Phone: 512-238-0762

Fax: 512-341-7370

March 14, 2020

Exploring All Options: Dr. Mistry and Dr. Jacomides Discuss the Importance of Options in Healthcare and the Treatment of BPH

Speaker 1: 

Welcome back 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, happily providing you information on men’s health topics on our show here on KLBJ news radio and on our podcast, the Armor Men’s Health podcast, joined as always with my cohost, Donna Lee.

Donna Lee: 

That’s me. You can find our podcasts wherever you listen to podcasts and they’re free. You don’t have to pay a copay.

Dr. Mistry: 

You don’t have to pay copay. You know, that’s an interesting point. Kelly, our contact here at KLBJ, mentions the fact that this is probably the most intense and longest time you’re going to spend with a urologist maybe in your entire life.

Donna Lee: 

That’s right. And Daniel who produces the show…

Dr. Mistry: 

…even if you have a urologist.

Donna Lee: 

That’s right. I heard from Kelly that Daniel’s learning quite a bit as a young buck man [inaudible] he’s learning quite a bit. So thank you for Daniel and Kelly.

Dr. Mistry: 

He’s looking forward to aging, I guess.

Donna Lee: 

He’s like, “Geez, I’ve got to deal with all that?”

Dr. Mistry: 

He’s like “Oh boy, something is going to happen to us.” Today we’re joined by our newest partner here at our urology practice, Dr. Lucas Jacomides. Welcome Lucas.

Dr. Jacomides: 

Thank you. Appreciate it.

Donna Lee: 

Jacomides is Greek, correct?

Dr. Jacomides: 

[inaudible]

Donna Lee: 

That’s a yes.

Dr. Mistry: 

You know, I’ll tell you that although Jacomides is new to our practice, he is old hand here in the Austin/Round Rock area. Why don’t you tell people kind of what your work experience has been and who you worked for before?

Dr. Jacomides: 

I have been in the Austin metropolitan area for the last 15 years, since 2000…it’d be 2006, actually, so 14 years up in the Northern regions with the Baylor Scott and White, Austin/Round Rock region. Started my own practice 2 years ago and then joined up with these fine folks approximately one month ago.

Donna Lee: 

Been a month.

Dr. Jacomides: 

It’s been a month.

Dr. Mistry: 

For our listeners, a urologist is a surgeon, a surgical sub-specialty. My training was after 4 years of medical school and a year of research, I did a 6 year residency that was a surgical residency and then then came here to Austin. Lucas, where did you train? How long all those years take?

Dr. Jacomides: 

I trained for at least 17 years. No, it was, after I spent a decade in Dallas where I did 4 years of medical school, 6 years of residency. I was the last of the 6 year residents–now all these softies get 5 years and they think they know it all after that. And then everything else has been job training after that. So I think we’re at a good age. This is a good age to go to a urologist who’s in this 40 something.

Dr. Mistry: 

I think so. I think so.

Dr. Jacomides: 

We’ve figured it out.

Dr. Mistry: 

Yes, yes.

Donna Lee: 

Especially because y’all have 9 children between you.

Dr. Mistry: 

That’s right.

Dr. Jacomides: 

My god.

Dr. Mistry: 

You know, it’s an interesting comment there. When I was finishing up residency, some of my professors told me that as chief resident, I was at the peak of my surgical capabilities. I always thought that was prideful. Then I was like, “Oh man, I’m just going to get worse.” But I don’t think so. I think that having experience has made a far better surgeon today than when I first started. And learning when not to operate has been even more important than when to operate and how to operate. If you’re looking for a surgeon that has experience both on how to do the case, but also how best to determine whether or not the case is right for you, make sure you get a second opinion, if you have a urologist or a complex urologic condition and you want another opinion, Dr. Jacomides and I would both love to take a swing at what’s going on with you and maybe confirm either your concerns or confirm what your urologist may be doing already. Lucas, is there a particular topic in urology that really excites you? Are there particular types of conditions you that you’re really fond of taking care of?

Dr. Jacomides: 

I love it all. I really do. I think it’s an incredible trust that we’re given. I think cancer as, you know, you make such a big difference in people’s life, and they are forever grateful for the care and you see these people repeatedly. I like the fact that I can see people and decide, okay, now it’s time to operate on a big prostate versus medications. If they wanted to try something different for awhile or they want to do something in between–a very minimally invasive procedure. The instant gratification of a kidney stone and we’re coming up on stone season, you know, those people are very, very happy to see you and most people aren’t really happy to see their urologists. Let’s clear it up here. Incontinence, of course. I mean, again, I just like taking care of men, women, old, young, surgery, clinic. It makes my ADD brain very happy.

Dr. Mistry: 

That’s great to hear. And I think that you’ll see that often amongst urologists, there’s a survey done every year. 80% of urologists would become doctors again, and 88% would become urologists again. And I think it’s because nobody else can handle our sense of humor.

Dr. Jacomides: 

It’s really twisted, you know, it’s really a difficult…

Donna Lee: 

It’s a fascinating study, or questionnaire.

Dr. Mistry: 

Isn’t it?

Dr. Jacomides: 

88% would become urologists again. Yeah, I would.

Dr. Mistry: 

I mean I’m just drawn to it. What are you gonna do?

Dr. Jacomides: 

That’s right. Otherwise it’s just totally inappropriate to be like, what, you know…dentist. I mean, no offense, I love my dentist.

Dr. Mistry: 

So between when we both kind of started practice, similarly, you know, almost 15 years ago, one of the trends that I’ve seen with a lot of urologic conditions is getting away from medical management. I think that when I was training, and when you’re a medical student, you like the fact that you associate a disease process with a cure–you have disease A, here’s pill B. Good luck, go on your way. What I’ve learned though in practice is that although the pill may work for the condition in most people, it doesn’t work for all, and not all people is that pill the right answer for because the pill can cause complications and side effects. BPH is a great example of that conundrum. So there are 2 pills, 2 classes of pills that are classically used for people with an enlarged prostate. One is called alpha blocker therapy. Medicines like Flomax or Tamsulosin would be common for there. The other class of medicine are 5 alpha reductase inhibitors or medicines like Finasteride and Dutasteride, and both of those are associated side effects, right?

Dr. Jacomides: 

Yeah. I think it’s a great point you made, you know, but if you look back even further in the 1980s, the old roto rooter Terp was the number 2, if not number 1 surgery done in this country after cataracts because there were no pills. So these previous generation of doctors were really, really good resectionists because they could, that’s all they did. I mean that took up a lot of their day. And then when we started coming through, it’s like suddenly we were [inaudible] pushing pills. And then what you’re starting to see now is that these patients would need surgery at some point, but only when they were older and their bladder was in much worse shape. So…

Dr. Mistry: 

It’s like a swing of the pendulum, you know–you’ve had an operative approach and then it swung to more medications. And I really, you know, when I get a patient that I, that’s referred to me for an enlarged prostate and I see they’re already on Tamsulosin, you know, I do advise them that these medications do have longterm side effects and risks, and that there might be a minimally invasive approach to their condition, just like you said, to do when they’re younger and they can really appreciate and enjoy it and they can have fewer side effects and have a stronger bladder at the end of it.

Dr. Jacomides: 

Yeah. Nobody likes the word “roto rooter” applied in the same sentence as their genitals, you know, they want something that seems much more precise and, you know, words like laser are used, but you know, we can do a procedure and in 15 minutes take away your need for those medications. So, you know, there are things we can do in the office or things we can do as a quick day surgery. So, you know, at least know what your options are before you’re, you know, thinking it’s very binary of pill versus surgery.

Dr. Mistry: 

You and I have a little slightly different experience with 2 different kinds of minimally invasive BPH surgery. You do a lot of Urolift, I do a lot of Rezum. In Urolift, maybe you…describe it to our listeners how you describe it.

Dr. Jacomides: 

Well, Urolift is a usually a series of 4 or possibly 6 almost sutures, and I’m making my hand motion, which doesn’t translate very well in radio, but if you can see through the dial…

Dr. Mistry: 

It’s best that they can’t see you though.

Dr. Jacomides: 

It’s best to keep my hands where everybody can’t see that. But that makes [inaudible] sounds terrible. But the goal there is to basically create an opening and, you know, you can look at our website. There should be some great videos, or just look up urolift. But not every patient is a candidate for it. I think it’s a question of getting you in and making sure that we do further workup to say that can you have this procedure, and some patients are much more a candidate for Rezum or even surgery.

Dr. Mistry: 

So, you know, the urolift procedure, the way I explain it to patients, it’s a mechanical moving of the lobes away from the internal urethra and opening up that channel. So, it takes about 10 to 15 minutes. It can be done in the office or in the operating room. Your catheterization postoperatively is minimal. And really what you’re doing is just kind of moving the prostate lobes out of way. I do a lot of Rezum. Rezum is an office based procedure where we use hot steam, literally injected right into the prostate tissue itself. It leads to a death and a shrinking of that prostate enlargement tissue and less squeezing of the urethra. It can be done in about 15 minutes. Your catheterization lasts for about a week. And it really causes the prostate itself to shrink. We also, if you’re interested in it, do have a lot of patients referred for prostate artery embolization. This is where the blood supply to the prostate is actually cut off leading to a shrinking of the prostate. It’s a treatment that doesn’t require catheterization and takes less than an hour. So right here, 3 different procedures offered that do not require hospitalization, get you off your meds, and make you feel normal again, are things that really to me illustrate how urology has evolved.

Donna Lee: 

It’s fascinating. 3 options right here, guys, for free.

Dr. Mistry: 

That’s right. So if you have BPH and you’re on pills and you want another option, please let us know.

Donna Lee: 

That’s right. Give us a call during the week at (512) 238-0762. This show by the way, brought to you by Urology Specialists.

Dr. Mistry: 

That’s right.

Donna Lee: 

We haven’t mentioned that in a minute. So the Armor Men’s Health Hour is brought to you by Urology Specialists, Armormenshealth.com is our website and you can email us all of the questions you can think of to armormenshealth@gmail.com. That’s armormenshealth@gmail.com.

: 

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

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