Phone: 512-238-0762

Fax: 512-341-7370

December 22, 2019

Nutrition Care Planning: Robert Discusses Food Sensitivity Testing + Bonus Segment with Dr. Mistry on Lichen Sclerosis

Dr. Mistry: 0:00
For level of other types of urologic practices and something that I think is really important. I’ve said several times that, oftentimes when patients are diagnosed with cancer or have an inflammatory penile skin disease, I tell them to lose weight before surgery. You know, one of the first questions they ask is, what should I do? Or what should I eat?

Robert : 0:17
Right, right.

Dr. Mistry: 0:17
And so having you here, right on staff to be able to see and talk to our patients, I think gives us a next level of care. And what’s your educational background? Robert?

Robert : 0:26
So I have a Bachelor’s degree of science in dietetics. So you sit for an exam, you do rotations in different settings. So in the hospital, in different food service settings and community settings, just to kind of get a feel for the different applications of what a dietitian can do. So, yeah.

Dr. Mistry: 0:42
And most of the time dietitians work in hospitals?

Robert : 0:45
Yes. Most of the time.

Dr. Mistry: 0:45
And so it’s actually not that common, or it’s hard because it’s hard to make a living out in the community, when you’re trying to get people to come in and learn how to eat better.

Robert : 0:54
Right, right.

Dr. Mistry: 0:54
And so, I saw some interesting messaging from these Hollywood actors who talk about how they lose weight, get really ripped for roles and all of them, none of them say, “I just worked out all the time.” Right? All of them say that there was a very important component when it comes to nutrition.

Robert : 1:10
For sure.

Dr. Mistry: 1:11
In the bonus segment today, so if you’re, it’s not going to be on the radio show today. But if you’re listening to the podcast, we are going to do a bonus segment on a condition called lichen sclerosus and how it can cause a narrowing of the urethra and cause you not to be able to urinate. But that made me think of you because one of the areas that I think that we’re really trying to be pioneers of is the idea of how what you eat can cause inflammation in your body, and sometimes that shows up as inflammation in your skin or in the form of a rash.

Robert : 1:39
Right.

Dr. Mistry: 1:40
We offer food allergy testing for a variety of different reasons in our practice. What are some of the conditions that I send patients to you for that we’ll order food allergy testing?

Robert : 1:47
Definitely inflammatory skin conditions that are coming up, whether they’re directly urology related or not. I think that that’s really good to take that whole look at the whole person and their body. If there are a lot of autoimmune conditions that they might have a history of, definitely issues that are stemming from the gut–so inflammatory bowel diseases, interstitial cystitis I think is another one that’s really, that people benefit quite a bit from the food sensitivity testing. But in general, these really like inflammatory or auto-immune-seeming conditions that might be affecting how our immune system’s reacting to foods that we eat.

Dr. Mistry: 2:23
There was a patient that I remember very vividly taking care of who had came to me for infertility issues. And when I first saw them, they had a very, very red face that they attributed to rosacea.

Robert : 2:35
OK.

Dr. Mistry: 2:35
And it ended up that the rosacea started right when he started brewing beer at home.

Robert : 2:40
Oh yeah.

Dr. Mistry: 2:41
And it ends up he has a gluten allergy.

Robert : 2:44
Oh no, what a terrible way to find out.

Dr. Mistry: 2:44
So…I know, we took away…but his fertility got better.

Robert : 2:51
Good.

Dr. Mistry: 2:52
And his face got cleared up and he didn’t even know that he had this. And that always stands out as a very important reminder to me. People often will forget things they’re putting into their body by choice every day could be the very thing that’s making them sick.

Robert : 3:06
Yeah. I think it’s…so the test we use is through Greater Plains Labs. It’s a blood spot test. So we have the phlebotomist get a little bit of blood drawing because they’re better at that than I am.

Donna Lee: 3:18
Oh, so smart.

Robert : 3:18
Yes. Yeah. They’re way better at it than me.

Donna Lee: 3:19
We were at home trying to do that at home, like pricking our fingers and squishing the paper.

Robert : 3:23
Right. And the little kit comes with a little Lance that you can do at home. And, most of the time people are like, “I don’t really like it. I’m not comfortable with it”. So we just get phlebotomists, they’re, you know, experts at it…perfect. Yeah, we mail it out and within 10 to 14 business days, they send us back a really nice clear cut report.

Donna Lee: 3:39
It’s all pretty and color coded.

Robert : 3:41
Yeah. It’s very nice. And then we just use that to give recommendations that are a lot more targeted.

Dr. Mistry: 3:47
And it’s not always like allergic or not allergic, right. There’s like levels of what, and what we’re looking for is really whether or not your body has produced antibodies to a certain chemical or a certain component of food. And so in what you’re seeing, what are some common like surprising things that people end up being allergic to?

Robert : 4:05
There’s kind of like a miscellaneous section on there. It’s kind of interesting. So there’s like cane sugars, is some of like the outliers, you know, like grains and dairy and there’s different categories of those, too. So it’s not just like grains in this big umbrella. It’s like barley, oats, wheat, gluten; dairy is also gonna give you not just cows milk, but like yogurt, goats’ milk. So you, it’s not just a general blanket like, well, dairy may not work. Whatever. You get a lot more specific than that.

Dr. Mistry: 4:33
Which helps with diet planning, because if you just say, “Well, I can’t eat any dairy.” You’re not going to stick to that forever. It’s going to be hard.

: 4:40
Right. Yeah, yeah. So, we’ll get the results. We go over that in the office in an appointment or a one on one with somebody, and then we create, we kind of use that to create an elimination diet. Say, “Hey, okay, well this is what it looks like you’re reacting to or are highly reactive to. Let’s create a plan where those foods are removed, see how you feel. And then let’s slowly start to introduce one by one and see, you know, if some of those issues come back. And if they do, then you know that that’s not a food for you.”

Dr. Mistry: 5:05
You brought up several great points there. The first one was, it may not be everything that comes up positive on this test that you have to eliminate forever, right? It might just be a couple like really big triggers.

Robert : 5:16
Right.

Dr. Mistry: 5:16
So coming up with a plan that really tries to figure out what that trigger is important, right? And number two, you’re not always going to be, you weren’t always allergic to something, and you may not always be allergic. By eliminating it for a time period, maybe 6 months, maybe a year, we can retest it, see if, you know, and usually those numbers have all gone down because you haven’t been challenged with that meat or protein or whatever you were allergic to. So, a standard kind of patient that is going to go through this for us, a very like quintessential patient, would be somebody who comes to us with what we think is interstitial cystitis. So if we think that you have urgency, frequency, you know, even blood in the urine from an inherently inflammatory condition in the bladder, we’re gonna say, “Hey, you need to go on a special diet.” And that diet that you get from the interstitial cystitis association is very restrictive, because if you’re eliminating everything, you’re like, “Well I can do this for like three or four days, but I’m not going to be able to do this forever.” And so then it ends up being a recipe for failure. And so, by doing a targeted inflammatory test, we can say, “Okay, it’s not everything, but watermelon you need to get rid of.” That’s a very specific thing. And so I think that service that we provide is absolutely very innovative in the way that we’ve put it forth. Because most of the time you only get this kind of food allergy testing in like a very specialized functional medicine place.

Robert : 6:29
Yeah, yeah, I believe so too. I think, one thing that I think is really important and I let people know as we’re kind of going through the processes, you know, the cost that you’re going to find of this testing done here in the office versus, you know, having the testing and a report and a one on one, it’s gonna far outweigh the cost that you’re looking at here. And you’re getting some, you know, some sound targeted recommendations that are still specific to you. Another thing I let people know is, you know, dietician in private practice, because a lot of that changes will be in private practice, but the fee that you’re paying there will also outweigh what you would pay here to see an equally qualified registered dietician. And so I try to let people know that as well. “Hey, you know, this is honestly, it’s a really great deal and it’s, you’re going to get a lot of benefit from this. So, you know, we can continue to have our appointments and kind of, you know, see progress and how we’re going.”

Dr. Mistry: 7:19
You know, after treating men for almost two decades, there’s two kinds of takeaways that I think are important when it comes to effectively treating them. One, they don’t like to be told what to do, right? They like to be guided until into making these decisions on their own. And number two is that I think men love to see numbers. We like to see like a piece of paper that tells us how we’re doing and whether what we’re doing is working. I mean, can you imagine if our wives gave us progress reports, you know, and some might, you know, a report card, you know, maybe you don’t work on communication and then like, you know, these are the steps you need to take and then 6 months later…

Donna Lee: 7:56
Your romance test fails.

Dr. Mistry: 7:58
That’s right. “Can’t you tell what I’m thinking?!” “I can’t! I haven’t been able to for in the last decade.”

Robert : 8:03
But no, that’s such a good point. I had somebody actually, that I met with yesterday that was motivated because of the lab values that they had. And they said, “Well, now I actually know what’s going on. And so I know if I make changes where these should be moving, and if those changes are paying off, and things like that.” So, but somebody was like, “That’s what’s driving me. That’s my motivation right now.” I said, that’s great.

Dr. Mistry: 8:25
It’s a super powerful tool. I think that being able to give people feedback, specific information on what kinds of changes they’re making and how it’s affecting their body, right, is so powerful. So, if you’re interested in a more holistic level of care, if you think that you have a condition like inflammatory bowel disease, interstitial cystitis, even if you’ve been diagnosed with infertility, anything else that you think that may be your nutritional wellness could be given some added boost. We would love to see you in the office, come, uh, make an appointment with us and, Donna, how do people make an appointment?

Donna Lee: 8:58
They can call us at (512) 238-0762 and ask for Robert, or to see Robert. Our website is armormenshealth.com and you can send Robert questions or Dr. Mistry to armormenshealth@gmail.com. And hey, guess what? We’re on Saturdays now, starting January 4th, so tune in at 3PM.

Dr. Mistry: 9:16
…that’s right. So join us on Saturday, and please join us for the bonus segment on our podcast where we discuss lichen sclerosus and urethral disease and we look forward to seeing you next week.

Donna Lee: 9:26
Happy Saturday!

: 9:31
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.

Dr. Mistry: 9:48
Welcome to the Armor Men’s Health Hour bonus segment.

Donna Lee: 9:52
What?!

Dr. Mistry: 9:52
We’ll have to say “Armor Men’s Health Hour Plus.”

Donna Lee: 9:56
I thought we could call it the “Mistry Cast.”

Dr. Mistry: 9:57
Okay, well for those brave three of you that decided to listen to the podcast today, we really appreciate you coming back. This, topic in this question is not going to be discussed on the radio, at least not this week. And we would love to get questions from you guys. And we really look forward to interacting with more and more of our listeners. I thought, Donna Lee, why don’t you go through that question?

Donna Lee: 10:21
So this question came into armormenshealth@gmail.com, as they all do. And we read through every single one of them. So we appreciate that. This particular question is, “Dear Dr. Mistry, can lichen sclerosus stabilize? I was told I need a…”

Dr. Mistry: 10:36
“Urethra plastic.”

Donna Lee: 10:38
Thank you. Excuse me… “but I am not sold on that level of treatment. What is the non-treatment risk/reward?”

Dr. Mistry: 10:44
That’s a great question. So, lichen sclerosus is an inflammatory disease of skin. It can affect skin that’s not on your genitals or on your genitals. When it specifically affects the penis, it can cause like raised red patchy areas on the head of the penis or on the shaft of the penis. But a specific kind of lichen sclerosus can actually impact the urethra, the tube that you urinate from, and it can cause that urethra to stricture or to narrow down to make it difficult to pee. There’s one kind of lichen sclerosus that affects just the opening right at the head of your penis, that can cause a real big narrowing there. And what usually happens is as the condition progresses, it destroys like the local architecture, the penis doesn’t even look the same anymore. The ridges and the lines that are there get destroyed and the opening that you pee from gets real small and narrow. It can cause your flow actually to seem like it’s getting faster, because just like putting your finger over the edge of a of a water hose can cause it to spray. It can cause you to have drippage, so you can make a bigger mess, and that type of lichen sclerosus we’ll call meatel stenosis for this discussion. But that lichen sclerosus can actually grow and go down the urethra and cause a really bad stricture that goes all the way down to the prostate. And that generally does cause the urine flow to slow down greatly. So this caller is asking about whether or not lichen sclerosus, first are asking if it can stabilize. And I think they actually mean, can it reverse itself?

Donna Lee: 12:18
Right? Does it go away?

Dr. Mistry: 12:19
And the answer is not in my experience. Usually if the lichen sclerosus is getting to a point of causing the stricture, then it’s probably not going to get any better. It may not get worse, but it’s not going any better.

Donna Lee: 12:31
Right.

Dr. Mistry: 12:31
Topicals such as steroids have a limited benefit, but I don’t think a great, great, great benefit. We will have patients in our practice, actually we have a special compounding pharmacy that will concoct a special gel that has the steroid in it that you actually inject in the penis regularly to keep that lichen sclerosus or that inflammatory condition at bay, to kind of keep things from getting worse. But if you’ve reached a point where the narrowing is so bad that somebody’s recommended a urethral plasty, then you might be in a different league. And, the risks of not fixing a blockage are that you can develop urinary retention, where the fluid or the urine doesn’t come out of your bladder. You can develop stones, infection, your bladder itself can become damaged or diseased. And it can cause you just lots of leakage and, and difficulty. Repair is no easy task either. I mean somebody’s gonna cut your penis open and try to make it better. Now, you want to make sure you’re going to someone who has done a lot of them. You want to make sure that they have a plan for if it works and if it doesn’t work, and what you don’t want is somebody just internally cutting it over and over again. If you have a stricture or you have something like lichen sclerosus, you should know also that the condition could come back and it can get worse. And although none of these things are heartwarming, like promising things, you should know that the repair is actually successful most of the time. People get lots of benefit and usually are wondering why they waited so long for it. And if you just need a repair at the head, just a meatoplasty, just the very last little part of it, not only is the repair successful, but it makes you pee a lot better. Cosmetically, it looks just fine, and absolutely, if somebody is recommending this, I would certainly say getting a couple of opinions is probably smart for you just to make before you go through a major penis operation. And we do, I’ve been doing urethraplasties for almost 15 years. We’d love to kinda look at things, make sure you’re properly tested and make sure you’re on the right track. And don’t be afraid. I mean, if that’s ultimately the right thing for you, you may not need it right away, but you may want to get it done before an emergency happens and you can’t pee because things have closed up.

Donna Lee: 14:59
Right. And I think the takeaway message that you brought up is most people are like, “Oh, I shouldn’t have waited so long.”

Dr. Mistry: 15:04
That’s right. It happens a lot to us, dosen’t it?

Donna Lee: 15:06
Right.

Dr. Mistry: 15:07
Like, we should have had this show long time ago.

Donna Lee: 15:08
Should have been doing these podcasts all this time, to educate the masses. Well, that was an awesome answer.

Dr. Mistry: 15:16
Well, thanks for joining us for this bonus segment.

Donna Lee: 15:17
That was fun. When you have more time, we’ll do more bonus segments. How about that?

Dr. Mistry: 15:21
Yeah, well we’ll put more stuff on the radio too.

Donna Lee: 15:22
Okay, sounds good.

Dr. Mistry: 15:24
Well, thank you for joining us and we hope to have you catch us on the radio.

Donna Lee: 15:28
That’s right. Send your questions to armormenshealth@gmail.com for Dr. Mistry. That’s armormenshealth@gmail.com, and what maybe we’ll do another one soon.

Dr. Mistry: 15:36
Maybe. Thanks so much.

Donna Lee: 15:38
Y’all have a great day.

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