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January 18, 2020

Q&A with Dr. Mistry Including Questions on Crotch warmth and Elevated PSA With a Family History of Prostate Cancer.

Donna Lee: 

The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions during the week, call us at (512) 238-0762 or visit our website at armormenshealth.com. The Armor Men’s Health Hour is a show dedicated to providing information on a variety of medical topics, some of which may include sensitive subject material about penises. All cases discussed have been done with the permission of the people involved and their penises.

Speaker 2: 

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

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour this Saturday. I’m Dr. Mistry, your host, joined by my cohost, Donna Lee.

Donna Lee: 

That’s right, trying to get used to this Saturday thing, it’s like a time change.

Dr. Mistry: 

It is kind of a time change.

Donna Lee: 

I keep saying Sunday.

Dr. Mistry: 

We have to, we have to clean it up.

Donna Lee: 

You say that, but I don’t know if we cleaned it up.

Dr. Mistry: 

And then we have to change the sticker on the truck.

Donna Lee: 

And my car.

Dr. Mistry: 

The vasectomy van.

Donna Lee: 

The vasectom-a-thon van? Are we going to have another vasectom-a-thon this year?

Dr. Mistry: 

We are going to have a vasectom-a-thon the Saturday before the spring break. I want to see if that’s a good weekend, but we’ll see.

Donna Lee: 

Okay.

Dr. Mistry: 

I’m Dr. Mistry. I’m a board certified urologist. We’ve had the pleasure of bringing you this show for about 6 or 7 months now. We are very thankful to our KLBJ news radio staff here and friends and we’ve had amazing outpour of support from our listeners. And thank you so much for joining us this Saturday.

Donna Lee: 

And our patients, too.

Dr. Mistry: 

That’s right. It’s almost like our patients listen. I think between our patients and other urologists trying to learn a few things.

Donna Lee: 

You really think other urologists are listening?

Dr. Mistry: 

Oh, I know they are.

Donna Lee: 

I know you know like a friend of yours maybe, but you think like the guys that want to take us down?

Dr. Mistry: 

Maybe the ones who want to take us down. So, we started this urology practice in 2007, with an office in Round Rock and now we’ve expanded all over. Donna Lee, want to tell our listeners about our practice?

Donna Lee: 

Well, we are fabulous. That’s our practice. We are in Round Rock, Dr. Mistry opened in 2007, that is correct, and he had like 2 employees. Now we’re in North Austin. We’re in South Austin on South Congress and Dripping Springs. Our number through the week is (512) 238-0762. Send us your questions. These are a lot of fun. Our email address is armormenshealth@gmail.com.

Dr. Mistry: 

For those of you that are first time listeners, this is a show in which we really aggressively and intensively discuss a variety of issues that are related to men’s health. I’m a urologist, so we talk a lot about hormones, infertility, prostate cancer, kidney cancer, and things of that nature, but we have guests that realm from oncology to gastroenterology. We have, we’ve had previous doctors that do surgery for reflux, a lot of focus on sleep apnea, orthopedics. We’re going to have spine, podiatry, dermatology that’s going to be coming on. So we encourage you that if you’re new to the show and want to learn more, please, please visit our podcast and download it and listen to it. It’s a wonderful repository of information that I think that you’re not going to get anywhere else.

Donna Lee: 

You’re so smart, with the word repository. Other people are just saying, “Listen to our podcast. It’s full of stuff.”

Dr. Mistry: 

Don’t you make me spell repository.

Donna Lee: 

Spell repository.

Dr. Mistry: 

And we love your questions. So, Donna Lee, why don’t you hit us with a question?

Donna Lee: 

Well, we have a new one that I thought was interesting. “Dr. Mistry, I’m a 52 year old male who’s having a lot of difficulty with my crotch area being warm, especially at night. I’ve had periods of what seems like jock itch that feels more intense when I do itch. I have been told to wear boxers, keep gold bond around, and I have been to a dermatologist that tells me everything looks fine, but it does not feel fine. Is there anything I can do to help this?”

: 

That’s interesting. Although I haven’t met you, you know, really the first question is what is the status of the skin in that area? Most of the time patients who are overweight will have excess skin in the area. That skin layering on top of each other during prolonged periods of time, and especially in the summertime when it gets hot, will develop a fungal infection, even though it may not seem that bad when you go to the dermatologist, you’ll know that it’s bad when it starts itching terribly. And so what we generally do is prescribe either an antifungal powder like Nystatin. Gold bond is great. It may not work for more severe cases, especially if you know, the fungus is kind of always around and just may not do well, a simple over the counter agent. So Nystatin powder. But for the more severe cases, we will do a combination of an antifungal and a steroid cream. So we, uh, use a betamethasone clotrimazole cream that will have you put to the area. I would say this, even though I haven’t met you, 9 times out of 10, it’s going to be a fungal infection with a self-induced or body induced immune reaction that’s causing the severe itching. And I would say that most patients are better within the first one or two applications.

Donna Lee: 

Wow.

Dr. Mistry: 

And although you may have to reapply every 10 to 14 days because of recurrence, the true solution is going to be weight loss because you’ve got to get rid of that overlapping skin. Now if you’re thin and don’t have that, then you have to consider another condition called hydradenitis, which is an inflammation of the sweat glands in that area. And believe it or not, that condition can sometimes respond to Botox injections. There are actual medications now that are specifically for hydradenitis of the area, but most of those patients will develop what looked like little pustules or like lots of pimples in the area. And, although embarrassing to sometimes seek medical care for, it’s absolutely the kind of thing that there is treatment for. We’d love to see you about it and get it taken care of.

Donna Lee: 

It sounds terrible.

Dr. Mistry: 

Well, it can be very irritating to men. I mean, we as men like to scratch our…

Donna Lee: 

…areas.

Dr. Mistry: 

…you know, as it is and then, but if you’re scratching it just because of passing time…

Donna Lee: 

Do you scratch it just because sometimes?

Dr. Mistry: 

Sometimes.

Donna Lee: 

Just because it’s there?

Dr. Mistry: 

Sometimes.

Donna Lee: 

Just because it’s dangling out there and you’ve got to scratch it?

Dr. Mistry: 

You remember Ted Bundy and “Married With Children?” Sometimes you just like to put your hands on it.

Donna Lee: 

Is it Ted Bundy? I thought that was the guy that killed everybody.

Dr. Mistry: 

Well, I don’t know. This isn’t that…

Donna Lee: 

Wait, Ed Bundy?

Dr. Mistry: 

Ed Bundy! You think that’s why they named him Ed Bundy?

Donna Lee: 

Oh no, we need to Google this.

Dr. Mistry: 

Do we have any more questions?

Donna Lee: 

Yeah, I have a quick one from a patient: “Dr. Mistry, my PSA level has been going up slowly through the years. It was 3.83 last year, and it’s now 4.79 this year.” He has a urologist that gave him another order for an MRI to be done. He said there might be a 25% chance of cancer. He has no family history of it. So he was just wondering your thoughts on that sort of thing.

Dr. Mistry: 

This listener did not send an age, right? No. So let me just, let me just give like a scenario. Let’s say that you have a 60 year old patient and his PSA has jumped, what sounds like 0.9 in one year. So his risk just with the 4.75 of having prostate cancer is 40%, and his risk of having a clinically significant, potentially life threatening cancer, given that he jumped more than 0.75 in one year, is pretty high. If the patient is healthy, we generally order an MRI, but with the expectation that we’re already going to do a biopsy. So it’s such a wonderful question. So you know, I’m the kind of person that probably errs more towards doing imaging and biopsy because I want to know what’s going on.

Donna Lee: 

Why wouldn’t somebody want to do that? Why wouldn’t…

Dr. Mistry: 

because people are worried about getting a biopsy or having complications. So many patients are trying to look for a way to get out of not doing a biopsy, whether it’s because of something they’ve heard or maybe they don’t like how it’s done, or…I mean it all comes out down to fear. But what I’m really worried about are people putting their heads in the sand to a potential diagnosis and they’re worried…

Donna Lee: 

Wait, guys put their head in the sand for in the sand when it comes to diagnosis?

Dr. Mistry: 

I’m giving you an ostrich analogy.

Donna Lee: 

What?

Dr. Mistry: 

But the point is is that people sometimes avoid the truth…

Donna Lee: 

Guys. Men.

Dr. Mistry: 

…maybe men in particular, because they’re afraid of facing those truths. But absolutely, in our practice, unless there was another overriding reason at 4.7 he said?

Donna Lee: 

4.79.

Dr. Mistry: 

…that you would definitely be, if you were in good health, you would more than likely be scheduled for a biopsy with a pre-biopsy MRI. We would do that because we want to see if there’s a lesion that needs to be targeted. We have amazing technology now that can actually target MRI abnormalities and be a lot more specific in your prostate cancer diagnosis. And more importantly, we actually have therapies now, like high intensity focused ultrasound, that can just treat where your cancer is and leave the remainder of your prostate completely intact. And this is an opportunity that’s available widespread today that wasn’t widespreadly available 5 years ago. So it’s an incredible evolution in the science and technology of the field.

Donna Lee: 

And you do a free telemedicine discussion with patients, if they have questions.

Dr. Mistry: 

That’s right. If you have prostate cancer or you think you’re at risk, or you want to talk to me even before you get a biopsy, let us know. We do telemedicine appointments every Monday, Wednesday, and Friday after my main clinic…

Donna Lee: 

And what that means is, we will call you on the phone. A lot of patients wonder what telemedicine means.

Dr. Mistry: 

Yes.

Donna Lee: 

So we need to clarify that every so often.

Dr. Mistry: 

That’s right. That’s right.

Donna Lee: 

You stay home!

Dr. Mistry: 

You stay home.

Donna Lee: 

We’ll call you!

Dr. Mistry: 

You stay home and we get information. If you live in Austin, make the trip up to our offices.

Donna Lee: 

You can come see us.

Dr. Mistry: 

But it’s okay. But if you’re listening to this on the podcast, we have, I would say about 70% of our patients for high intensity focused ultrasound come outside of Austin. We get patients from all over the country. We got a consultation just today or this week from California. And it’s absolutely the kind of thing that we’re used to and do very frequently.

Donna Lee: 

Right. And it’s kind of amazing. It’s pretty side-effect free-ish.

Dr. Mistry: 

And I think that, you know, the listener pointed on something that wasn’t obvious in the question. And it really comes down to the philosophy your urologist or your physician may have towards that disease process.

Donna Lee: 

Right.

Dr. Mistry: 

And this is true of everything. High blood pressure, high cholesterol, you know, low thyroid, cholesterol screening, colon cancer screening, prostate cancer. Remember that your doctor comes into the, with some bias–how they read the literature, how they were trained. And you need to make sure that that doctor has the biases that you’re most comfortable with. Right? And if you think you should get colon cancer screening more often or you think that you need a more aggressive treatment for your PSA elevation, then you might need a second opinion.

Donna Lee: 

And It’s okay to get a second opinion.

Dr. Mistry: 

It is. It hurts my feelings, and it definitely hurts your doctor’s feelings, but I’ll tell you your doctor’s feelings aren’t keeping you alive necessarily.

Donna Lee: 

That’s right…I need to go get our special guests in here.

Dr. Mistry: 

Tell people how to get hold of us.

Donna Lee: 

Call us at (512) 238-0762 or email us at armormenshealth@gmail.com. That’s armormenshealth@gmail.com. We’ll be right back with a special guest.

Speaker 3: 

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

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