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March 14, 2020

A Closer Look Below the Belt: Dr. Mistry and Dr. Jacomides Discuss the Importance Self-Exams in Finding and Treating Testicular Cancer

Donna Lee: 

The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions during the week, call us at (512) 238-0762 or visit our website at armormenshealth.com. The Armor Men’s Health Hour is a show dedicated to providing information on a variety of medical topics, some of which may include sensitive subject material about penises. All cases discussed have been done with the permission of the people involved and their penises.

Speaker 2: 

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 wonderful co-host and practice manager Donna Lee.

Donna Lee: 

Oh, is that me?

Dr. Mistry: 

Yes.

Donna Lee: 

That’s me.

Dr. Mistry: 

Today anyway.

Donna Lee: 

Maybe not yesterday, but today.

Dr. Mistry: 

That’s right.

Donna Lee: 

Awesome. Dr. Mistry is your real name. M-I-S-T-R-Y when you go to Google him.

Dr. Mistry: 

The Armor Men’s Health Hour is a health show really dedicated towards addressing health issues that men will experience. Sometimes we talk about issues that affect women as well. I’m a board certified urologist.

Donna Lee: 

And I’m a board certified co-host.

Dr. Mistry: 

And a self appointed award-winning cohost.

Donna Lee: 

I have the award on my desk.

Dr. Mistry: 

That’s very good. We’ve had excellent, excellent feedback from all of our wonderful listeners. I think we have some great listeners and I know that many of you just catch this show accidentally while you’re in the car driving your kids around to lacrosse games, but for those of you that are catching us on the podcast, we really appreciate it. You can find the Armor Men’s Health podcast anywhere you podcast.

Donna Lee: 

That’s right. We’re famous in the podcast world.

Dr. Mistry: 

We’re famous.

Donna Lee: 

I heard we’re award-winning as well.

Dr. Mistry: 

Well, I think that we’re going to just make up our own awards.

Donna Lee: 

It doesn’t matter. It is all legit.

Dr. Mistry: 

Before we tell you a little bit about our clinic, we are joined today by the newest addition to Jurassic Park around here, Dr. Lucas Jacomides. Lucas, welcome.

Dr. Jacomides: 

How’s everybody doing today?

Dr. Mistry: 

I do love how everybody’s voice drops two octaves when they get on the radio?

Donna Lee: 

I know, right? Dr. Jacomides is fluent in Greek, Spanish, and English, of course.

Dr. Jacomides: 

English is really good.

Donna Lee: 

And French?

Dr. Jacomides: 

French. Italian in a pinch.

Dr. Mistry: 

Really?

Dr. Jacomides: 

I can do sign language, I can do Bohemian Rhapsody.

Dr. Mistry: 

That’s weird. I wouldn’t expect so much from a Rice graduate.

Dr. Jacomides: 

Well I could cuss you out in six languages.

Dr. Mistry: 

You could probably speak Klingon.

Dr. Jacomides: 

By the way, for those kids listing on the trip to the lacrosse game or lacrosse practice, if we offend any way, I will start by speaking in some language to make sure your parents turn the dial for just temporarily and we’ll come back.

Donna Lee: 

We’ve never offended anybody.

Dr. Mistry: 

Are you kidding? Donna Lee, why don’t you people about our practice and how to get ahold of us?

Donna Lee: 

Our practice is lovely and we are all over the place. We are in Round Rock, North Austin, South Austin and Dripping Springs. So give us a call during the week (512) 238-0762. Our website is armormenshealth.com, armormenshealth.com. You can see Dr. Mistry’s smiling face there and you can also send your inquiries through that website or you can email us directly at armormenshealth@gmail.com, and I get every one of those. I share them with Dr. Mistry. We enjoy those. So keep sending those questions in for Dr. Mistry, Dr. Jacomides, any of our providers, or any of our guests.

Dr. Mistry: 

We’ve had some amazing questions, too. We had Dr. Lough on a couple of weeks ago talking about hernias and esophageal reflux and…

Donna Lee: 

Bariatric surgery.

Dr. Mistry: 

…an obesity hero, he called himself. And we’ve got some great questions.

Donna Lee: 

And they went straight to him and then I responded to those patients with his information to get in touch with him at his clinic.

Dr. Mistry: 

That’s great. So why don’t we go through some questions?

Donna Lee: 

We certainly can. We’ve had a few come in in the last couple of days. This one alerted me and worried me, so I did reach right back out to him. But anonymously, we answer these always anonymously. He says he likes to keep things simple and to the point I’m very positive I have testicular cancer and I just don’t know where or who to go to. I just need a little guidance on where to go to from here, so…he needs to get in to be seen.

Dr. Mistry: 

Well that’s a great question because this has been kind of testis cancer week for me and you, huh Lucas?

Dr. Jacomides: 

Yes it is. I think, yeah, to your point, this is something that [inaudible] deserve a call back and I’m sure you were taught the same thing, that the sun should never set on testicular cancer. You know this is a very, can be a very aggressive tumor that can double in size in a matter of weeks. So if you feel like you have one, then email’s not the best way to reach out. So I’m glad, hopefully we got to hold him. But yeah, we…

Donna Lee: 

I did ask him if he’s been seen by a urologist, if he just randomly sent that, or can we please see him? So I sent two emails. So, hopefully he responds.

Dr. Mistry: 

And generally if you are a patient and you think that you have an abnormal testis mass, that is the one, that is one of the things that our call center knows to immediately get you in today for an exam, possibly an ultrasound, possibly labs. When Dr. Jacomides says we never let a sunset on a testis cancer, what we mean by that is back when we trained, we would immediately take them to the operating room and take it out to see what it is because we’re afraid that you’re going to run away. But, luckily when you’re not practicing at Ben Taub, most of our patients do come back.

Dr. Jacomides: 

Very [inaudible].

Dr. Mistry: 

This week, I had a man who had a testis tumor for about a week that had doubled in size. It was removed on Monday, and he’s got what’s called a mixed germ cell tumor. It’s one that makes different kinds of hormones that can be checked in the blood. And Lucas, you had a very interesting one just recently. Well.

Dr. Jacomides: 

Yeah, no it’s, things are still kind of in play in evolution on that. But, I mean the point is that this is a very curable type of malignancy. So just because we might even think that you might have one, you know, one, if there’s, can be a good thing about fast-growing cancers is that oncologists and surgeons have figured out how to treat them.

Dr. Mistry: 

Sure, I mean, there’s a very famous Austinite that had testis cancer that even metastasized to the brain and he managed to win several Tour de Frances.

Donna Lee: 

Or did he?

Dr. Jacomides: 

Depends who you ask, but that’s…

Dr. Mistry: 

But, you’re right. The management of testis cancer is a medical miracle. The treatments for it are well tolerated and fortunately, very few people actually die even if the cancer is quite extensive. What are some recommendations that you like to give men on self exam?

Dr. Jacomides: 

I think the bigger factor is that again, this is a young man’s cancer, unlike most malignancies that, you know, this is not typically something that it’s going to be, you’re going to find it when you’re 60 or 70. So be careful in that 20 or 30. The advice I tell guys is that, you know, the good thing is that we can feel our ornaments perhaps somewhat excessively from time to time, but we are our own symmetry evaluators. So if you feel something off on one side versus the other, then that’s time to come on in. Especially in that 20 to 30 year old age bracket. And certainly shortness of breath, pain, bleeding. I think it’s incredible what Lance had and ignored. And I read his book and, I mean, he’s been an absolute, you know, aside from all the controversies, he has brought this disease to light and I think most guys owe him a great gratitude for being open about it so people can get it taken care of. But yes, don’t ignore asymmetry, and let us tell you it’s something or nothing and not to worry about.

Donna Lee: 

So do you check monthly, like women check their breasts?

Dr. Mistry: 

I think that it’s always a good idea to make sure that when you’re in the shower, you know, soap, you’re cleaning yourself down there and make sure it’s really…in my experience, it’s not that people don’t know that it’s there, it’s that they are unclear of how to follow up or how worried they need to be if they feel something.

Donna Lee: 

Or they’re embarrased.

Dr. Mistry: 

And so what I would tell all men, and especially it’s going to be young men who aren’t sick and don’t, may not even have a doctor, they may not even know how to access the medical community. But if you feel a testis mass, call urologist. Most of the time your insurance doesn’t require a referral. And if it does, we’ll let you know. And those are things that we’re going to make a lot of leeway on seeing you as quickly as possible. So Lucas, if somebody does have a testis mass, what are the tests that usually run to evaluate it before we take them to surgery?

Dr. Jacomides: 

Well, in the office we do blood tests. We’d look for AFP, HCG, LDH, these are all tumor markers that can tell you ahead of time if it’s something that’s, if it is a test cancer, how bad is it? And then we’re going to want to do an ultrasound fairly quickly and ideally that day, to tell us what we’re dealing with. Again in the “sun never setting” argument, sometimes you admit the patient, do all that and figure it out [inaudible] that’s when you’re going to figure it out sooner. But you do want to get an ultrasound that day, at the latest the next day to make sure and to define this thing. And then besides our exam, like I said, you know, there’s very little excuse to miss a testis cancer when it’s right there for all to behold. You know, women aren’t that lucky. Breast cancer self exams of course are important, but ovarian cancers hide, you know, the analogous tumor hides and you don’t know until it’s one of these 300 pound tumors. So we really want to get you in and then feel it, examine it, ultrasound it, get markers, and then if we feel like it’s something that is a testicular cancer, we take it out that day or next.

Dr. Mistry: 

No, you know, if you do have testis cancer, you’re gonna have a surgery which your testicles removed. And although that may seem very off-putting, given how important those organs are to us, it is possible to put a prosthetic in there so that it visually and physically will feel and look normal. It’s possible to make sure that any hormone loss that your experience from that testis being gone can be replaced. And in my experience and with patients that I treat specifically, we very, very aggressively do things to preserve your fertility. So, believe it or not, the Lance Armstrong Foundation will actually pay for you to have sperm frozen if you’re diagnosed with cancer–all cancers. So if you are someone who has been diagnosed with cancer and are afraid that your fertility preservation may not be a priority of the person taking care of you, please let us know. It’s an absolute critical thing for us to make sure that if you want to have children, that that genetic material is salvaged before you experience radiation or chemotherapy. And if you think that you have a testis mass, you should be seen immediately. There’s no reason for you to question it. Maybe it is nothing–then halleluja! Good for you. And if it is something, then you’re going to be in great hands.

Dr. Jacomides: 

No, that’s a great point. And you’re right about all cancers. I mean, there’s very little time to do that when your goal is to make sure it gets out soon as possible. But before radiation, before chemotherapy is the time to do if you’re interested in banking. And I always tell folks that, you know, this is one of the few organs that, you know, we get a spare. So if the other one is working just fine, you should see no huge loss in testosterone. You should not see a huge loss in fertility preservation. Lance had three kids after diagnosis, I believe. So, yeah, absolutely. We can work on that and make sure that everything is done right before the next step, the next phase.

Dr. Mistry: 

Well, that’s great. Great question.

Donna Lee: 

And I hope that guy reaches out to us, or somebody.

Dr. Mistry: 

Donna Lee, why don’t you tell people how to get a hold of us?

Donna Lee: 

Calls during the week at (512) 238-0762. You can email us at armormenshealth@gmail.com and our website is armormenshealth.com. We’ll be right back.

: 

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

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