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April 11, 2020

Dr. Mistry and Donna Lee Explain Urology Specialists’ Holistic Approach to Urologic Care

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: 

Hi, you sound exceptionally smooth today.

Dr. Mistry: 

Well, I’m telling you I’m nice and healthy, thankful for all that I have. A big shout out to our amazing, wonderful staff here at NAU Urology Specialists. Diligently working and trying to stay on task even though they probably have a lot of different stressors in their life and a big shout out to all of the first line medical workers out there that really are risking their lives to maintain the ERs and maintain what we have, you know, as a profession and as a community. We’ve had several cases of the Covid-19 in the Austin area and I’ve even had some of the patients that we’ve treated in the past call us and let us know that they were admitted to the ICU or sick from the disease. And our prayers go with them.

Donna Lee: 

Mhmm. Prayers to everybody, that’s been a really stressful time. Big shout out to our staff. Like you said, working from home has been challenging, but we’re pulling it off, Dr. Mistry.

Dr. Mistry: 

Yes, and for those of you that are our patients or are prospective patients, please be patient. We’re doing our best to try to get ahold of everybody and answer all the phones and do everything we can. The fact that we were able to change so many things over to telemedicine so quickly is actually a real testament to the work that you do as our office manager. Thanks a lot Donna Lee.

Donna Lee: 

Thank you. And kind of a pun on Peyronie’s disease–we were ahead of the curve on the telemedicine. We’ve been doing it for a while.

Dr. Mistry: 

I’m going to get in trouble again.

Donna Lee: 

I’m sorry.

Dr. Mistry: 

Very good.

Donna Lee: 

You know, I was thinking the other day about how, I remember the first time you called me, I was working at Victory Medical Center in South Austin–shout out to them, they’re fabulous. I was one of the directors there, but the practice manager came to me and she said, “This guy named Dr. Mistry called and who is this guy? He’s looking to chit chat with us and, you know, maybe join forces kind of thing.” And I was like, “Oh, that’s crazy.” And then the next thing I know on my voicemail, I get Dr. Mistry, a voicemail from Dr. Mistry with this smooth voice. And I was like, “Who’s this cat with a crazy name?”

Dr. Mistry: 

This cat with a crazy name…

Donna Lee: 

It turns out that’s your real name!

Dr. Mistry: 

…We still got a lot of people wondering if that’s my real name.

Donna Lee: 

Right? It’s M-I-S-T-R-Y.

Dr. Mistry: 

I’ve always grown up with it. So I’m always confused when people don’t think it’s my real name.

Donna Lee: 

Is it, it’s pretty common in India?

Dr. Mistry: 

No, I don’t think so.

Donna Lee: 

No, it’s not like Smith.

Dr. Mistry: 

No, it’s not like Smith at all.

Donna Lee: 

It’s like Mordecai or something? Anyway, you and I met and I remember taking you through the clinic and we were chit-chatting about your philosophy and how you approach urology. And I found that to be unique and exceptional because the other urologists did not stand out to us. One of the main reasons why I joined forces with you was your holistic approach to urology, and I think that’s something we can talk about.

Dr. Mistry: 

Well, I think absolutely. When you train as a urologist, you spend a lot of time in the operating room. In fact, it’s a surgical sub-specialty. When you’re in training, that’s all you want to do is operate, operate, operate. Taking care of patients in the clinic actually isn’t a huge either fun thing to do when you’re training or something that I think is really focused on. And so when I started practice, while you were trying to find surgical patients all the time, it really opened my eyes to something that we were taught in the early beginnings of training by the more senior doctors, which is that it’s one thing to learn how to operate and the more experienced person will know when is it time to operate. And so this idea of trying to understand where the patients are coming from, understanding the underlying processes that are going on that have led to a disease process became more and more interesting to me. And in no other field that we handle was that more seen than low testosterone. We were getting just inundated with low testosterone referrals. If you just want to do it easy, you can just put people on testosterone because they’re feeling fatigued or they’re feeling low libido.

Donna Lee: 

Quick fix?

Dr. Mistry: 

It can be a quick fix, a 3 minute appointment, get them on testosterone and get them out the door. But what ends up happening is that 70% of these men are not happy. The testosterone doesn’t do anything for you. And so you take a step back and say, “Okay, well this guy is overweight by 40 pounds. He’s got obstructive sleep apnea. His hypertension and his high cholesterol aren’t treated. What favor am I doing this guy, by just putting him on testosterone when I know he’s going to have a 70% failure rate?” Because I was armed with this experience, I could have either said, “Well, you know what? I’m treating 30%. The other 70%, I’m sorry, you know you need to go somewhere else.” But I decided to take a different take on it. I said, “Okay, if they’re overweight, let’s have a weight loss program. If they have sleep apnea, let’s have a sleep apnea program. If they need their cholesterol or their hypertension managed more aggressively, let’s work with their primary care doctor, or let’s take on some of that responsibility ourselves.”

Donna Lee: 

And sexual dysfunction.

Dr. Mistry: 

And then of course the sexual dysfunction aspect of it, because there can be biologic, neurologic, hormonal, there can be psychological impacts. And so that’s why we put together a sex therapist on staff to really kind of get to the root of what’s going on. And that’s where the Armor Men’s Health program really was born out. We had a number of patients come to us that don’t have insurance, and they in their minds think that testosterone therapy or getting kind of taken care of, is very expensive. Our program is $150 a month. That includes whatever form of testosterone you want to take, whether it be pills–whether it be injections, whether it be pellets, whether it be creams–as well as all the labs and all the visits. And we try to make it really comfortable and very convenient for you. So if you’re concerned that your insurance isn’t going to cover testosterone or you don’t have medical insurance, rest assured that you’re still going to be well taken care of for a very affordable price.

Donna Lee: 

Right. And it’s not, it’s $100 dollars for the first exam, and then $150 a month, and other programs are easily $1,000 a month…you know, $800 to $1500 a month. So…

Dr. Mistry: 

Oh yeah.

Donna Lee: 

So ours is really an expensive and, you know, we’re not making, trying to make $1 billion on this. We just want to help some people.

Dr. Mistry: 

Oh, sure. And I think that for those of us that do this in a medical setting, really look at people that just have hormone clinics and say, there’s no way they’re providing anything different than what we are. And I think that our basis, our biologic basis of education is going to make us just a more powerful ally for you if you have hormonal issues that you need treated.

Donna Lee: 

And we do have a lot of people that send in questions to armormenshealth@gmail.com. And their first question is, “Do you accept insurance?” So I want to make sure we point out that we do accept insurance. We can create a customized treatment plan for you, even if you’re of course presenting with insurance. This is just a different program, and another option that we offer.

Dr. Mistry: 

And a constant struggle really is trying to provide the maximum level of what I feel like is a concierge level of care to patients within a budget that they have and they can abide by. And although some of the services that we offer are cash pay, like shockwave therapy or vaginal rejuvenation, some of the aspects of our psychologic therapy, the vast majority of what we offer is covered by insurance. And is something that most people can avail themselves to.

Donna Lee: 

People come in every week, guys come in for their injections. Women, too. It’s really inexpensive. It’s like $10 if they have their medication and $20 if they don’t, and it’s like $60 to $80 at other clinics for injections…per pop.

Dr. Mistry: 

Right. If you have an aversion to giving yourself injections, if you have, if you’re concerned that you’re not going to do it right or get a dose right, then in-office injection therapy is something that we can do. It is our preference to try to teach you and arm you with that skill set, or to arm somebody in your family that can give you those injections. But if it needs to be done, we can do it, and we can do it in a very affordable way.

Donna Lee: 

The majority of patients do do their own injections though, correct?

Dr. Mistry: 

That’s right. The majority of patients do their own injections. If you’re part of a clinic in which you’re getting very, very small bottles and you’re having difficulty drawing up the right amount or you feel like your second or third injection of the cycle isn’t getting, you’re not getting a full dose, then then we have some other options available. Larger volume vials, you know, easy to obtain syringes and needles. It’s just something that, you know, after you’ve seen a thousand patients go through these struggles, you know exactly what we can do as a medical facility to try to make those struggles less burdensome.

Donna Lee: 

Mhmm. I have a question about testosterone. So do you think that the creams or the gels are as effective as injections for some people?

Dr. Mistry: 

Well, I would say that only about 5% or 8% of our patients are on the gels. I think that there are several concerns that people have with gels. There’s first of all, a risk of transference. It is a gel that lies on your skin so it can get on your spouse or get on your kids. There’s also a concern about how well it’s absorbed into the skin. And so, not everybody does it absorb or absorb very well. And when you’re doing testosterone gels, the way the studies were designed, it was designed to take men whose testosterone levels were around 250 and get them to around 350, so about 100-point range of bump. You’ll see some men that get much higher rises in testosterone. You’ll get men who have variable levels of absorption. So, you know, for our patients, I try to steer them towards injections because I know what they’re getting. I can adjust the dose more easily. It works pretty well if it’s going to work at all…meaning if low testosterone is the cause of your symptoms, of fatigue, of poor sex drive, of poor muscle mass, of poor cognition, then the injections are a nice way to get to the bottom of it. And so for those reasons, we do creams in some patients, especially legacy patients that come to us from other clinics. And we have wonderful, inexpensive options for you for compounded cream.

Donna Lee: 

You know a nice side effect that I have when I get my testosterone injection every 2 weeks is that I have the most amazing, vivid, crazy, wonderful dream that night.

Dr. Mistry: 

Oh boy.

Donna Lee: 

I know that’s not a common side effect, but I really look forward to my injections every two weeks.

Dr. Mistry: 

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

Donna Lee: 

You can call us during the week at (512) 238-0762. Our email address is armormenshealth@gmail.com. That’s armormenshealth@gmail.com, and our website is armormenshealth.com. Listen in and we’ll be right back after these messages.

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

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