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March 14, 2020

Dr. Mistry and Patient Dave Discuss Overactive Bladder and Neuromodulation Treatment

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: 

Hi, how are you? I almost forgot to put my face up into the mic.

Dr. Mistry: 

Oh, very good. It doesn’t really help when we can’t hear you.

Donna Lee: 

When I yell from across the room.

Dr. Mistry: 

That’s right.

Donna Lee: 

Awesome.

Dr. Mistry: 

Practicing urology here in Austin has been really satisfying. One of the things I really like to do is to help people with problems they’ve been dealing with for a long time and getting inadequate answers.

Donna Lee: 

And bringing on special guests?

Dr. Mistry: 

And bringing on special guests. One of the problems that we deal with very commonly for both men and women is the problem of overactive bladder with urinary frequency and urgency. There’s a variety of treatments available for it. In the past, the mainstay treatment has been medications, and these medications can have side effects. More recently, we’ve become a lot more interested in doing nerve stimulation or something called neuromodulation for overactive bladder. And I thought it would be a great idea to bring on somebody that’s actually had it done.

Donna Lee: 

Right! What a great idea. That must’ve been your idea because it was great.

Dave: 

It was great.

Dr. Mistry: 

So, we have Dave from Fort worth.

Donna Lee: 

Hello!

Dr. Mistry: 

Dave, thanks a lot for joining us.

Dave: 

Thank you. Thank you for inviting me.

Dr. Mistry: 

And Dave, you’re a retired Presbyterian preacher.

Dave: 

Yes.

Dr. Mistry: 

And that means that you can’t lie.

Donna Lee: 

Or cuss.

Dr. Mistry: 

Or cuss? You can’t cuss?

Dave: 

No, no.

Dr. Mistry: 

Man, lots of rules. You’re a big fan of TCU.

Dave: 

Yeah, I used to be a Houston Astros fan, too.

Dr. Mistry: 

Really?

Donna Lee: 

But that changed.

Dr. Mistry: 

My neighbor’s father was the coach. The…what’s the name of the stadium there at TCU?

Donna Lee: 

TCU stadium?

Dave: 

No, I forget.

Dr. Mistry: 

Anyway…

Dave: 

Patterson’s the coach. He’s almost like a God up there in Fort Worth.

Dr. Mistry: 

Is he?

Dave: 

Gary Patterson.

Dr. Mistry: 

And coming from your mouth, that’s saying something. So, your struggles with urination are unique in that a lot of them began after back surgery.

Dave: 

Yes.

Dr. Mistry: 

And I hear that a lot. So people with recurrent back surgeries often will end up with overactive bladder and urinary issues. What we’re going to talk about today doesn’t just pertain to people with urinary symptoms after surgery. Maybe you could tell us, what were some of the symptoms you were having?

Dave: 

I had to, I couldn’t sleep. I had to go to the bathroom every hour, sometimes every 15 minutes. So I had to go into another bedroom so it wouldn’t interfere with my wife’s sleeping. When I would get home or even when I was out working, and I would get the urge to go to the bathroom, and I had to go right now. And it wouldn’t wait. But the main thing was not being able to sleep at night.

Dr. Mistry: 

And I think that that’s a very common complaint. So a lot of the guys that I see, you know, they’ll deal with the daytime frequency because they’re, you know, they either are retired at home, or they have a job in which they can have easy access to the bathroom. But having to get up 4, 5, 6, 7 times at night is really very disruptive to them.

Dave: 

In the daytime, too. When you’re out, say working outside in your garden and you have to keep going to the bathroom.

Dr. Mistry: 

When you’re a man, a lot of times your urologist or primary care doctor is going to blame your prostate first and talk about your prostate as being the main culprit. Is that what happened to you?

Dave: 

No, because the real problems came on after my 5th back surgery, and I had a good doctor and she explained to me–she was a occupational rehabilitation doctor–and she explained that the nerve damage in my foot and also this urinary problem, there’s often several side effects of having back surgeries.

Dr. Mistry: 

Well, I think you’re really lucky because that means that you weren’t kind of led around different kind of treatment pathways that weren’t gonna work. And so, I really like to talk a little bit about kind of how the procedure of neuromodulation was explained to you. Like, I’d like you to, you know, sometimes maybe the words I use are hard to understand. How was the procedure explained to you? And then we’ll talk about the process.

Dave: 

They wanted to use me as a test, first of all, and they asked if I would be willing to have electrodes implanted in my buttocks and keep a 3 day test and keep a record of the results and when I had to go to the bathroom, what happened, how much flow and so on like that. If there was a 50% improvement over that 48 hour period of how often I had to empty myself, that I would be a candidate for the surgery. The surgery then would, they would put in electrodes similar to the test process. And after 2 weeks I would choose whether I wanted the one type of electrode or the other type of electrode, left or right. They would implant a permanent battery and I, and then there would be a charger that was kinda like my brother’s pacemaker almost, you know–lasted 15 to 20 years.

Dr. Mistry: 

I think you used a great term. And that’s the pacemaker. And so when I explain it to patients, I really try to explain that a lot of this is a lot like kind of finding a pacemaker for the bladder. So, when you talk about the electrodes that are put in your buttocks, it’s because the nerves that are going from your spine to your bladder actually emanate from the very bottom of the spine, and traverse kind of in the buttocks region. And so what we’re trying to do surgically is put in electrodes that stimulate those nerves and then make the nerves that are going to your bladder behave better. So just like a pacemaker. And you went through a test for 3 days, and that test, did you to go to sleep for that test? For those electrodes to be put in?

Dave: 

No, I did it awake.

Dr. Mistry: 

So you were awake and so there was no anesthesia there, and how soon after…

Dave: 

Oh no. When the actual electrodes, the permanent electrodes were put in, yeah, I was, but that was surgery in an outpatient surgical room. Yeah, I was put to sleep.

Dr. Mistry: 

And so how soon after the permanent implant was put in did you start feeling improvement?

Dave: 

Almost right away.

Dr. Mistry: 

And would you say that was more than 50% or right about 50%?

Dave: 

Yeah, right about 50%. And my wife, fortunately I have my wife who can help me position the charger over the battery and we would charge it every 7 days. Although many people, it’s supposed to last up to 21 days, and anybody can, you can recharge it anytime you want. And I recharge it every Wednesday afternoon. It takes about an hour, hour and a half. My wife helps position the charger. You have a remote control where you can make it the stimulus higher or lower. And, I started going to sleep again and I would fall asleep around 1:00AM or 2:00AM, because often I work up untill that time of the day. And I would sleep for 3 or 4 hours until my cat would waken me thinking it was her breakfast time, and breakfast time could be anywhere from 4:30 to 6:00.

Dr. Mistry: 

So, this type of stimulation called neuromodulation and this kind of nerve stimulator has been around in some form or fashion for many years. And the original product that we were using, one of the problems with it was that the battery that you use to kind of power the electrodes, you couldn’t get MRIs when you had this battery pack in. And unfortunately, it’s a lot of the same patient demographics. A lot of the guys and ladies that you’re putting this in, you may want to get an MRI on later. And so that was one problem with it. And the battery’s pretty big. But more recently, there’s been another product brought to the market. It’s made by a company called Axonics, A-X-O-N-I-C-S, that is the type of implant that you had put in, right?

Dave: 

Yeah. It’s about size of a cigarette and there’s a battery in there and you can wear a belt and recharge it. The belt is worn outside and it’s only, you only wear it when it’s time to recharge it.

Dr. Mistry: 

That’s a great point. So if you’ve been kind of counseled on getting neuromodulation in the past, one of the problems with it was the battery goes out, you know, every 5 or 7 years. And so you have to go back and get it changed out. So having a rechargeable battery, one that you can not have to change out means less surgery and less discomfort overall.

Dave: 

Yeah. This one’s supposed to last 15 to 20 years, and since I’m 74, I didn’t buy a extension warranty.

Dr. Mistry: 

Oh, man. Well, I think that for those listeners out there who are suffering from urinary frequency and urgency, and if somebody has already done the whole gamut of things from treating your prostate or putting you on meds or giving you dietary advice and you’re still not getting anywhere, for our own clinic patients, those that are getting intermittent Botox injections into the bladder, but are looking for a more permanent solution, neuromodulation therapy is something that I would strongly urge you to do. And Dave, it sounds like you’re pretty happy with it.

Dave: 

I’m very happy. I was happy to drive down here to Austin from Fort Worth to do that.

Dr. Mistry: 

Absolutely.

Dave: 

Be on the radio.

Dr. Mistry: 

Well, we really appreciate your input and uh, and I’m sure that if there are patients that have questions, they can let us know. We’ll forward them to you. And I really appreciate all your advice and information.

Dave: 

Thank you for inviting me.

Donna Lee: 

Thanks for being on. That was fascinating. So 2020–put a little device in your backside and you don’t have to pee as much.

Dr. Mistry: 

That’s right.

Donna Lee: 

You can sleep at night…until your cat wakes you up.

Dr. Mistry: 

Until your cat wakes you up. You can’t…there’s a special kind of stimulator for that. Just a taser for your cat.

Donna Lee: 

A cattle prod?

Dave: 

Catatonics.

Dr. Mistry: 

Catatonics. Donna Lee, how do people get a hold of us and send us questions?

Donna Lee: 

If you have any questions, email them to armormenshealth@gmail.com. That’s armormenshealth@gmail.com. Our website is armormenshealth.com. We’re in Austin, in Round Rock, North Austin, South Austin, and Dripping Springs now, so we’ll be right back after these messages.

Dr. Mistry: 

Right back.

: 

Dr. Mistry wants 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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