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March 2, 2020

Dr. Mistry and Donna Lee Address Fertility Preservation and Vasectomy Reversals

Speaker 1: 

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

Dr. Mistry: 

Welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here as always with my cohost, Donna Lee.

Donna Lee: 

Hello. That was a fast hour.

Dr. Mistry: 

It was a fast hour. You know, a lot of people don’t know what a urologist does.

Donna Lee: 

Well, they do, if they listen to our show and they’re smart.

Dr. Mistry: 

How do you…how do you explain what a urologist does?

Donna Lee: 

I say a urologist…I had explained this to my mother. Because, you know, she’s an 80-something-year-old Thai lady. So I said “It’s everything in the middle section of your body.”

Dr. Mistry: 

Okay.

Donna Lee: 

But she still didn’t understand.

Dr. Mistry: 

Yes. I’m not sure you did a great job.

Donna Lee: 

No, I said the penis/vagina area. Isn’t that right? We do a lot of that stuff.

Dr. Mistry: 

Well, urologists take care of things that I think a lot of you would know about, so certainly the genitals of men, so testicles, penis, scrotum, but we also take care of kidneys. Being a kidney surgeon was actually the reason that I was so interested in becoming urologist. Then there’s the reproductive system that includes the seminal vesicles in the vas deferens, the bladder. So, bladder issues like urinary incontinence, urgency, frequency, prostate issues such as prostate cancer, kidney issues like kidney stones or kidney cancer, and then a variety of fertility issues.

Donna Lee: 

That’s amazing. I didn’t know that until I started with you three years ago.

Dr. Mistry: 

So, we had some, you know, this last month we’ve taken care of a couple tragedies. And really nothing breaks our heart more in our clinic, then hearing about children who have died tragically by accident. This week, we also had a child who was diagnosed with brain cancer travel from all the way in Dallas to our clinic, all for fertility preservation. So we are…

Donna Lee: 

…stuff no parent should have to really think about.

Dr. Mistry: 

Absolutely, or family member. And, in this town, I’ve done probably a dozen posthumous, sperm collections. So these are, wives of husbands who have certainly discussed their intent to have babies or get pregnant usually through a tragedy or an accident have died. And then have requested through the courts the ability to extract and save sperm.

Donna Lee: 

There’s nothing more heart wrenching than that phone call, from a former wife.

Dr. Mistry: 

It is a bad phone call because it’s always, everybody’s panicked and there are certainly many ethical issues that surround it. Fortunately, our governing bodies have put this through the ethics testing and a lot of times the spouses end up not using the sperm. We were really challenged, in an interesting way, with a situation where the boy was too young to be directed to masturbate and was just too sick to be able to masturbate. So he was unable to give a sample for freezing that way. And so what we offer in our clinic, really apparently nowhere else outside of Houston, in this state is something called electroejaculation. It is something that we use very commonly in diabetic patients who are unable to ejaculate, spinal cord injury patients who are unable to ejaculate. And then this third little category, which is children who are unable to ejaculate but are probably going to undergo chemotherapy or some treatment that will stifle their future fertility. Increasingly we, because pediatric and childhood cancers have been so successfully treated in so many cases in so many instances you want to, you want to plan for the treatment being successful. Fertility preservation is something that is hard to bring up with parents and kids because they’re sick and you know it’s the job of you know, you as the parent, your oncologist and the people treating your children to bring this up and if you do ever come across somebody who was going through that kind of challenge at something that that we can help with on the boys’ side. For girls going through treatment, there are similar fertility preservation options available in some cases. And if you have questions about that, we would be happy to answer those questions. The other kind of patient that we see are those couples who lose a child, usually a young child, but the husband’s already had a vasectomy.

Donna Lee: 

Yeah, we had that recently.

Dr. Mistry: 

Yeah, we’ve had two recently.

Donna Lee: 

That’s awful.

Dr. Mistry: 

And there are several options that you have. If that does happen, we can do, have a vasectomy reversal, or we can do what’s called a sperm extraction, which we use with in vitro fertilization. The decision to go through one or the other can be difficult because IVF can cost a lot of money, but then the urgency to have another child can be really significant in your heart. Also, depending on the age of the mother, there may only be certain options available. If you are looking to have children after a vasectomy, we encourage you to get a couple of opinions. Some people just just run out there and get a vasectomy reversal and when it doesn’t work, they are surprised. They don’t have a plan B when they probably weren’t a good vasectomy reversal candidate in the first place. If you’re thinking about going and getting, you know, a vasectomy reversal in somebody’s office while you’re awake, but they’re not going to do any follow-up or any pretesting, then take that as kind of a red flag. You know, you should be going to a urologist who cares about men’s fertility and men’s health and make sure that your hormones are right and make sure you’re the right candidate. And I can’t emphasize that enough because the fertility journey is hard enough without avoidable disappointment.

Donna Lee: 

Right? I mean, we had a patient on the lighter side awhile back, we had a patient send in a question for vasectomy reversal, but it had been like 40 years. He was like in his seventies and was still looking for the right lady. And I was like, “Oh.” Because I thought he wanted to a vasectomy reversal after like a few years. And then when I started inquiring more by email, he was like, “I’m a very virile 70 year old man.” And I was like, “Oh.”

Dr. Mistry: 

I love that question. As a matter of fact, I would almost do his vasectomy reversal for free.

Donna Lee: 

Just to see what happens in life?

Dr. Mistry: 

Just to see. But you know, in his particular case, a vasectomy that’s over seven years old, or over 15 years old. So those are the two kind of steps that lead to much lower success rates in terms of vasectomy reversal rates.

Donna Lee: 

But not 40?

Speaker 1: 

But you never know, you know? You never know. And, but usually even in vasectomies that are much older, 20, 25 years old, we can almost always extract sperm either from the testical or the epididymis. And so, it doesn’t matter how long it’s been, you should have an evaluation. And, if you have a desire to be a dad again, then…

Donna Lee: 

Kudos to that guy.

Dr. Mistry: 

…we are here and ready to help you accomplish those goals.

Donna Lee: 

“How old is your daddy?” “75” That’s just a lot. We have a really quick, funny little question.

Dr. Mistry: 

Let’s go for it.

Donna Lee: 

What is your question is, this made me laugh out loud. “Dr. Mistry, I take Cialis to enjoy sex with my wife, but I’ve woken up with an erection on occasion. I was wondering if this is common with ED/erectile dysfunction?” He’s bragging.

Dr. Mistry: 

Well, the thing about Cialis is that it has a very long effective time range. So, generally speaking, it’s going to work for up to 36 hours depending on whether you’re using a daily dose or the on-demand dose. And so if you’re using an on-demand dose, it is going to heighten your regular nighttime erections, which is a normal physiologic thing. So getting erections at night while you’re sleeping is something that we consider a sign of health of your erections. It’s healthy. So if you’re taking Cialis and then you get one of these nighttime erections, it’s certainly going to make it more robust. Now that being said, this is probably bothering the caller.

Donna Lee: 

Yeah, because he wrote in…

Dr. Mistry: 

Because he wrote it, because he’s not happy that he’s getting one in middle of night.

Donna Lee: 

Nor is his wife.

Dr. Mistry: 

You know, it’s probably causing him some discomfort. So what I would tell you in that case is that lowering the dose, if you’re taking a 20, go to 10, and if you’re not using a daily dose, consider that even a 5 and some patients will work just fine. And so, and then the likelihood of developing a bothersome nighttime erection is probably much lower. I think that that’s probably going to be the best sort of advice. There’s also some people who get an erection when they have a full bladder. And so, for that particular question, I would all say that perhaps making sure that your bladder is empty prior to going to bed will also help when you take the Cialis.

Donna Lee: 

That’s an easy step. And you prefer the daily Cialis, we’ve talked about this, over the Viagra because Viagra, you have to have an empty stomach.

Dr. Mistry: 

That’s right.

Donna Lee: 

And you don’t hear about that on the commercial.

Dr. Mistry: 

Sildenafil or Viagara works best if you have an empty stomach and an hour before, which means that if you take it after dinner because you’re having sex at night, it may not work very well.

Donna Lee: 

I’m just so fascinated, they don’t talk about this on the commercial.

Dr. Mistry: 

Well, it’s complicated, you know.

Donna Lee: 

But they need to know because it’s not working if they’re eating. Poor guys.

Dr. Mistry: 

And the Cialis, you have to take four hours before for it to have optimal effect. And the daily Cialis, what it gives you is spontaneity. And it also helps with urinary urgency, frequency, and your urine flow. And so with all that in mind, you get kind of an added benefit of Cialis daily, and it greatly improves spontaneity, and it’s cheap, you know. In our clinic it’s 90 bucks for 90 days, so…

Donna Lee: 

I know, it used to be so expensive.

Dr. Mistry: 

It used to be so expensive and that cost issue isn’t there anymore. So, you know, if you’re interested, if you have ED, if you’re interested in a better form of treatment, if the pills aren’t working anymore and you want to know why, or if you really just want to find out why you have ED. If you’ve just been told some story like, “Well, it’s just blood flow? Here’s your pill, good luck.” But you’re 35 years old, or even 45 or 55 and you want a deeper answer. Come to us. We’re gonna help really try to unpeel what’s going on with you and that way we can individualize the treatment for you.

Donna Lee: 

Good answer.

Dr. Mistry: 

Very good. Well…

Donna Lee: 

You have more questions.

Dr. Mistry: 

Donna, how do people get ahold of us?

Donna Lee: 

Send us your questions. These are amazing questions and we’re giving you free advice on the radio. Armormenshealth@gmail.com. That’s armormenshealth@gmail.com. Our phone number is (512) 238-0762 our website is armormenshealth.com. Have a wonderful rest of your Saturday, Dr. Mistry!

Dr. Mistry: 

Yeah, everybody too.

Donna Lee: 

Bye!

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

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