have her here. Super excited. Thank you for joining out of pain . Well, if we had time, they would call us at 5.22384762 and email at [inaudible] dot com. The Armour men’s health hour. We’ll be right back. If you have questions for dr. Mystery, email him at Armour men’s health@gmail.com

What Is “Primary” In Finding a Primary Care Doctor: Dr. Kevin Spencer of Premier Family Physicians on Finding Your PCP

Speaker 1: 

Welcome back to the Armour men’s health hour with dr. Mystery and Donna Lee . Hello,

Speaker 2: 

Welcome to the armor men’s health hour. I’m dr. Mr . Your host as always with my wonderful, beautiful and lovely. Oh no, you done . He got me confused with that . My practice manager. Thank you so much for joining us today. I’m a board certified urologist men’s health cohost, and an award winning cohost . That’s right. As far as we know, dumb dumbs and Dingalings and dumb, dumb. Very good. Thank goodness that you got so many awards when you were in junior high so that we can rebrand them for ourselves. This show is brought to you by NAU urology specialists. We are a urology specialty practice that has been in practice since 2007, 13 years, 13 years in your state . And your name is still mystery. T R Y. People think that dr . Mystery is a gimmick. It’s a fake name. It’s really hurtful when my wife says it. Okay . Oh, Krista , no , you can’t say her name. He actually got on me today about how we never include her in the show. And I was like, well, every time we talk about your husband, we talk about it , right? Well, does she have something like big boobs that we can talk about? She’s amazing. She was pretty hot, right ? Um , this is a men’s health show. We talk about a number of men’s health topics that affect our community. And we’ve been so happy to bring this show to you for the last, almost a year and a half feels like 13 years. I mean, the last year I felt like two years. Uh , Donna don’t you tell people about where our practices are and how people get hold of . We are all over central Texas. We’re in round rock, North Austin, South Austin, and dripping Springs, Texas, cute little dripping Springs, or you can reach us during the week at (512) 238-0762 . Our website is Armour men’s health.com and you can send us your amazing anonymous questions to Armour men’s health@gmail.com. And we have a special guest today. We need to get to, we do, and I’ll tell you something. I’m a little disappointed that his radio voice is better than mine. Yeah, well, most of them are. We have today, dr. Kevin Spencer from premier family physicians , premier family physicians is one of our best partners all throughout South Austin and an amazing group of doctors. And Kevin, thank you so much for joining us today. Absolutely. Thanks for having me. I appreciate it. So, you know, as a urologist, we are really dependent upon the referrals from primary care doctors and their evaluation. And one of the most common questions that we get from patients is what should I look for when I’m looking for a primary care doctor? And for us, it’s all about the interaction that that doctor and the patient have that we see. And we see them in notes. We see them in how they’re cared for how their chronic diseases are taken care of. And so from your standpoint, I’d love for you to talk about what is kind of the goal of primary care medicine. And especially in this world where a lot of people do their own research and go to their own doctor, like, you know, why even have a primary care

Speaker 3: 

Doctor? Yeah, that’s a, it’s a great question. Um, I think the cornerstone of primary care is really the doctor patient relationship itself. You know, before you have a very specific need blood in your urine, a kidney stone and abnormal lung lab test , where we would send people to a urologist, you know, the global holistic view of that whole person, what are their health goals? What’s their life view? What do they want out of health? What scares them about sickness what’s happened to their family? What are things that we could prevent much earlier in the course so that instead of the big surgery or the worst outcome, they have something much more minor because they have a relationship that’s trusted where they share their symptoms. So relationship to me, finding a physician who’s, well-trained part of a group that can deliver care, where you have the results returned to you in a timely fashion, but really someone you’re comfortable sharing your story with I’m about one out of three people we see in the primary care setting , um, have either depression, anxiety, or sleep disorder. So a big piece of what we do is, is designed to think about that person holistically, not only their physical health, but also their mental health. And so I think the world has changed rapidly in the last year. So when you say relationship, I think the ability to use technology to leverage that relationship. So we have the ability to do telehealth visits. We have a patient portal where people can email and connect with us in real time, schedule their appointments online and get to us having a great doctor who listened to you. Doesn’t do you much good if you can’t get to them, if there’s too many barriers to care. So, so being accessible as kind of that first place into the system, when you do your own research, potentially you may end up going out into the healthcare marketplace and wasting a specialist’s time. And you thought you needed a neurologist, but you really needed an ear nose and throat, or you thought you needed a kidney specialist, but because you thought something was the kidney, but it’s really within the field of urology. So that, that drives up costs . It wastes the patient’s time. It wastes the specialist time. So that’s, that’s a big piece of what we’re geared to do.

Speaker 2: 

Great example you you’ve raised. I mean, I get probably twice a week, somebody referred to me because of a concern about kidney failure. And I hate to tell them like, I’m a surgeon, you know, unless you want your kidney cut on. And this idea of having a relationship with a physician is such an important concept because I think that unfortunately too many people self-diagnose , or they feel like the type of care they’re going to get from that doctor, isn’t going to be exactly what they envisioned. And unfortunately, I think that so many patients lose out on the idea of having, you know, a family practitioner or an internal medicine doctor really taking care of their global health, because I mean, as good of a doctor , as I think I am, I’m probably not going to deal with your other medical issues quite as well as a primary care doctor will.

Speaker 3: 

Yeah. And I mean, I think if you just think about what our story’s going to be, our health story, we may need you, but for, for a very specific episode, but the things we take care of, they’re the kinds of things that we manage. We don’t cure oftentimes, you know, your blood pressure. Well , if you manage that instead of a stroke at 68, you get to die of something else when you’re 102, because we did that. Well, if your blood sugar starts to rise, if we can work on your weight and your sleep and your mood and your exercise patterns, these are things that are really geared at being healthy. The other thing is there’s there’s screening tests that are recommended that save lives, mammograms, colon, cancer, screening, certain immunizations. These are things that we make sure and shepherd your health and help you keep up with along the way. So we’re sort of that person who’s kind of riding in the seat next to you for the whole story. And yeah, you may need your gallbladder out and we’re going to go get that person and they’re going to help us. And they’re going to be the best person in the city. That’s our duty to you. And then you may go a little bit longer and maybe your kidney function does worse than, and we need to get that specialist involvement and thoughtfulness about how we would help manage that. So those are the way to think about it as we were the primary relationship within the healthcare field. And that is designed to then walk you through all of the rest of your story. A lot of it, we treat many times we will rely on our specialist colleagues for very specific needs that, that they have specialty in that we would, we would utilize.

Speaker 2: 

And it may seem unfair, but like as a specialist, we really rely on you to be the quarterback of that patient’s care. So if I’m seeing somebody and I do a scan of them and they have a lung nodule or a thyroid nodule or a blood clot in their legs, like these are things that I don’t take care of. So I tell you, and so if you don’t have a, you , if you’re a patient out there and you don’t have a primary care doctor or a relationship that I can rely on, then a lot of things get lost in the crack .

Speaker 3: 

Yeah. I mean, that’s a piece of what’s going on in our healthcare system that I would like to think we’re beginning to be at the starting line of fixing. This is that’s exactly right. That kind of fragmented care are where results get lost. People aren’t followed up. You know, you may tell a scared patient, Hey, you have a nodule. You really, really need to go to this other doctor. And after they sit on that for a week and they’re not having any symptoms from it, they forget about it. And lo and behold, six or 12 months later, they’re presenting with a very bad problem where, you know, you send that result to their primary care doctor. We reach out to them . We have the ability to put them into a tickler system in our computer. If we haven’t seen them in three or four weeks. And we told them to come in and we’ll, we’ll get ahold of them again. We’re busy people. This is not always done out of denial. It’s not always done out of a lack of belief of needing to seek care. The world is incredibly frenetic and people can forget. And it’s our job to really shepherd their care when a situation like that.

Speaker 2: 

So in the Austin market, I hear oftentimes from patients that they’re concerned that if they’re a Medicare patient or a Medicare advantage patient, they’re not going to be able to find a doctor like a it’s funny to me because I take all patients of all insurances and people out there are really worried that people won’t take their insurance. Maybe you could talk about that and how premier kind addresses that issue. Yeah ,

Speaker 3: 

I think that’s one of the things I’m most proud of is really in the last three or four years, is our ability to really change our model for our senior patients. So number one, we’re wide open to Medicare. We’re wide open to Medicare advantage. We would love to see the senior community come into premier . We’ve developed a lot of expertise in this area. We have care management nurses, so certain people of a certain age and a certain functional status. They need more than a doctor. They need a nurse reaching out to them. That’s their primary nurse who may come visit them at their house. They may come visit them to their PCP appointment. They may help them with their medication costs so that it’s an extension of their PCP visits . So we have nursing care management , um , where we’re beginning to look at transportation services that we’re going to provide for our patients. And so we’re, we’re looking at other models of care that we can deliver more to the senior, but certainly from an access standpoint, if you’re a patient in Austin, Texas, and one of our locations is anywhere near close to you. Um, we would love to see you and keeping people out of the hospital and out of the emergency room is such a humongous benefit. And so people are trying to make an appointment with a primary care doctor or an internal medicine doctor. How do they get ahold of you? What’s your website and phone number? Yeah. So that’s a great question. Our website is www.pfpdocs.com. And our phone number is (512) 892-7076. And that’ll be on our Facebook page and on the transport and the site and how to be able to get ahold of us.

Speaker 1: 

Five one two, two, three eight [inaudible] and we’ll be right back

Speaker 3: 

The armor men’s health hour. We’ll be right back. If you have questions for dr. Mystery, email him at Armo men’s health ed gmail.com.

So You’ve Had a Radical Prostatectomy…Now What? Dr. Mistry Explains Treatment Options

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 cohost, Donna Lee.

Donna Lee: 

Hello, everybody. Happy day!

Dr. Mistry: 

Happy day, Donna Lee . Thank you guys so much for joining us here on our radio show on news radio KLBJ 590 AM 99 .7 FM.

Donna Lee: 

That’s right. The only AM and FM station available in Central Texas.

Dr. Mistry: 

Well, there you go. It’s the most popular talk radio show, talk radio station. And I’d like to say, you know, maybe the best talk radio show.

Donna Lee: 

I think so. And they’re the smartest for sure for having us on board.

Dr. Mistry: 

Well, there you go. I’m a board certified urologist. This is a men’s health show. The kinds of topics that we talk about range from urologic type issues, such as erectile dysfunction and low testosterone. But we also talk about issues that affect both men and women, such as kidney stones, kidney cancer. We talk a lot about kind of advanced medical treatments for cancer, and then specifically highlight the approach that our practice takes to urology, which is a more holistic whole body approach, where we try to maximize your health while treating your medical problems .

Speaker 1: 

That’s right. We also have speaking of women’s health, we’ve had a couple of women email us requesting more information about women’s wellness. So that’s when I referred to the dr. Donner show. That’s funny,

Speaker 2: 

You know, how I started in urology was a real focus on hormone health and wellness. And we did a lot of treatment of women for women’s sexual dysfunction. When we first started practice right over the years that women’s sexual dysfunction practice has been kind of taken over by a lot of the great OB-GYNs in town. And so now we just see like the really, really tough ones, the super hard, the severe pain, since, you know, since the very first time they had intercourse or the anorgasmia, or the very difficult to treat patients after breast cancer. And we’re happy to take care of these patients and really try to provide them amazing high level service when it comes to their sexual functioning. Uh , but we do treat a lot of men. Uh, fortunately for us, we think we do an excellent job and a lot of men who are out there trying to explore their health may go to physicians or practices that don’t really take care of men. They just kind of offer a service like, you know, if your car’s making a funny noise and you only go to a place that changes your oil, you’re probably gonna get your oil change, what they’re caused the noise or not. And so that’s where I think a lot of men, you know , ultimately find us as a practitioner and as a urologist , uh , I started a practice here in Austin in 2007 called NAU urology specialists . And that is who brings you this show? We have four physicians, five physician assistant and nurse practitioners. We have two physical therapists, a sex therapist. We do, we have a strong program here when it comes to the association between obstructive sleep apnea and your logic condition . So we also do an order home sleep test out of our office. And I really try to go to that extra mile to take care of you, including doing an integrative nutrition approach.

Speaker 3: 

Yup . We have lots of people on staff and a little funny story about our billing supervisor, Yolanda, her boyfriend forced her to go through our sleep program because apparently she said ,

Speaker 2: 

That’s funny. You know, when you’re single for a long time, they’ll be complaining, you know ? And then all of a sudden, all of a sudden, maybe , uh, maybe stick a C-PAP

Speaker 3: 

That’s right. He’s like no more sleepovers. Didn’t get slaked debts . And so she came right back to work the next day , looking for her sleep then,

Speaker 2: 

Well, there you go. So your questions really drive this show and seeing us patients in our clinic really keep us going, obviously from a business standpoint, that also helps. And so we’d love you to come see us as a patient. We are seeing patients in as safe as up manner as we can possibly do here in the COVID environment, by telemedicine in person in a socially distanced way, in an well cleaned office with fully max staff. And then you ask us questions by contacting us here . So Donna, if people want an appointment , uh , where our offices and how do people get on ,

Speaker 3: 

You can call us at (512) 238-0762 at during the week. Of course. And we’re in round rock, North Austin, South Austin in dripping Springs. But back to your point about a clean office, this is probably the safest place to be is probably a medical office because I was at the store the other day. And I went to put in my credit card and then I went to touch the little, the little buttons to do my security code. You just saw the mucusy fingerprint , right? And there was like that little piece of plastic. And I thought, how many people have touched this? And it hasn’t been cleaned. So yuck indeed. So you will come to a safe

Speaker 2: 

Wash your hands clear mass state .

Speaker 3: 

That’s right. Do you want a question? We got a bunch. Well , I’d love to hear a question. All right . This patient sent in after RP two and a half years ago for aggressive Gleason score of eight, having zero PSA labs until this week, PSA has shown up again. Not sure if I read that right, but physician believes it’s cancer all the way. Rechecking again, in a couple of months choices, given one, do nothing to radiation, three chemo pill, or four chemo castration. I’ve chosen to wait for the next lab test. Curious as to what other questions I might ask. Thanks .

Speaker 2: 

That’s a great question. So this is a question from a patient who had a radical prostatectomy. That means their prostate was removed after being diagnosed with a very aggressive prostate cancer. A Gleason’s eight now as a confusing thing for many patients, is that when they’re diagnosed with prostate cancer and undergo something as radical as removing the prostate, they kind of feel like they’re never going to have to worry about cancer. Again. When in fact a really aggressive cancer can have little bitty kind of tentacles of microscopic cancer. That’s extending out of the prostate into the surrounding tissue and even more frightening, a little microscopic satellites can actually break off the cancer and go travel to other parts of the body, the bones, the bones, the lungs, lymph nodes. And so those are things that you don’t see before surgery because they’re too small to show up on imaging. So the only way we track it later is by measuring your PSA. And in our practice, we do something called an ultra sensitive PSA measurement. So there are two things that are really important after a radical prostatectomy or after your prostate’s removed. When it comes to PSA is coming back to consider if the PSA never went down all the way, if it never went down to zero, then there was probably cancer there from the very first day, the prostate was removed. It’s probably somewhere else. And considering therapy really needs to be geared towards treating the whole body. But in this case, this listener had a PSA that was undetectable or PSA of zero for several months, or I don’t know how long, but then more recently started coming back. So it is why is this too look and see how many, how long in between PSA increases you can go. So we do something we calculate what’s called a PSA doubling time to see how fast it’s doubling. And that gives us an idea of how much cancer’s lying around the options given to this listener were to do radiation and that’s called Agilent salvage radiation. And it works really well up to 70% of people can get cured with a little bit of radiation where the process that used to be not a lot of side effects. So , and in the adjuvant setting, really people tolerate it very well with minimal side effects. Okay . And so what’s the difference though? I think psychologically is people are wondering what are they radiating? The prostate is gone, right? And so what we have tried to convince her, explain to people is that we’re really radiating where the prostate used to be, because that’s where we think the recurrence of those small cancers were. Now again, if the recurrence is very quick, like just a few months after the radical prostatectomy or the PSE never goes down, then we start thinking about castration therapy or which is therapy designed to take away people’s testosterone. And the pill probably should never be given or habit the pill for chemically castrating. Somebody should rarely be given by itself. Usually chemical castration has given by an injection and , uh , the pill and the injection, or sometimes use in combination, huh ? The one imaging test that we almost always try to get, if somebody’s PSA is coming back is a bone scan and a cat scan, but there’s another scam . And that’s a specific scan. That’s only indicated in this environment and that’s called an Ottoman pet scan. A pet scan is a special kind of CT scan that looks for metabolically active cancer. And the Axeman dye that we use is specific for prostate cancer. So depending on what your urologist things is appropriate, it is a paid for by insurance. It is paid for by Medicare. It’s a fairly quick and easy test to do, and it can find if there’s cancer outside of where the prostate used to be over the prostate bed and how that affects your treatment is that if it’s not just in the prostate bed, if it’s say it’s in your bones or your lymph nodes, then doing radiation to your prostate bed is not going to help you. You know, it’s not going to fix anything. So you don’t want to go through treatment that has no hope of working. So in our practice, we’ll wait for two consecutive PSA rises each separated by three months and then do an Axeman pet scan along with a bone scan and a cat scan. And if we don’t find any evidence of it anywhere else, because sometimes that pet scan can be negative, then we will do radiation to the prosthetic bed. Um, and , uh, and like I said, we have almost a 70% cure rate. So we’re very happy with that.

Speaker 3: 

Well, that’s awesome. Low side effect, issue and hive , um , cure

Speaker 2: 

That’s right. So I think that , uh, for this listener , uh, there’s certainly no reason to think that all hope is done or just because the cancer has come back potentially. Um, that, that means that that was a failure of decision making beforehand. I mean, this is why cancer scary because it does things that are unpredictable. Right? So thank you so much for that. Caller has done a , how do people get ahold of us ?

Speaker 3: 

You can call us during the week at (512) 238-0762. And this is a perfect example. I’m going to respond to this person’s question, let them know that we’ll send them the podcast as a link if they don’t catch the show. So if you send in your question at all, please let me know. If you don’t catch the show and you get a free pocket , then you know, they can listen to our podcasts everywhere. That’s right . You can sit at home and just tell Alexa, the Armour men’s health hour and we will magically appear in your home. Um, our website is [inaudible] dot com and again, send those questions to our mental at Gmail,

Speaker 1: 

The armor men’s health hour. We’ll be right back. If you have questions for dr. Mystery, email him at Armour men’s health, ed gmail.com.

Testosterone After Prostate Cancer: What Levels Are Safe, and What About Libido?

Speaker 1: 0:09
Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee .

Dr. Mistry: 0:16
Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my cohost Donna Lee .

Donna Lee: 0:21
Hello, everybody! Listen to our podcasts!

Dr. Mistry: 0:28
I am Dr. Mistry. This is my real name. This is a radio show brought to you by our friends here at KLBJ news radio. We really appreciate all their help. The show is sponsored by our urology practice, NAU Urology Specialists. We are the second biggest urology group in town, but the biggest in your heart.

Donna Lee: 0:43
That’s right. We are the most fun for sure. I mean, we’re still at that fun size, like those little candy bars.

Dr. Mistry: 0:49
Yes . That’s right. When you’re too big, that’s right–I can’t eat all this!

Donna Lee: 0:51
It’s too much to eat. It’s so much candy. I’m sure they love us. You know, I remember the story you told a couple of weeks ago about one of the guys at that group who noticed your show. I thought that was kind of cool.

Dr. Mistry: 1:02
No, it was, it was nice to get a little shout out from them.

Donna Lee: 1:05
But then it was me he said that made the show.

Dr. Mistry: 1:07
That’s right. Probably the recruiting letters coming from them already.

Donna Lee: 1:12
Yes, I got it yesterday.

Dr. Mistry: 1:15
I’m a board certified urologist. A urologist is a specialty-trained surgeon of the genitourinary tract. Most of us have both a mixture of clinical practice as well as surgical practice. That is the same for all of our doctors here. We have lots of availability. We are seeing tons of new patients and we have lots of practitioners here ready to take care of your urologic needs. What you’re going to get that’s different here is really a focus on the whole person. So a great example of that is going to be men’s fertility. If you have a male fertility concern out there, you may go and just get a semen analysis or just a set of labs to try to see what drug can be given to you or to assess what your fertility potential is going to be. Now, that seems boring to me.

Donna Lee: 2:08
Right? It doesn’t seem like very much.

Dr. Mistry: 2:09
Anyone can do that. No wonder people think that you can do medicine through a computer on the…you know what I’m saying? With the labs that you got on your own and at home sperm tests…

Donna Lee: 2:20
By Skype.

Dr. Mistry: 2:20
I mean, everything–there’s no, there’s no nuance. There is no really, you know, intelligent doctorly kind of information you’re getting from just a couple of labs and a semen analysis. What we do here is we first start with what are those factors that could be affecting your fertility? We look at genetic factors, hormonal factors, lifestyle factors, environmental factors, anatomical factors. You’re going to get your diet worked on . You’re going to get put on supplements. You’re going to get, we’re going to work hard so that you guys have a baby, because you know, that’s ultimately, that’s the difference. I’m not here to, you know, quote unquote “assess your fertility.” I’m here to help you have a child, and that’s gonna require going the extra mile, the extra step. And if, and that’s how we treat virtually all urologic conditions here. We’re not here to treat your kidney stone, we’re here to also help you stay stone free. Same with testosterone and feeling better and fatigue and weight loss, and prostate cancer and kidney cancer and all the different things that we take care of. We really look forward to going that extra mile for you.

Donna Lee: 3:30
You know, we had a patient called the other day and he was a fertility patient, and he sounded super relaxed and laid back. And he was like, “Yeah, I found out I don’t have any swimmers at all. Like none of my sperm are swimming around. And I’m, I’m told I have to see Dr. Mistry.” I said, “Well, you’ve come to the right place. Dr . Mistry is the best for sure.” And we were talking and talking. So I got all his information and I realized as I put in his date of birth, he’s 70 years old and his wife is 35.

Dr. Mistry: 3:56
That is, that is my favorite case, as you know.

Donna Lee: 3:59
I know. I was so excited to book him.

Dr. Mistry: 3:59
That’s right. That’s right. If I could, if I could always just treat men over the age of 65 who were looking to live like they were 35, it would be, I would be in heaven every day, because that is, that’s a motivated patient. He’s going to follow all the recommendations. He’s never going to miss a dose. He’s going to be there for his labs. He’s going to talk to me about his response, and he’s going to , he’s going to be on point.

Donna Lee: 4:22
Well, I don’t think that his 35 year old wife would have it any other way. So, she’s having a baby. Dang it.

Dr. Mistry: 4:30
Dang it. Well, your questions, your experience with us is what drives us. And so Donna Lee, how do people ask us questions and get ahold of us?

Donna Lee: 4:36
You call us during the week, if you want: (512) 238-0762. It is easier though, to send us an email that I can respond to with your questions that we can answer anonymously to armormenshealth@gmail.com. That’s armormenshealth@gmail.com. Dr. Mistry’s one of our patients or friends, rather, Carl, said that when he can’t listen to us on Saturday, when he misses the 3:00 PM show on KLBJ, he always catches it on Sunday at 4:00 PM. So we forget to tell people that we’re on twice.

Dr. Mistry: 5:03
That’s right .

Donna Lee: 5:04
So more fun for the weekend.

Dr. Mistry: 5:05
That’s right. And , you know, as people are driving around less and less for sports and things like that on the weekend , I feel like, you know , a lot of our listenership has changed to podcast, but then when things ramp up again, you know, I can’t wait to get that listenership listening in the car.

Donna Lee: 5:19
That’s right. You can get the free KLBJ app and listen anywhere. We listened, my husband and I listened in Vegas to our show on a weekend once.

Dr. Mistry: 5:25
That’s nice.

Donna Lee: 5:25
Yeah. I didn’t think it would work. And so anyway, get the app.

Dr. Mistry: 5:29
You were doubting technlogy?

Donna Lee: 5:29
I did, totally. I was like , “What is this amazing technology?”

Dr. Mistry: 5:32
Do we have a question?

Donna Lee: 5:33
We do. This patient sent in: “I had a prostate surgery about a year ago. My libido is poor. Would it be dangerous to start testosterone?” Now he’s in his sixties and he had cancer was fairly aggressive, but now he’s fine.

Dr. Mistry: 5:45
So this is a great question. And really what it’s getting at is, is it safe to use testosterone if you have prostate cancer, are at risk for prostate, or have already had prostate cancer and have had treatment? The short answer is that it’s not dangerous. The longer answer is that there’s ample evidence now to suggest that a normal testosterone level and feeling normal in your overall health is protective against cancer recurrence, better predicts whether you’re going to get through treatment better, and does not alter your prostate cancer risk whatsoever. But I think that somewhere, including my own educational mind, we convinced ourselves that testosterone and prostate cancer were linked. And I think it’s important that we explore how we got there. So years ago, scientists won even a Nobel prize when they discovered that if you had metastatic prostate cancer and you castrated these men and removed all their testosterone, or as much as you could, these men would have a slowdown in their prostate cancer. So it would, it would grow slower. It showed that cancer was responsive to testosterone, and if you took it away that the cancer slowed down–but it didn’t cure it. What it did was, it now it made the cancer something called androgen independent. It made it so it didn’t need testosterone. And that’s the bad boy on the block. Those guys grew faster. As soon as you develop androgen independent prostate cancer, you actually accelerate your death. So I have a number of patients that understand the biology of this. And so when we have to do something for metastatic prostate cancer, like take away their testosterone, we don’t take it away and then leave it away. We take it away and let them have some back, take it away and let them have some back. And what that does, it’s called intermittent androgen deprivation allows them to go longer and longer and longer having some of the good kind of metastatic cancer, not just the only the bad kind of metastatic cancer. And so that’s where people get the idea in their mind though. If taking away testosterone helps to stop prostate cancer, then giving testosterone must fuel it. And that is not what the data bears. The data shows that it doesn’t matter if your testosterone level is 200 or 700, it won’t grow any faster. It’s 50–50’s the cutoff. If your number’s over 50, then it will grow at the same rate. If it’s under 50, it’ll grow slower. Now you might say, “Well, listen, I don’t like cancer, doc. Just take all my testosterone away.” But this is, this is a cancer that very much lends itself to a balance between lifestyle and life years. You don’t want to feel like crap no longer how long you’re going to live. No libido, no erections, poor muscle mass, poor memory, bone demineralization. I mean, it’s not great to live with no testosterone. And so in most cases, prostate cancer is not going to be a lethal disease. You know, very few people die from prostate cancer relative to those that get it. You’ve already had it treated, now you say you have no libido, this, this caller. Usually it’s just a , it’s just a terminology issue. When we say no libido, we use libido to mean sex drive–your desire to have sex. But a lot of men use libido as their ability to get an erection.

Donna Lee: 8:57
Oh, that’s right.

Dr. Mistry: 8:57
So, but those go hand in hand. If you don’t want to have sex, that erection ain’t going to do you no good. And if you’re in your sixties, it’s rare that you’re going to just get spontaneous erections like when you were 15, when you were thinking about sex or not, but of course were 15 years thinking about sex all the time anyway.

Donna Lee: 9:11
Well, what if you’re that 70 year old guy with a 35 year old wife?

Dr. Mistry: 9:14
That’s right. You know what I’m saying? So if you have a high libido and aren’t getting erections after your prostate was removed, then that could be nerve damage related and you could need more aggressive treatment. Testosterone may not be enough. But if your sex drive really is low and your desire to pursue advanced treatments for your erectile dysfunction are low, then taking testosterone may help you in the libido department as well as others. But the last and final point I’ll make on this is that sometimes, if you don’t get an erection, your libido can be low as a result of that. Just like I tell people I don’t play golf because I play golf terribly, and I have no desire to play golf .

Donna Lee: 9:46
Why put yourself through it?

Dr. Mistry: 9:47
Why do I put myself through a disappointing experience like golf ? So that’s another consideration. And so then we work on those patients from the erection standpoint. We can use injections, inflatable penile prosthesis, vacuum erection device, all sorts of things to give you an erection and then see where your libido goes after that.

Donna Lee: 10:03
Good answer.

Dr. Mistry: 10:04
It was a great question.

Donna Lee: 10:05
It was a great question. You know what raises the woman’s libido naturally?

Dr. Mistry: 10:08
Doing the laundry.

Donna Lee: 10:09
The laundry and the dishes. That’s a little hint for you guys out there.

Dr. Mistry: 10:13
Dish soap–the world’s greatest aphrodisiac.

Donna Lee: 10:15
No, no charge for that little hint, y’all–Michael. Anyway, you can call us at (512) 238-0762. Our email address is armormenshealth@gmail.com. Be sure to send us your question and we’ll get them answered right away. Back later!

: 10:29
The Armor Men’s Health Hour is brought to you by NAU Urology Specialists. For questions, or to schedule an appointment, please call (512) 238-0762 or online at armormenshealth.com.

More Donna Lee: Co-Host Donna Lee On the Benefits of Testosterone Therapy for Both Men and Women

Speaker 1: 0:09
Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 0:16
Welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, you host, here with my cohost Donna Lee .

Donna Lee: 0:20
I think we should be syndicated.

Dr. Mistry: 0:22
I think we should be syndicated.

Donna Lee: 0:23
How do we make that happen? If you’re a listener out there, or an agent…

Dr. Mistry: 0:26

Donna Lee: 0:28
…call Dr. Mistry.

Dr. Mistry: 0:28
You know what a common criticism I hear about this show?

Donna Lee: 0:31
That I don’t talk enough?

Dr. Mistry: 0:32
That’s right.

Donna Lee: 0:32
Because you talk too much. I don’t like to interrupt you. You’re so engaging and amazing that your words stream together like fluid, liquid gold.

Dr. Mistry: 0:43
Nobody here is going to question why you still work for me. That’s that’s the nice, kiss-assing.

Donna Lee: 0:48
That’s right. I kiss your ass hard.

Dr. Mistry: 0:49
That’s right.

Donna Lee: 0:51
Cause I don’t like to get fired.

Dr. Mistry: 0:52
Well, there we go. So, you know what I thought we would do here?

Donna Lee: 0:55
A question/answer session?

Dr. Mistry: 0:55
Really, I want you to ask me questions that you think are interesting about what’s going on here in the clinic. And I’d love to hear some feedback that you’ve had from patients about some of the different treatments we’ve had, that we can just like put it all together in one show.

Donna Lee: 1:10
Okay. Well that sounds fascinating.

Dr. Mistry: 1:12
So I didn’t give you any prep time.

Donna Lee: 1:14
You did not.

Dr. Mistry: 1:14
You start. Go ahead.

Donna Lee: 1:15
Thanks. On that note, my husband’s always asking questions.

Dr. Mistry: 1:20
Let’s see.

Donna Lee: 1:20
Cause he’s got all those cardiovascular issues and you know his history since y’all are so close. I would like to announce though that I came home one day and I told my husband that you made me cry at work and his response was , “Well, what did you do, Donna?”

Dr. Mistry: 1:36
That’s right. And so for a lot of men out there, they’re confused because that sounds really like a reasonable thing to ask. But now that I’ve becoming more of a well -aware person, I now realize it should have been, “What did he do?”

Donna Lee: 1:51
Yeah. That’s what I thought he was going to say. You know, he takes your side and I don’t understand. Anyway, his questions are always, as are his friends, cause they’re all in the same age group in their early to mid fifties is, how healthy is it to be on testosterone if you’ve got cardiovascular issues? So he had a quadruple bypass. He’s got a lot of friends in his position. A lot of them are overweight. They’re not healthy, they’re smoking, they’re drinking. So I think he’s scared as they are about taking testosterone, because I think it’s like, you know, they’re worried some sort of weird cardiovascular boost that they’re going to get that’s gonna give them a heart attack.

Dr. Mistry: 2:22
Totally. And I think that, that’s a great question, so.

Donna Lee: 2:24
Thank you.

Dr. Mistry: 2:24
There is some controversy because of some studies that came out several years ago that suggested that testosterone use might be dangerous for some men and make their cardiovascular disease worse. I can tell you that not only have those studies and the methods behind them been not supported, but for decades, we have known one thing for sure, without a doubt: having a low testosterone puts you at higher risk for death from cardiovascular disease. We know that.

Donna Lee: 2:56
OK. Well, there you go.

Dr. Mistry: 2:56
We know that. We know, that is settled science. If you are walking around with a testosterone level of 185 or 210, and you go long enough, you are going to have a higher risk of heart attack and stroke than your neighbor who has walking around with a testosterone of 500. So…

Donna Lee: 3:11
What’s a normal range of testosterone?

Dr. Mistry: 3:14
350 to 1000 is what we use. The numbers from your insurance company, your lab may not be completely in line with those. And I think a lot of men, they don’t do testosterone therapy because they’re scared that their insurance won’t pay for it or somebody told them it wouldn’t.

Donna Lee: 3:27
Or it’s expensive.

Dr. Mistry: 3:27
Or it’s expensive. I mean, it’s super cheap.

Donna Lee: 3:29
It’s really cheap.

Dr. Mistry: 3:29
It’s super cheap. Like of all the things that we do to people, it’s super cheap.

Donna Lee: 3:33
When I came over here three years ago and found out the pricing, I was like, “Are we charging enough? Cause it doesn’t seem like it.”

Dr. Mistry: 3:39
Yeah. I mean, if such as somebody out there, whenever somebody tells me that, “Man, Dr. Mistry, whatever you recommend , it was a lot cheaper than what I thought it was going to be,” that makes me so happy, because you know, I want people to know that that good healthcare is completely accessible. And if you just kind of disassociate yourself a little bit from what you kind of think you’re entitled to get paid for with your insurance, then you get to be the boss of your own treatment. And you know, so many guys buy testosterone, like from some back alley gym or ordered online or, you know, pick some extra up when they’re across the border. And I’m like, “It’s super cheap here. Just let’s just buy it here! Why are you going through such craziness?”

Donna Lee: 4:17
Oh gosh, I had an angry patient once at my previous clinic. He was yelling and screaming, and the staff brought me in as a manager, and I had to deal with him. And he was yelling and screaming, and then we looked at his testosterone level and it was 3000. And I was like, “Oh.” And he like owned a gym. He was very upset.

Dr. Mistry: 4:32
I’m glad you brought that up because that’s a common myth, in fact–that being overly testosterone may cause you to have a bad attitude. Let me tell you something. That guy was probably a real jackass to start with.

Donna Lee: 4:44
He was.

Dr. Mistry: 4:44
He didn’t need any help from the testosterone.

Donna Lee: 4:45
He was amazing. He physically got in my face as if we were about to go throw down on the parking lot.

Dr. Mistry: 4:51
After more than a decade of treating patients, and because we do it in a controlled way , I would say that incidences of road rage, ‘roid rage, or incidences of greatly altered personality are extremely rare and uncommon. And people often will say, “Well, what am I going to turn into once my testosterone’s normalize ?” And I say, “Well, were you kind of a d**k before? Because if you were, then you might turn back into that guy.” But it’s not going to take an otherwise mild-mannered, regular person and turn them into the incredible Hulk.

Donna Lee: 5:22
Hulk Hogan.

Dr. Mistry: 5:23
Which would be awesome.

Donna Lee: 5:24
That would be kind of cool, if you turned green.

Dr. Mistry: 5:26
It would be awesome.

Donna Lee: 5:26
It would be cool. Well, I can tell you, I take testosterone through our clinic. I see Leonora Brown, one of our providers and I feel amazing all the time. And when I get that shot every two weeks on a Friday, did I tell you? I have the most amazing boss dream ever. Like I’m the boss of the world.

Dr. Mistry: 5:43

Donna Lee: 5:43
Every two weeks I have the best dream. The staff thinks it’s hysterical.

Dr. Mistry: 5:46
Well, I , you know, that’s great because a lot of , if you are listening with your wife or, you know , my incredible cadre of women listeners are tuning in.

Donna Lee: 5:54
All two of them.

Dr. Mistry: 5:56
Yeah, all two of them. Both of you. Testosterone replacement therapy is something that is possible in women. We usually do that in conjunction with estrogen replacement therapy, but not always. So for some reason, you’re just not comfortable taking estrogen , or you’re not a candidate for it. We have a lot of young patients with low libido who do get better libido with testosterone replacement. Topical creams are probably the most common way that we give testosterone, or pellets in women, but occasionally , like yourself injections , because they’re so inexpensive, tend to be the one. The volume is real low that we have to give. So , sometimes it’s hard to drop such a low volume, but we definitely have ways of replacing testosterone. It does help maintain muscle mass. It does have a role in bone health and libido and mood, you know…

Donna Lee: 6:48
Yeah. I’m still looking for my libido, but I feel amazing.

Dr. Mistry: 6:50
That’s right. We’re still looking for it . It’s like a scavenger hunt around here.

Donna Lee: 6:54
I heard dr. Wang on our show, not too long ago, talking about hot flashes and the menopause episode that I thought was super fascinating, because that’s my age group. She said, “That’s What She Said,” that’s the segment that is called, “That’s What She Said.” Women have hot flashes in this age group because their estrogen has dropped. So I went to Leonora, our provider here that I see. And she put me on estrogen and guess what? My hot flashes are gone. That’s like magic. It’s amazing.

Dr. Mistry: 7:20
That’s nice.

Donna Lee: 7:20
I’m the best testimonial you’re going to have all day.

Dr. Mistry: 7:22
I guess. And you know, women are also going to notice an improvement in their skin and hair texture and really a return back to feeling better. And so the same thing happens in men. In women it’s called menopause, and in men we call it andropause. And that is a part of the natural decline in testosterone. So either you’re going to be a guy out there that says, “Well, this is natural and this is supposed to happen to me.” Or you’re going to say, “Well, this is happening to me. And I want to do something about it.”

Donna Lee: 7:48
I have a question. I wanted , well, my husband actually had another question. He wanted to know if there’s something similar to women when they’re on their monthly angry cycle…Is there something that men go through? Cause he feels like he has a monthly issue where he’s just angry.

Dr. Mistry: 8:01
The answer, the answer is probably not. But if he’s like me, it’s probably payroll for his employees.

Donna Lee: 8:07
That’s every two weeks though!

Dr. Mistry: 8:07
And maybe, and maybe his wife is going through her time and I’m just having my little response to it.

Donna Lee: 8:11
Maybe my boss made me cry and then I went home angry and it made my husband angry. But then he took your side.

Dr. Mistry: 8:17
Yes. Because I was probably right.

Donna Lee: 8:19
It’s true. I have to admit it. You’re more rational. I get it. Okay. Anyway, what else do we have to talk about today? We have the shockwave therapy that you wanted to talk about it.

Dr. Mistry: 8:27
Well, I think it’s great. You know, you get to be on the frontline with a lot of our patients. I’d love to hear what feedback you’re getting on patients that undergo shockwave therapy for erectile dysfunction.

Donna Lee: 8:38
Goodness, I knew we’d have positive feedback, but I didn’t know it’d be this good. We’ve had patients, several patients, many patients, but by the fifth cycle, they get six treatments. By the fifth treatment, the reactions are incredible. One guy said he has to, he stopped taking Viagra altogether by his fifth treatment of shockwave therapy. Another patient who’s gone through chemotherapy and radiation who thought he would never ever have an erection again, he started getting natural organic erections after the fifth treatment.

Dr. Mistry: 9:03
” Organic erections.”

Donna Lee: 9:05
Was that good? Did that sound holistic.

Dr. Mistry: 9:07
That’s pretty good. That’s what we want you to have–an organic erection.

Donna Lee: 9:09
No, that’s incredible. We have more, but we don’t , I don’t have time to go into all the details. But I was super impressed with that. We had one guy who on his first treatment said he didn’t have to use Viagra when he went home to have relations with his wife. Now our provider said some of that might’ve been psychological, but hey, I’ll take it! Right? It was his first treatment.

Dr. Mistry: 9:28
That’s right. That’s right. You know, we’re big believers in the placebo effect around here. And if you’re interested in getting a more thorough evaluation for your erectile dysfunction, or if you have an enlarged prostate, or you have prostate cancer and want a second opinion–we’re big fans of second opinion. That’s what we do. It’s different than what you’re going to get elsewhere. And that’s something that we would like to push.

Donna Lee: 9:50
Right? And we welcome all your questions and your comments to armormenshealth@gmail.com. Thanks for letting me talk .

Dr. Mistry: 9:57
Oh yes . Please let us know if you’d liked more Donna.

Donna Lee: 9:59
I like more Donna. I’m unhinged! We’ll be right back.

Speaker 1: 10:03
The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.

Female Sexual Dysfunction: Dr. Mistry Explains How “Votiva” Can Improve Vaginal Health and Sexual Function

Speaker 1: 0:09
Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee .

Dr. Mistry: 0:16
Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry,, your host, here with our cohost Donna Lee.

Donna Lee: 0:21
That’s right. Award-winning radio co-host, I am.

Dr. Mistry: 0:24
You are , you are an award winning person . My awards must’ve stopped in high school

Donna Lee: 0:29
We do have the Yum Yum and Ding-a-lings award right in front of us.

Dr. Mistry: 0:32
That’s right. I really appreciate you bringing in all the awards from junior high. Your junior high band award has been repurposed.

Donna Lee: 0:38
You know, I got a label maker and some junior high awards, and when you put those two together, they make current awards.

Dr. Mistry: 0:47
I’m a board certified urologist. This is a men’s health show. We are happily brought to you here on…

Both: 0:53
News radio, KLBJ.

Dr. Mistry: 0:55
590 AM. We have wonderful producers here that help us get the show together. And you can hear our show in podcast form, or just sort of another recording of it, wherever you get your podcasts: A-R-M-O-R.

Donna Lee: 1:10
We need to give Sam a shout out. He’s our new KLBJ guy.

Dr. Mistry: 1:13
That’s right. That’s right. He’s our new producer.

Donna Lee: 1:14
Thank you, Sam.

Dr. Mistry: 1:14
And really, really appreciate all of his help putting this together. I’m a urologist. This is a men’s health show in which we discuss a wide variety of topics dealing with men’s health. This can deal with just straight up urologic health, like kidney stones and bladder cancer and overactive bladder and BPH and prostate cancer. Low testosterone and erectile dysfunction, and Peyronie’s disease makes up a big part of what we talk about on the radio, because a lot of men are just kind of embarrassed to talk about it with their doctor.

Donna Lee: 1:42
They won’t even say some of the words when they call us at the clinic. Like I had one guy who would not say “penis” or “vasectomy,” but he was trying to schedule the vasectomy. It was very difficult.

Dr. Mistry: 1:51
Why would he need to say the word “penis”? [inaudible]

Donna Lee: 1:54
He was trying to say it. Like, I didn’t need for him to say the word “penis.”

Dr. Mistry: 1:57
Everybody comes from a different place in their life in terms of their ability…

Donna Lee: 2:01
Well, he was funny.

Dr. Mistry: 2:01
I mean, I became a urologist…

Donna Lee: 2:02
So you could say the word “penis” a lot?

Dr. Mistry: 2:04
That’s right. You know. It’s just…

Donna Lee: 2:07
You can say “vasectomy” though. I mean, if you call us that’s okay .

Dr. Mistry: 2:10
Yes. I can also say “epididymis” and a lot of people can’t say that word.

Donna Lee: 2:13
I can’t say “epididymis.”

Dr. Mistry: 2:15
That’s a hard word. Even harder to spell. There’s a ‘y’ in there.

Donna Lee: 2:18
It’s like “porte cochere.”

Dr. Mistry: 2:22
“Porte cochere.” Anyway, this show is brought to you by our practice, NAU Urology Specialists. We’ve been in practice since 2007. We’ve been happily treating patients in what I would like to think is an ever evolving, more holistic, more comprehensive way. To accomplish that, we have lots of different types of providers in the office, including therapists that handle your pelvic floor and biomechanics therapists that handle your mind, specifically sex therapy. Then we have a nutritionist, an integrative medicine specialist. We have multiple PAs that are ready and willing and able to see you right away, as well as four physicians, all of which have unique personalities, unique interests–we make an amazing team.

Donna Lee: 3:04
We do. We should really briefly explain what a PA is for the people who are, or don’t know what a physician assistant is because the word “assistant” throws people off.

Dr. Mistry: 3:11
That’s right. In the world of medicine because physicians take such a long time to train, and because the needs of the population are growing so quickly, one of the ways that the medical community has tried to take care of patients is to have people who have been specially trained perhaps in a certain area, or maybe have not gone through surgical training, really to get more people to help take care of you out there. Now in our practice, becoming a physician assistant is a grueling process, mainly because you have to spend so much time with me.

Donna Lee: 3:39
Taking care of you, feeding you, and caressing you.

Dr. Mistry: 3:43
The care and feeding of Dr. Mistry is a full time job.

Donna Lee: 3:46
Poor Heather.

Dr. Mistry: 3:46
And for most of the PA’s that go through it, they’re happy to be done with it, but they end up being extraordinarily competent practitioners. We recently celebrated the 10th anniversary of what my very first clinical nurse specialist named Leonora Brown. And literally when you get treated by her, it’s almost identical to get treating by me.

Donna Lee: 4:06
It’s a female you.

Dr. Mistry: 4:06
Except her fingers, her fingers are smaller.

Donna Lee: 4:08
It’s a female you with smaller hands.

Dr. Mistry: 4:10
It always hurts my feelings a little bit when the patient would prefer to be seen by her. It does happen.

Donna Lee: 4:15
And it’s a win win for the patient.

Dr. Mistry: 4:18
We are seeing patients. We are seeing patients by telemedicine and in person. And if you would like to see us, Donna Lee, tell people how to get ahold of us.

Donna Lee: 4:24
You can call us at (512) 238-0762 . During the week. You can also send us your amazing questions that fuel our fire to armormenshealth@gmail.com. You can visit our website that directs you to our other main website, armormenshealth.com. You can also respond that you want a t-shirt so I can give some away.

Dr. Mistry: 4:42
Yes, please. They’re taking up a lot of space.

Donna Lee: 4:43
I have a giant box of t-shirts in my office.

Dr. Mistry: 4:45
That’s right, “Nuts For Urology.”

Donna Lee: 4:46
We are nuts for urology on Fridays. That’s what our t-shirts says.

Dr. Mistry: 4:50
Well, Donna Lee, what have you seen around the office that you’d like to learn more about?

Donna Lee: 4:52
You know, we don’t talk enough about some of the female things because we have this amazing men’s wellness show. So I saw a patient the other day who had questions about the “Votiva” equipment that we have. And I know we can’t, we’re not supposed to use the words “vaginal rejuvenation,” but that’s kind of what it is. So for women who…

Dr. Mistry: 5:09
When they tell you not to use the words, you’re not supposed to use the words.

Donna Lee: 5:10
I know, but I thought nobody’s listening but our KLBJ friends, and they won’t tell the FDA or anything. But we have this amazing treatment that helps women after they have babies. If they jump up and down or they laugh or they sneeze, and they tinkle a little bit, so we have this amazing thing to help that.

Dr. Mistry: 5:28
Okay. So very early in our practice, we introduced kind of a more comprehensive approach to a condition called female sexual dysfunction. And this is a variety of causes, but really ultimately the same effect, which is that there are many things that can cause women to not enjoy or to seek out sexual relations . And I think this directly affects men, right? Because that’s, you know , one of our primary objectives after we get up in the morning. So if I could help women overcome a lot of the issues that prevent them from enjoying intercourse , then that I felt like I’d been a service to both members of the couple. Okay . So with women, there is no one thing that causes less interest in sex than pain. When we’re examining a woman for sexual dysfunction, we try to categorize the issues that she’s having into one of four categories. The first one is interest, the second one is arousal, the third one is orgasm, and the fourth one is paid–pain, excuse me.

Donna Lee: 6:30
Are we being paid?

Dr. Mistry: 6:30
No, no I’m not getting paid. Just pain.

Donna Lee: 6:34
You might want to get paid.

Dr. Mistry: 6:35
And the strongest , the strongest…new Louis Vuitton bag. There’s the pain aspect of sexual dysfunction is the strongest because , as much as you might be able to force yourself, even if you have low interests , the more , even though you can use a lubricant, if you have poor arousal, and even though you might, you know, fake it to make it on the orgasm at some point…

Donna Lee: 6:59
Pain throws it all off.

Dr. Mistry: 7:00
The pain, the pain makes it both not only severely unenjoyable for the woman, but also unenjoyable for the man. You know, most loving, caring partners have no interest in causing pain. And so by looking at vaginal lubrication, vaginal lubrication is a common problem that affects women as they age, as they go through menopause. It can also affect young women. Oral contraceptive use and different kinds of hormone use will affect lubrication. And it might seem on its surface that that seems like an easy one–just go by a tube of KY and get to town, but that’s not all that lubrication and vaginal moisturization does. There can be discomfort throughout the day. There can be an increased incidence of urinary tract infections. There can be problems with sexual enjoyment in terms of ability to achieve an orgasm because you’re not sexually aroused. And for all those reasons, finding ways to help improve the health of the vagina is an important component of what we do when it comes to sexual dysfunction. The most obvious and sometimes the most tragic patients are those that have undergone chemotherapy or hormone treatment after a breast cancer diagnosis. So although survivorship after breast cancer has a lot to do with the cosmetic appearance of the reconstruction, kind of the empowerment of getting through the disease process, the one that people don’t talk a lot about is just kind of the personal challenges that women go through to try to reconnect intimately with their partner. And , the dryness and the pain that many of these women experience is substantial, and you can’t give them estrogen because a lot of them are reticent to take estrogen, even though estrogen vaginally is very safe, even in this patient population and certainly in just the run of the mill menopausal population. So the use of the Votiva, which is a radio frequency device which we do here in the office. It’s done over a series of three treatments, each one taking about 30 minutes. Is designed to cause microtrauma to the tissues of the vagina that leads to a regenerative response–thickening, and then a reestablishment of a thicker vaginal layer that then gets aroused, produces moisture and lubrication, and also helps it so that when that tissue gets thicker, it helps with stress incontinence, which you so delicately put as “tinkle when you jump.”

Donna Lee: 9:38
Tinkling–nobody likes to tinkle when they jump or laugh.

Dr. Mistry: 9:41
Well, I think that this type, this topic still applies to the men’s health topic because, you know…I mean, all the erectile dysfunction repair in the world’s not going to help if you’ve got nothing to use them on.

Donna Lee: 9:52
That’s true. While there are those toys and devices that we promote as well.

Dr. Mistry: 9:56
That’s right. That’s right. Donna Lee, tell people how to make an appointment with us and get a hold of us.

Donna Lee: 10:00
Call us during the week at 512 -238-0762 . You can send us your questions to armormenshealth@gmail.com. Check out our podcasts . They’re amazing, they’re brilliant, they’re magical, and they’re free . Thanks!

: 10:14
Dr. Mistry wants to hear from you! Email questions to armour men’s health ed g-mail dot com. We’ll be right back with the Armour men’s health hour.

Prostate Inflammation: Causes, Treatments, and Why Ejaculation Is Your Prostate’s Best Friend

Speaker 1: 0:08
Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 0:16
Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host here with my cohost, Donna Lee.

Donna Lee: 0:22
Hello, everybody. Happy day.

Dr. Mistry: 0:23
Happy day. This is a men’s health show. I’m a board certified urologist. And our program here is brought to you by our urology practice: NAU Urology Specialists.

Donna Lee: 0:34
What did NAU stand for?

Dr. Mistry: 0:36
It used to stand for North Austin Urology, but then we became worldwide.

Donna Lee: 0:39
We become came South and Dripping Springs Urology.

Dr. Mistry: 0:42
And then what happened ? One of my marketing people said that we couldn’t use lose the website, and now we’re probably going to lose the website because now it just doesn’t makes any sense.

Donna Lee: 0:49
It doesn’t make any sense. We’re too many names.

Dr. Mistry: 0:52
You know, it’s appropriate for this world nowadays, because the world doesn’t make any sense, so…

Donna Lee: 0:57
We can be “Urology Specialists 2020: We Don’t Make Sense.”

Dr. Mistry: 1:01
You know, sometimes you see these companies with weird names and you’re like, “I wonder how it finally ended up with that name?” And now I know. It’s because some sentimental boof out there wanted to keep a little piece of his old life. Now the name doesn’t make any sense.

Donna Lee: 1:13
That’s right. Because when people see “NAU” they go “NOW?” They try to say it out loud.

Dr. Mistry: 1:19
Well , what’s great about that is that it really speaks to one of the most important things that we try to accomplish in our practice, which is to see you now!

Donna Lee: 1:26
That was a stretch, but okay. To see you NAU–Now!

Dr. Mistry: 1:30
For years, our practice has been defined by what I learned early on were the three A’s of a successful specialty practice: the three A’s are availability, affability, and ability.

Donna Lee: 1:41
You should throw in affordability because it’s pretty affordable.

Dr. Mistry: 1:44
Okay. The four A’s

Donna Lee: 1:46
Sorry, I just messed with your whole mentality on our 3A’s.

Dr. Mistry: 1:51
It’s a concierge level practice. We’d like to see you in our office. We are seeing new patients. We are seeing them by telehealth. We’re seeing them in person. And we would highly encourage you to remember that putting off your health isn’t safe.

Donna Lee: 2:04
Does not benefit you at all.

Dr. Mistry: 2:06
It’s not safe.

Donna Lee: 2:07
Don’t let Covid win.

Dr. Mistry: 2:08
That’s right. Don’t let Covid, don’t let the terrorists win. Very good. Donna Lee, why don’t you tell people where our offices are and how do people make an appointment?

Donna Lee: 2:15
That’s right. You can call us during the week at (512) 238-0762. I feel like I sound sexy because my voice is raspy. Is that, is that correct?

Dr. Mistry: 2:24
It is true.

Donna Lee: 2:25
It’s the allergies, but also known as sexy. We’re located in Round Rock, North Austin, South Austin, and Dripping Springs, Texas. We have availability throughout the week, so call us when you can. We’re happy to help. You can send your questions to our email address, armormenshealth@gmail.com, and our website is armormenshealth.com. We have all sorts of facilities available: sex therapy, we have a sleep coordinator, we have two pelvic floor physical therapists . Now we added on a new provider, Heather.

Dr. Mistry: 2:54
That’s right. And in order to achieve that goal of seeing you where you are and when you want, we have four physicians, we have five physician assistant and mid level providers. It’s really important for us to treat you from head to toe, so we also have an integrative and functional medicine PA who works with us. She’s amazing. She really helps us kind of round the corners on what I think is a feature of medicine that is largely missed, which is this idea that the whole body’s connected and that when you come into a urologist for one problem forgetting or ignoring the other problems is a bad idea. And oftentimes we’ll help you fix your, urologic condition in ways that you may not even know. This week we had, for example, a man who had both erectile dysfunction and a slow intermittent urine stream. Both of those issues got fixed with pelvic floor physical therapy. We’ve had men with frequent urination at night along with low testosterone get fixed by, you know, repairing their sleep apnea. All of these things kind of are connected to one another, and for you to come to us with your men’s health problems or your, urologic problems if you’re a woman and let us help you take care of them as something that is a great joy to us and a great motivation.

Donna Lee: 4:00
That’s right? And I guess it is not true when I say that erectile dysfunction can usually be fixed with a hot new girlfriend. So I assume that there’s more to it than that.

Dr. Mistry: 4:08
Especially when you won’t let your husband get his hot new girlfriend. I mean, if you say it, if you say it there’s like an implicit, you know…

Donna Lee: 4:18
That I should allow it?

Dr. Mistry: 4:18
That’s correct. That sucks for you.

Donna Lee: 4:21
Sorry, Michael.

Dr. Mistry: 4:22
Your questions are what drives and motivates this show. And so we’ll tell you how to send questions, but it means a lot to us that people would take the time and be engaged enough to send us questions. There’s a lot of topics that we’ve covered in previous episodes, but it’s okay. Ask the question. If you want to catch a previous episode, you can catch it on our podcast, wherever you’re getting your podcasts.

Donna Lee: 4:42
Our award-winning free podcasts.

Dr. Mistry: 4:44
Maybe we should charge for that, Mrs. Affordable.

Donna Lee: 4:47
Something. You charged for something around here. We do have an incredibly detailed question. You ready?

Dr. Mistry: 4:51
Yes. Go ahead.

Donna Lee: 4:52
This gentleman starts off with a compliment, so of course I had to ask his question first. “Love your radio show and sense of humor!!” With two exclamation marks. “I am 63. I had a prostate biopsy due to enlargement on one side, PSA of 2.27, no malignancy in any of the six samples, but with one sample, each showing prostatic duct calcification or chronic inflammation characterized by infiltrates of lymphocytes. PSA last week was 2.29. Does calcification inflammation tend to increase risks or mask future possible cancer growth? What is the best manner to gauge changes over the coming years with annual checkups? And does prostate exercise help improve any of these situations?”

Dr. Mistry: 5:29
That’s a great question. So first we’re going to just talk about what your PSA was and why the indication for the biopsy. So if there was an asymmetry in the prostate, meaning one lobe was bigger than the neck, then your doctor may have been concerned that difference in size was due to some underlying cancer. Now, believe it or not, it’s not just the big side that could be at risk for cancer. The small side could also be at risk. So the asymmetry could have been caused by atrophy or a shrinking of the prostate due to cancer. And I think that it was perfectly reasonable to proceed with the biopsy. Now you have these results. You’re relieved that you don’t have cancer, which is what the purpose of the biopsy was in the first place. But now you have all these words on this very complex report and not know what to do about it. Calcifications, which is a hardening of the structures of the ducts of the prostate, just like the hardening of the arteries or other areas where calcification occurs, is an inflammatory response. It doesn’t mean that a stone developed there, even though that may seem like what it means. What they mean is microscopically, when they look at these cells, there’s been changes that has increased calcium deposits along the ductal walls. We would consider the most common reason for this is inflammation. Now that inflammation can be from a prior infection. It can be from an injury. It can be from blockage. There can be many reasons that inflammation occurs. And in this case, there was another indication of inflammation, and that’s the ingress of inflammatory cells . So one of the ways that our body takes care of a foreign organism is it sends in these, you know, our army of immune cells. Each of our immune cells has a different kind of process, a procedure to get rid of a foreign body. Some use very caustic chemicals, some make antibodies , some engulf the foreign body and eat it. And so, and each of these little players has a specific role in the inflammatory cascade. But you can tell whether an inflammatory process is acute, which means, you know, just now or right away, or chronic or more long lasting based upon what cells are coming. So neutrophils that come in are usually more acute, lymphocytes are usually more chronic. And so then when, then we look at what are some common causes of chronic prostatitis? I’m sorry to say, we don’t know a lot of those, a lot of those reasons. But a previous infection of the prostate or blockage or enlargement–these are all things that can lead to a chronic inflammatory process. And I guess for this listener, the first thing is, “Do I need to worry about it? Is that something that I need to worry about?” And fortunately there should not be any increased risk of cancer development just because of this inflammatory process. If you were treated in a practice like ours, we would put you on an antiinflammatory kind of regimen, which includes some mild dietary changes. Usually the addition of foods, not necessarily the subtractions of foods. We routinely put people on a curcumin supplement. We routinely put people on a supplement with Saw Palmetto, and really it comes down to whether you’re having any pain. If you’re not having any symptoms, then that chronic prostate inflammatory process may not result in anything. And you would deal with it in our practice, for example, if the lifestyle and dietary management, but you know, Donna, the last part of this was my favorite part?

Donna Lee: 8:33
Which part?

Dr. Mistry: 8:34
The prostate exercise.

Donna Lee: 8:35
Oh, I thought that might make you peak your interest.

Dr. Mistry: 8:40
You know how a man exercises prostate don’t ya?

Donna Lee: 8:44
With his finger?

Dr. Mistry: 8:44
No! Finger? You have a son for heaven’s sake . Don’t you know what he’s doing in there? It’s ejaculating. Ejaculating helps exercise the prostate. And there have been innumerable studies that have shown that increased sexual activities and the number of ejaculates can reduce the number of the risk for the development of cancer. So when you were a teenage boy, that’s why you didn’t have prostate cancer, you working it pretty hard . And it also reduces the currents and how long prostate infections last . And so I’m a big fan of exercising the prostate.

Donna Lee: 9:21
Is that why I keep getting a text every week from my husband that says, “Please help me not have prostate cancer.”

Dr. Mistry: 9:26
I think that’s a good one.

Donna Lee: 9:27

Dr. Mistry: 9:28
And it makes me laugh now because sometimes for a different prostate awareness programs, they show like a little prostate with legs running. I’m like, “Oh boy, that’s not the right kind of exercise.”

Donna Lee: 9:39
I wouldn’t know what a prostate looks like. With the little set of legs, that would be even more confusing.

Dr. Mistry: 9:43
I think that we need to change it. I have an idea for our next t-shirt. And if you want a t-shirt, send us a message. Tell us you want a t-shirt.

Donna Lee: 9:50
We have all sorts of t-shirts. We used have one that said, “Make America Pee Again,” but those sold like hot cakes.

Dr. Mistry: 9:54
That’s right.

Donna Lee: 9:55
We have no more of that .

Dr. Mistry: 9:56
We don’t have anymore? Thank God. Or “Nuts For Urology.”

Donna Lee: 9:59
We have those, because I keep ordering those.That’s right.

Dr. Mistry: 10:03
How do people get a hold of us, Donna Lee?

Donna Lee: 10:03
You can get a free tee shirt by calling (512) 238-0762. Our email addresses armormenshealth@gmail.com and our website is armormenshealth.com. Please check out our podcasts . They’re amazing and informative and magical, and they’re free. Thanks Dr. Mistry.

: 10:19
The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.

Increased PSA and Low Free-PSA: When To Worry About Prostate Cancer Risk?

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, Donna Lee .

Donna Lee: 

Hello everybody. I feel like we have a new studio space. We sound so good today.

Dr. Mistry: 

We do sound good today. I’m pretty proud of ourselves. I’m a board certified urologist. This is a men’s health show. Thank you so much to our partners here at KLBJ news radio 590 AM. 99.7 FM.

Donna Lee: 

Oh , it’s always a little backwards when you say it. It’s “News radio KLBJ!” That’s what you’re supposed to say.

Dr. Mistry: 

Well, until, you know, I’m put on permanent staff…

Donna Lee: 

But you’re right about the numbers: 590 AM and 99.7 FM.

Dr. Mistry: 

Well, if you’re listening to us, then you already know where we are, and if you’re listening to us on podcast or you’re in another country listening to the podcast and have no idea what these numbers mean…

Donna Lee: 

That’s right. And until you, we say [inaudible]. How do you say hello in German or Japanese? Hello!

Dr. Mistry: 

Anyway, this is not a foreign language show. This is a men’s health show, fortunately for you. I am a board certified urologist. Our practice is NAU Urology Specialists. It has been around since 2007. We have four physician providers: myself, Dr. Christopher Yang, Dr. Stacy Ong and Dr. Lucas Jacomides. We also have five mid-level providers. We have two physical therapists that do pelvic floor physical therapy, sex therapy, and we have a real interest in the connection between obstructive sleep apnea and urologic conditions. So we do have a sleep apnea coordinator in the office. Really a focus on a more holistic approach to the way that urologic care is delivered to you.

Donna Lee: 

That’s a lot going on in one office, don’t you think? We need more space.

Dr. Mistry: 

Every day, it almost seems like the introduction of our practice gets longer and longer.

Donna Lee: 

And we have like a hundred thousand employees now.

Dr. Mistry: 

And if I had to think of a motto for our practice, I think “Longer and longer” is not bad.

Donna Lee: 

Can I get the software that does the drums, drum sounds when you make a joke?

Dr. Mistry: 

Or you can get a real drum set. Donna Lee, why don’t you tell people where our offices are and how to get ahold of us?

Donna Lee: 

That’s right. You can call us during the week at (512) 238-0762. You can also ask for me and give me your question anonymously, which has happened, you know. That’s interesting. You can send us an email to armormenshealth@gmail.com and you can visit our website, armormenshealth.com, where you can learn all about our practice and Dr. Mistry and our other partners as well.

Dr. Mistry: 

So your questions when you’re a patient in our clinic or your questions that you ask for our show is really what drives this show. We are so happy to answer those questions. Please make sure you email them to us. Our producers here at KLBJ tell us what it means that our listeners have such high engagement with us that they’ll actually listen to the show in the car and then go home, remember the website, and send it to us. But if you have any questions and don’t remember the website, if you do put my name in , it’s M-I-S-T-R-Y, Dr . Mistry. Our website will come up and you can click on us for a quick question for the radio show.

Donna Lee: 

That’s right. You can send a question through our website, our main website as well. So there’s a little “contact us” page. So I’ll get that as well. I get every one of them and I respond to every one of them. And guess what? They get a free podcast in response.

Dr. Mistry: 

Free podcast. We used to say free shirt.

Donna Lee: 

Whether they want it or not. But no, the podcast is free.

Dr. Mistry: 

And if you want a shirt , please let us know because we have thousands.

Donna Lee: 

Not a thousand, hundreds. Oh, we have a patient who you did answer his question. I responded to him. He said he did hear it on the radio. And then his response was, “Well, I didn’t think he’d answered quite like that, but it was really interesting.”

Dr. Mistry: 

Well, we do our best. We do our best. So do you have a question for us?

Donna Lee: 

I do have a question. So a patient sent in the subject line is “Increased PSA and low free PSA.” He started with a sweet comment: “Thanks for your show and what y’all do. A couple of questions concerning PSA numbers. My regular PSA has been on the increase over my last two physicals. It’s gone from 0.25 to now 0.93, and now I have a new item from my PSA blood test: a free PSA of 0.09. I’ve had several issues with BPH, enlarged prostate. I’ve had a varicocelectomy”–did I say that correctly?

Dr. Mistry: 

That’s right.

Donna Lee: 

“…cremasteric release and spermatic cords denervation for chronic testicular pain and didn’t resolve the pain.” That was so many syllables, I’m sorry about that. “I have a family history of…”

Dr. Mistry: 

Usually you’ll say, “That’s a mouthful.” I don’t know why I have to be the one that’s joking today. Donna Lee, you’re fired.

Donna Lee: 

…”I have a family history of prostate and testicular cancer–father and older brother. I’m interested in new additional free PSA number findings. Is it serious, and how aggressive should I be with my urologist for a serious diagnosis? As always, thanks again for what y’all do and discussing men’s health issues.”

Dr. Mistry: 

Well, I love it. I’ll start with a question that wasn’t asked, which is “What else could people do after a spermatic cord denervation and cremasteric release?” If the pain has not resolved, then what we usually do is we move on to medication therapy, such as the use of medicines like Gabapentin or Lyrica. We also will often do a pelvic floor physical therapy with percutaneous electrical nerve stimulation. And so those are some things that we would do or could do if chronic testicular pain was not resolved. And if it’s severe enough, there are even some patients that choose to get their testicle removed. With that, however, the question of the PSA, fortunately for you, the answer is pretty simple. The free PSA percentage has no value if you are, have a PSA under 4. So the test that that showed that free PSA levels could suggest a higher risk of prostate cancer are only true if the PSA is over 4. We use these tests like free PSA really to help further distinguish those that are likely to benefit from a prostate biopsy or not. But if your PSA is as low as it is,2under two, then your overall risk for prostate cancer is pretty low, even with your father’s family or the family history of your father having it. I would say that there are other tests available that if you’re really trying to assess your risk for prostate cancer, there are tests that are non-PSA based. There are urine tests that can look for certain markers for prostate cancer, there’s an MRI of the prostate that we can get you done for for about $800 if your insurance won’t pay for it and that can identify lesions in the prostate. So, you know, if you’re , if you think you’re at risk and you’re willing to take that extra step , we certainly have ways beyond the PSA to help diagnose you. So even though for this particular caller, the question of free PSA didn’t really enter into their risk for prostate cancer because the PSA is too low. Just so I can be comprehensive enough for those patients out there–so if you do have a PSA over 4 and you get something called a free PSA, so PSA as it’s made by your prostate circulates in the blood, and some of it gets bound to other proteins and is not, you know, is not free. It’s bound. The lower your free percent is, so the more that’s bound, the more dangerous it is for you in terms of your risk for prostate cancer. And although it changes a little bit by age, there is a risk of having prostate cancer based upon how low your free percent is. Generally under 15% free PSA, we think that you may have a 28% to 30% risk of cancer, and if your free PSA is over 25%, then your chances of cancer drops substantially to under 10%. And so, but these percentages are predicated on having a PSA over 4 on the first place. So…

Donna Lee: 

So he’s looking good?

Dr. Mistry: 

He’s looking good. I mean, I think that, you know, except for the testicular pain. And unfortunately , testicular pain , excuse me, testicular cancer, which his brother had apparently has some genetic like predisposition, but you really you’d have to be in the, you know , the correct age bracket. So if you’re, if you’re not, you know, under the age of 25, then I would say you probably escape this genetic risk of testicular cancer.

Donna Lee: 

Wow. Well, that was quite the question. I’ve never seen that question about free PSA.

Dr. Mistry: 

It was a very specific one. And I think something that really distinguishes how we approach questions and topics here on our show. You know, that’s a lot of inside baseball when it comes to understanding urologic conditions. Bu if you come and see us as a patient , that’s what you’re going to get. You’re going to get kind of our very frank opinion on medical condition and avoidance of surgery and avoidance of procedures if and when possible, and kind of trying to look outside the box to help treat your conditions.

Donna Lee: 

You know, this is kind of a side note, but in the clinic I noticed the other day that we had a ton of shockwave patients–we’re calling it “spark wave,” but we had so many patients that day. And then I talked to one of our providers, Jason Ramsdale, and I was asking his feedback and he said the patients are loving it, and that traditionally based on studies that we’ve seen from Europe, it should take about 10 weeks after the series of 6 that you get for shockwave treatment for ED. But his patients are seeing big differences in just 2 or 3 or 4 treatments.

Dr. Mistry: 

Well , I like the idea of “big difference.”

Donna Lee: 

Big difference! Enlongated difference.

Dr. Mistry: 

And so for those of you men that are…finally waking up, aren’t you? For those of you out there that suffer from erectile dysfunction that’s mild to moderate, maybe you’re still responding to medications, those patients with chronic pelvic pain and those with painful Peyronie’s disease , considering spark wave therapy or in our case, this linear acoustic therapy working on the perineum and the penis to help regenerate those tissues is something that if you’re interested in learning more about, we would love to hear from you.

Donna Lee: 

That’s right. You can call us during the week at (512) 238-0762. You can send us an email to armormenshealth@gmail.com and you can visit our website armormenshealth.com. Thanks so much Dr. Mistry.

Dr. Mistry: 

Thank you so much.

Speaker 2: 

The Armor Men’s Health Hour is brought to you by Urology specialists for questions, or to schedule an appointment, please call us

Speaker 1: 

(512) 238-0762 or online at Armour men’s health.com.

Dr. Mistry and Donna Lee Answer a Listener’s Question: When Should I Start Seeing a Urologist?

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 partner in crime, Donna Lee.

Donna Lee: That’s right. Hello everybody. I am a partner in crime. I am a criminal.

Dr. Mistry: You know, it kind of hurts my feelings whenever the listeners say that they like, that they need more Donna Lee.

Donna Lee: It doesn’t hurt my feelings. I’m just trying to get a word in edgewise. I can’t.

Dr. Mistry: [ Inaudible] was like, “You guys are really great on the radio. She’s better.”

Donna Lee: That’s right.

Dr. Mistry: I don’t think it’s fair. I don’t have any professional, like entertainment experience.

Donna Lee: Well, I do in my years past , but I’m now switching over to the Dr. Donna Lee Show.

Dr. Mistry: No. You cannot call yourself a doctor. We’re going to get so much trouble.

Donna Lee: Why? I am doing it in air quotes.

Dr. Mistry: This is a men’s health show: Armor Men’s Health. I am a board certified urologist.

Donna Lee: I’m going to turn this into a women’s health. Women’s health show with Dr. Donna Lee.

Dr. Mistry: We started this practice in 2007. This show is brought to you by our urology practice, NAU Urology Specialists. We are a full service, fully contact–no…

Donna Lee: Fully functional?

Dr. Mistry: COVID.

Donna Lee: Yeah, damn Covid.

Dr. Mistry: COVID protective. We are open for business. We are seeing patients. We have telemedicine visits. We have in person visits, and we are here to take care of your urologic needs, hopefully in a holistic manner in a way that you are going to be very pleased with the kinds of treatment options that we have. And this show has really been developed and designed to help delve into some of the topics that we deal with in our own practice, health effects on men, in a deeper way. Your participation as a listener and your participation in our practice as a patient are what keeps us going. Donna Lee, gow do people become patients of ours?

Donna Lee: You can ask any question of Dr. Donna Lee that you’d like: armormenshealth@gmail.com. I’m just kidding. You’re actually going to ask Dr. Mistry a question. And our phone number during the week is (512) 238-0762. Our website is armormenshealth.com. We are blessed to have so many amazing providers. We added on a new provider, Heather Lins . She’s joined our team. So welcome, Heather. We have four incredible MDs, five incredible mid-levels, Dr. Mistry?

Dr. Mistry: That’s right.

Donna Lee: Wow. We have physical therapy, pelvic floor physical therapy we have two physical therapists. We have a sex therapist. We have a sleep coordinator. We are just fully packed around here.

Dr. Mistry: That’s right. Really to help you achieve your maximum health goals.

Donna Lee: Right. I thought you were gonna say something sexual.

Dr. Mistry: No, it’s too early.

Donna Lee: Okay, well, there’s that. We’re in Round Rock, North Austin, South Austin, and Dripping Springs, Texas. And again, you can reach out to us. We will answer your questions on air anonymously, but I will respond to every one of them and you get a free podcast! Forget the free t-shirt. I can’t get anybody to ask for a t-shirt, but I’ll send you a podcast. You can listen to our podcasts wherever…

Dr. Mistry: You’re no longer in charge of ordering t-shirts. You get too many.

Donna Lee: I have a couple.

Dr. Mistry: You know, your questions really do drive the show. Donna Lee, give us a question.

Donna Lee: Right ? This is a really good one. I was really impressed with this. “Dr. Mistry,” M-I-S-T-R-Y, “at what age should men start seeing a urologist to be proactive with their health?”

Dr. Mistry: That’s a great question .

Donna Lee: Isn’t that a good question? I’m impressed.

Dr. Mistry: In our clinic this week, we saw patients that range from 8 to 98.

Donna Lee: Really?

Dr. Mistry: Right. The answer is that seeing a urologist as a routine medical practitioner may not be required if your general practitioner is someone that’s doing a great job. We have been so impressed and so pleased with so many of the general practitioners in this, in this town. If you are looking for a really good internal medicine or general practitioner, please email us. We would love to share those people that we think go above and beyond for patients. We have functional medicine people, we have people who really adhere to the guidelines, people that listen to you and really care about your health because not all doctors are going to spend the time or have the commitment, and not all health systems are designed to kind of provide care that is individualized for you. The next part of that really is when, at what age do most men start experiencing some degree of urologic complaint? And that’s how I’m going to answer that. Erectile dysfunction starts effecting men as early as their early forties.

Donna Lee: Unless there’s like a trauma.

Dr. Mistry: That’s right, unless there’s a trauma, whether it’s a psychological trauma or true trauma or the etiology is purely psychological or hormonal. But what we call vasculogenic erectile dysfunction really starts becoming more evident in the early forties, and it kind of tracks as a percentage of your age. So about 50% of 50 year olds , 60% of six year olds start having some type of rectal dysfunction. The earlier you get that addressed, whether it be through hormonal interventions, or managing your cholesterol to improve blood flow, or getting put on like a daily Cialis to help improve girth and flow–these things are really important. And if you think that your doctor is kind of brushing off your complaints or not treating them well, then a urologist would be a great place to go to.

Donna Lee: We have a patient too, sorry to interrupt–a gentlemen wanted his 25 year old son to see one of us, one of the doctors, because he wanted to be proactive because of what was the actor’s name who died? The Black Panther guy, that guy that , you know, I don’t know his name either now. I feel terrible. But the gentleman who called is African American, as is his son, and he wanted to make sure to be ahead of this, and I thought, “What a great idea?”

Dr. Mistry: And I think that’s right. I mean, if you are predisposed to prostate cancer, for example…

Donna Lee: And there was a history of that in the family.

Dr. Mistry: …that’s another great topic here. When you are predisposed to prostate cancer, let’s say that you were diagnosed or your father was diagnosed with prostate cancer in his 50’s, or if your father died of prostate cancer at any age, then being very, very proactive in terms of getting PSA checked by a urologist starting at age 45 is something that I’d recommend. Now, that’s not even the earliest that we’ve taken prostates out. I’ve taken process out in men in their thirties, and they den generally do have a strong family history of prostate cancer going on. And so prostate cancer, as an example of something to have a very close relationship with a urologist. And the main reason is this: the kinds of criterion that puts you at risk for having cancer are different in a urologist’s eyes than they would be in your primary care’s eyes . We use the PSA as a standard test, but if you’re 45 years old and your PSA is 2.5, I would consider that abnormal. On the piece of paper where the results are printed out, it looks normal. You really need a more keen eye if you’re at risk particularly for a disease process like prostate cancer. The next thing that kind of is more age related would be low testosterone. And testosterone people treat that all over the map from a primary care standpoint. Some people are pro-testosterone in everybody for everything, and some people won’t give you testosterone unless they get a letter from the government, I guess. But you need to know that there’s nuances in how testosterone is prescribed, whether or not you need it, and my feeling is really to judge it based upon symptomology rather than numerology. You know, I don’t really care exactly what your number is. I use that more to guide how much we’re giving you, if what we’re doing is working, and less to determine absolutely whether or not you’re in need of testosterone or a testosterone patient. Erectile dysfunction, low testosterone predisposition to prostate cancer–these are areas in which I think having a close relationship with the urologist really is going to be a benefit. Kidney stones–you don’t need to come see us prophylactically unless you have a kidney stone. When it comes to kidney cancer or other types of cancer that we deal with, they’re usually found incidentally, and then the relationship with the urologist begins. Where a men’s health specialist, where we fit in on that on that really comes down to whether or not you’re feeling at your top best. And that a lot of that is derived from complaints, from sexuality or testosterone and things of that nature. And what we want to do is we want to help make sure that your sleep apnea issues are addressed, we want to make sure that you’re hormonally balanced, we want to make sure that from a nutrition and weight loss standpoint, you’re being optimized. But I hate to tell you, you’re not getting that at another urology practice. I mean, you’re getting that here, you know ? And that’s because , you know, we wanted to build right, Donna Lee, we want to build an amazing place that patients are really well taken care of. I can’t make the other urologists in town or anywhere in the country, you know, really wake up to the need for sleep apnea and nutrition integrated into their practice.

Donna Lee: Right. Well, we had, we’ve had a few patients that complained that their urologists who were a little older and probably heading maybe into retirement, they’re not asking the questions that we’re even discussing on the radio, like talk about your diet, let’s talk about sleep.

Dr. Mistry: Well, I mean, if you think, if you think that a pill is going to fix everything, you’re sorely mistaken. And so , it’s such a great question about physician relationships. I probably have, I would say probably about 15% of the patients that I see on a daily basis are really here just to make sure that they’re optimizing their urologic health. And although they don’t admit it, I think it’s because of probably something in their family or some close relative or friend that had a urologic condition that went undiagnosed. And that’s something we hate to see. A failure to diagnose as one of the most common reasons that people’s health degrades quickly and unexpectedly , you know , and unexpectedly, but presumably some way that could have been avoided if somebody had kind of paid attention a little earlier. An enlarged prostate is another area that we think that I feel once you start having urinary complaints , like from an enlarged prostate, you should probably have a relationship with a urologist earlier rather than later, because that’s how we identify problems earlier, rather than later, and keep you out of trouble. And what a great question. Donna Lee, if people want to learn more about our practice or become our patient, how do they do that?

Donna Lee: They can call us during the week, but I want to point out the actor’s name is Chadwick Boseman. Sadly, he died–he was only 43, I think.

Dr. Mistry: Of colon cancer, can you believe that?

Donna Lee: Of colon cancer. Yeah, Super sad. But yeah. Find a doctor, you guys out there. (512) 238-0762 is our phone number. Our website is armormenshealth.com where you can see Dr. Mistry’s smiling, happy face. We’re in Round Rock, North Austin, South Austin, and Dripping Springs, Texas. Call us during the week, like I said, or you can email us anonymously armormenshealth@gmail.com and listen to our podcast . Thanks so much.

Speaker 1: 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.