Welcome back to the armor Men’s health. Our with Dr Mystery and Donnelly. All right, Mrs Donnelly again. Dr. Mystery stepped out, but I wanted to continue the discussion we were having with our urologist, Dr Yang. Christopher Yang. Welcome back. Um, and Doctor Krishna, the cardiologists from Seton. So you guys continue that discussion. It’s fascinating that we want to keep talking about more testosterone and cardio.
Yeah, So basically, we’re Well, we’re talking about was the link between erectile dysfunction and cardiovascular disease? A lot of men who have heart disease have in a lot of men, have a
lot of the patients present with erectile dysfunction is their first sign. And so this gives ah, multi specialty way of being able to, you know, help prevent what’s the number one leading cause of death in our country, which is cardiovascular debt.
It’s not because of the Penis,
because the Penis for the Penis brings you there. So
does have a mind of its own. To the doctor,
it’s kind of up in the air. Which one is more
important, right? You help them get up in the air. So, you know, there’s a wonderful study performed into another 19 meta analysis of multiple trials, particular 154,000 patients. You know, a small study joke. Just jokes aside, it basically looked at if you had erectile dysfunction versus not erectile dysfunction, what is your risk of death, stroke and overall coronary heart disease? And overall, it’s around 30 to 60% increased risk if you have erectile dysfunction. And if you have erectile dysfunction and you’re over the age of 55 our smoker, diabetic and have a shorter duration of Edie. Typically those air these most severe risk factors for having a heart and point cardiovascular event. Hence, it’s important to treat these risk factors as well as treat erectile dysfunction. I thinkit’s important as a multi modality approach that we re screened These patients and screening would typically include coronary corner artery calcium scoring EKGs and just a basic panel with most primary physician’s could do as well as cardiologists.
Basically, what you’re saying is that patients who have bad erections shouldn’t be mad if we send you to the cardiologists for a primary doc to look for diabetes toe. Look for high blood pressure to look for high cholesterol, right? Absolutely, and then also patients who have had heart attacks and strokes. They might have other things going on, but a lot of them probably have poor erections that need to be treated and can be treated.
And that’s usually my number. One question I get 62 year old I fixed their heart that came in with a heart attack. They’re in for their two week appointment. They feel great. And then when the wife or partner leaves the room, they say, Doc, when can I have sex? And then the next question is like, Go ahead. If you’re not having any symptoms in the American Heart Association, they recommend, like six weeks doing a sub maximal stress test. You know, I currently state if patients able to do cardiac rehab or participate in walk one mile. You’re good enough in cardiovascular condition, have sex, but then they come back and say it will talk. I can’t get it up. And then this is where we have the conversation. So I’m gonna throw it back to you. Dr. Yang, what is your algorithm for treating erectile dysfunction?
I wanted to comment first on what you just said. From what I’m hearing if the attempt to have intercourse, That’s a pretty good stress test right there, right? Okay. So probably not as good as
the stress. That’s if you order right, but more fun. Yeah, but having intercourse is stressed. It’s no one that I can prescribe which many men probably would want me to, but
a note from their doctor to their wife that it’s OK for men. You come in with erectile dysfunction. Think we’ve talked about it before on this show. There’s kind of a lot of different potential causes. You know, 11 thing We look at hormones, you know, including testosterone, estrogen, some others. We look at the vascular disease to basically look at. If there’s any diabetes, any high blood pressure, high cholesterol that can be contributing to erectile dysfunction. We also look at structural issues of the Penis. And then we look at kind of psychological social issues as well. Treatment wise, you know, typically look at medications like Viagra. See, Alice, things like that.
How do you decide? So what? Say, what would be a typical starting dose? And how do you decide between Viagra, Cialis, now that both 13 Eric’s
here? Yeah, You know, it kind of depends on the patient’s preference. Some they work a little bit differently in that. See, Alice is in your blood stream for a little bit longer. So patients who are younger, who might want to have multiple you know, multiple episodes of intercourse over the course of a weekend. Sometimes callous works better. People who don’t really want to think about it too much. You know, we can prescribe a low dose, see Alice, that you take every day. But you know some people, since my anger is the one that’s been around the longest. Some people prefer that. So it’s basically a discussion as well as patient preference.
And it’s really inexpensive now,
right? Yeah, from a cardiology standpoint, I typically go with Viagra only because a lot of my patients are on multiple medications that may drop their blood pressure on. We know that being one of the side effects of this class of drugs is that this, in conjunction with other smooth muscle relaxers, can really drop someone’s what pressure. So I typically go with a lower dose and use a shorter acting agent as my most patients are elderly and on other combinations of their piece that may affect their blood pressure. So, you know, I get the question all the time. Where is the safe for me to take these drugs? And I tell them these are safe. Well, study drugs. It just matters the pharmacology of of all your medications put together. And this is why you come see specialists like Dr Yang myself.
One of the other things that we had talked about before is one of the other tests that we do. Here in the office is a peanut duplex holders where we’re looking at the actual blood flow into the Penis. There’s an artery on each side called cavern ozel artery. It actually fills up the Penis with blood when you get a direction. So one of the test that we do is called a peanut duplex Ultrasound. Basically, we’re looking at the blood flow head that ties in with Dr Kirshner here because he does a procedure where we actually can put a stent in there.
That’s correct. Yeah. Who? Dental artery stenting. A topic that was been hot for the last 78 years. And, uh, the how it works is you have iliac arteries and you have an internal iliac artery that gives off the arteries to the Penis. And so, like we were talking about before, they typically range anywhere from 2 to 4 millimeters, and they they could get disease. Depending on the risk factors that you have. There’s approaches that you can engage the internal iliac artery and then put a wire and able to put a stent that is metallic.
Tell the listeners what extent? Yeah, I don’t know
most of the stents that we use currently for this would be a cobalt chromium metal stent, and they typically yes, if it is very fast. It’s mounted on a boat with scrimped on a balloon on when you expand the balloon to step, goes onto the wall and becomes part of the artery within 45 days, and then it has a drug coating on it so that it prevents new tissue from re growing inside the stent.
Now, after they get a step like that, they set off the X ray detectors.
Airports? No. No, As much as guys like to say that, you know, they have a metal rod, right? Uh, exactly. Unfortunately, they will not or fortunately they will not be setting off any metal
detectors. Okay, Now, you know, from from what I’ve seen as faras you know the times to do this stent it seems like it works better with younger patients. It works better with patients who had this issue because of trauma, right? Not the older patients who had a heart attack like that.
Absolutely. So the premise of this is that typically if you wait later in life, you don’t generally have more diffuse disease. And so when you have diffused disease, you can’t put stents threat entire Penis artery, and so that becomes a too bad. Yeah, it becomes it becomes a problem. So your point is, when you have trauma, you’re typically having a focal spot. Where there is, there’s a change in flow, and that’s typically were stands work best anywhere in the body. And when you’re dealing with diffuse diabetes or elderly age and the arteries really become narrowed, stenting is not the optimal option. And again, this is still not something that’s, you know, I would say everyday practice. It’s This is one where you’d want to see a specialist who were endovascular trained and partner with the urologist on this topic. Not one that I cz just performed in everyday basis.
Okay. And, um, that sounds good. I think we’re almost done with this segment.
Yeah, Almost done. I wanted to take a minute to to reintroduce Doctor Krishna and let you guys know where he’s at. He’s accepting new patients? Yes. Ah, seton dot net is the website where you can find Dr Vase me saying that Krishna um, you can see his handsome face on the website there, so just search for him. The numbers 5125040860 he again. Is that Westlake? Kyle and Luling at Secret Locations. Thank you so much for coming in today.
Thank you for having me.
That was not something startling for popping in and saved the day because Dr Mr Disappeared
Yeah, gladly. Take over the coast
off so you can send us your questions at Armour Men’s Health at gmail dot com. Um, armor. Men’s health dot com is our website were located in Austin, North Austin, Round Rock South Austin and in Dripping Springs. But we want to hear your questions. So if you have a question for Dr Krishna. Send it over to me. Is it okay if I reach out to you? Okay. This patient had a question. Absolutely. Well, we appreciate your time and thank you guys so much again and we’ll be right back after this commercial.