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May 2, 2020

Dr. Mistry and Donna Lee Discuss Thrombocytopenia and Other Medication Side Effects

Speaker 1: 

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

Dr. Mistry: 

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

Donna Lee: 

That’s right. Hello, Dr. Mistry with the real name.

Dr. Mistry: 

That’s right.

Donna Lee: 

M-I-S-T-R-Y.

Dr. Mistry: 

I’m a board certified urologist. We are currently seeing new patients. Absolutely love to tackle problems that others may not have tackled for you. So, we’re really big fans of the second opinion. Common conditions that we will see patients as a second opinion for are chronic testicular pain or ball pain as we call it around here, prostate cancer or other types of cancer where surgery or nonsurgical treatments have been recommended. We have a whole host of patients that we see for low testosterone, patients that have been getting treatment at other facilities or people that want to get their testosterone levels checked or they want somebody else to take a second look at their testosterone. So if any of those things are happening or you feel like your urologic care may benefit from a fresh set of eyes, these are definitely things that we really savor to take care of and would love to see you for.

Donna Lee: 

Why do you think, what’s the number one reason that we get a lot of referrals from little popup testosterone clinics?

Dr. Mistry: 

I think that there’s a couple of reasons. Number one is in order to make prescribing testosterone easy enough for anyone to do it, you have to have some rules so that you don’t get into trouble. A frequent example of that is there’s a myth that testosterone, exogenous testosterone will cause prostate cancer. So that’s a long held myth.

Donna Lee: 

Why did that start, was there a study that was misread or something?

Dr. Mistry: 

It was not misread. It’s that if you have cancer of the prostate that spread somewhere, and you take away all the testosterone in the body, that cancer slows down, but it doesn’t die. It just slows down. And so people took that information and then extrapolated the opposite side, which is that, well, if taking away testosterone starves the beast, maybe testosterone feeds the beast. What more recent testing has found is that there’s a, there’s a level of testosterone above which the cancer will, it’s immaterial to the cancer, and that level is probably somewhere above 150’s. If your testosterone level is 300 or 800, there is no evidence to show that taking testosterone is going to cause prostate cancer to form or cause any existing prostate cancer to grow more quickly. But getting back to your original question, the way we check prostate cancer in most cases is by finding an elevated PSA or prostate specific antigen blood level. It’s a test that’s routinely done in men over 50, between the age of 50 and 70 to look for prostate cancer. And so if the number’s high, you know, algorithmically people want to have that person seen by urologist prior to prescribing the testosterone. It’s because we want to make that easy. Now, another reason is because if you’re getting testosterone, you may have other male problems like difficulty urinating or ED or testicular pain. If the clinic that you’re going to only does testosterone, if that’s the only hammer they have, then everything looks like it can get fixed by testosterone. It’s similar to those clinics that are around that do penile injection therapy for erectile dysfunction. It’s called intracavernosal injection therapy. So for those people, for those clinics, everything can be solved with an injection into the penis when maybe that’s not really what the problem is, maybe it won’t fix it.

Donna Lee: 

Sounds like a party!

Dr. Mistry: 

That’s right. I guess, you know…

Donna Lee: 

A terrible, terrible party.

Dr. Mistry: 

…come here for low libido or Peyronie’s or for premature ejaculation or for erectile dysfunction. So it’s not like every problem with your penis is going to get fixed with that injection, but because that’s what they do, they sell injections, they’re going to do that. We believe in a more kind of holistic approach. So not only do I feel strongly that erectile dysfunction is connected to hormone levels, but I think it’s connected to your overall health, your weight, it’s collect connected to your neurologic system. If you have somebody that has a real narrow view of what’s going on with you, then they’d be missing the bigger picture. Another great example is people that have urinary complaints like urgency and frequency, but also have irritative bowel symptoms. Now, both those things can be caused by dietary issues and dietary changes can affect both. Similarly, over the years, we’ve put a lot of connection between infertility and chronic skin conditions. There’s some inflammatory mechanism that that leads to perhaps increased, you know, infertility rates in people with certain dermatologic conditions and certain metabolic conditions. We see a ton of male fertility patients here, we’re incredible partners with many of the reproductive endocrinologists or IVF doctors in town. They send us patients who have complicated but unexplained infertility. And we found that up to 10% to 15% of those patients have undiagnosed chronic medical conditions like diabetes or high blood pressure. And those things do affect your testicles and your sperm production because, you know, if you’re not healthy, your body doesn’t think that you’re in baby-making mode. You know, it’s almost like a like a where’s their body gonna put resources. If you’re an undiagnosed diabetic, it’s probably not putting it into making great healthy sperm.

Donna Lee: 

Right, and inflammation is a big discussion point everywhere.

Dr. Mistry: 

That’s right. That’s right. For us, you know, we believe that in inflammatory conditions contribute to kidney stones and cancer development, obesity and low testosterone and erectile dysfunction, all the things that we take care of. One of our big pushes is nutritional guidance guided towards or nutritional guidance that’s developed in a way to reduce inflammation in the body and we’re just very pleased with all of the people here that help us put that together. We have an onsite nutritionist, Robert Mendiola, excellent. Many of you who patients of ours have been referred to our nutritionist and if you think that there may be a nutritional component of your underlying medical condition, it’s absolutely a tool that we are ready to use.

Donna Lee: 

Get it checked out. And we do food sensitivity testing too. That’s always a fun topic because when you find out that you are gluten sensitive or dairy sensitive, your whole whole world is rocked at that point.

Dr. Mistry: 

It is rocked.

Donna Lee: 

I did that to my husband, my step sons and my son. They all did their food sensitivity tests with us and all of them are sensitive to dairy and wheat.

Dr. Mistry: 

Oh boy.

Donna Lee: 

Sorry guys.

Dr. Mistry: 

There goes the pizza.

Donna Lee: 

It’s really been awful.

Dr. Mistry: 

They’re feeling better though.

Donna Lee: 

They do feel better and they’re teenagers, so they’re following the guidelines and they feel better.

Dr. Mistry: 

They’re teenagers, so they’re following the guidelines? That doesn’t make any sense to me.

Donna Lee: 

They’re staying away from wheat, they’re staying away from dairy. They’re not happy about it.

Dr. Mistry: 

You’ve got some well behaved kids.

Donna Lee: 

Well, sometimes.

Dr. Mistry: 

Well our show thrives on your questions. So Donna, you got a question?

Donna Lee: 

We do have a question. Let me get to this one. I appreciate the questions that come into armormenshealth@gmail.com. And again, that’s armormenshealth@gmail.com. “My husband was prescribed Bactrim for 30 days for an infection, Dr. Mistry. He went to a urologist for testicular pain and blood in his urine. At 14 days, he developed thrombocytopenia. He was on blood thinner. So this is very serious. Is 30 days of the normal protocol? Can Bactrim cause this side effect? Thank you.” From a listener.

Dr. Mistry: 

That’s a great question. Really, this has to do with two parts of this question. One is how do we treat something like chronic, or an episode of epididymitis, which caused can cost testicular pain, and blood in the urine, which could be caused by prostatitis. What is our standard kind of course of treatment for it? And then what are some potential side effects or negative outcomes of some of the antibiotics we give? So…

Donna Lee: 

What’s thrombocytopenia?

Dr. Mistry: 

Thrombocytopenia means that the platelet count dropped very low and the platelets are what component of our blood help us stop clotting. So if you’re on a blood thinner, that means you’re already not clotting. And then if your platelets are low, that means you’re even worse not clotting. And, I have to say that it’s, that thrombocytopenia certainly could be a side effect of that medication. Whether that was the case in this situation, I couldn’t say because there are blood thinners in other medicines that can also cause the platelet count to go down and other medical conditions that cause the platelet count to go down. It’s an unexpected one. And to be honest, not one that I specifically mention when we give Bactrim to them, either. It’s in the foldout sheet that comes with the medication. But Bactrim for that condition is a very commonly used one in our clinic. We do have, we do also use Cipro or a Quinolone kind of antibiotic, but those are associated with tendon rupture, with ligament injury, and actually, over the years we’ve gotten away from using it routinely for these kinds of infections. So that antibiotic choice I certainly have no strong argument with. And the length of time to treat is also something that is very consistent with what we do. We do about a 21 day course for most prostatitis infections because of how difficult it is for antibiotics to penetrate the prostate. It’s a very kind of protected area and the testicle is even more protected. So prolonged courses of antibiotics for both testicular and prostate infections are something that we do quite commonly. The side effect is not common. And knock on wood, I haven’t seen thrombocytopenia with Bactrim. But recently, as early as this year, we did have a patient who had a very abnormal skin reaction to Bactrim, had blistering and almost like a burn sensation. And it was highly unexpected, not something that we’ve ever seen before, and just goes to show you that, you know, there’s a give and take for almost everything that we do as doctors, and there is a, there’s a risk inherent in virtually every intervention, just as there are risks to not doing anything. And, to the best of our ability we try to educate our patients and educate our staff and educate ourselves. But, you know, atypical kind of reactions are unfortunately atypical, but they do happen. They’re not impossible. So, that’s a great question.

Donna Lee: 

Thank you to that listener. We’ll respond for sure. I will respond to each email, but you can reach us at armormenshealth@gmail.com. Keep sending those questions and we’ll be right back.

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

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