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March 28, 2020

Seventy-one and Never Done: Dr. Mistry Gives Us an In-Depth Look at Treating Erectile Dysfunction

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. This is Dr. Mistry, your host. Once again, happy to bring you a wonderful segment along with my cohost, Donna Lee.

Donna Lee: 

I thought you were going to say wonderful cohost.

Dr. Mistry: 

Well, there you go.

Donna Lee: 

‘Tis I.

Dr. Mistry: 

Award winning.

Donna Lee: 

That’s right. I have the award on my desk.

Dr. Mistry: 

It was a self made award.

Donna Lee: 

It was my junior high band award.

Dr. Mistry: 

You know, I check the podcasts on Apple Podcasts and Spotify all the time, and I don’t see any other long lasting men’s health shows. And I think it’s because a lot of times you think that men’s wellness shows are only going to have two topics…

Donna Lee: 

Penises.

Dr. Mistry: 

Penises and erections.

Donna Lee: 

And erections.

Dr. Mistry: 

That’s right. When it comes down to the questions that were asked, Peyronie’s disease, erectile dysfunction, these things are very common themes. And I think it’s because men just feel either embarrassed or undertreated by when they look for a treatment by their doctors.

Donna Lee: 

And and I think they’re also inundated with commercials and they don’t know where to start.

Dr. Mistry: 

It’s so confusing.

Donna Lee: 

They’re so similar to…

Dr. Mistry: 

So confusing.

Donna Lee: 

It’s very confusing.

Dr. Mistry: 

I think where I have a little bit of trouble in dealing with patients with erectile dysfunction is them not understanding how erections are only one component or a symptom of underlying medical conditions. And I think that sometimes when I tell a patient that I can just see their eyes glazing over, like, “Don’t tell me again because I’m fat.” You know? I mean, they’re so, it’s because they already understand that their functions depend on their overall health, but they don’t want to be told it…they’re just hoping there’s some medicine that just fixes it. And then when you give them the medicine that just fixes it, they’re like, “Well, why do I have take a medicine to fix it?” You know, I don’t have a magic…there’s no magic. I can’t snap my fingers and fix some problem that was created by either poor health habits or something else. And so that’s a theme that I see in a lot of younger men who are unhealthy with erectile dysfunction. But I think right now we have a question on one of my favorite types of patients. Why don’t you go through that question?

Donna Lee: 

You do love you this kind of patient.

Dr. Mistry: 

Yeah, I do.

Donna Lee: 

So this question came in to armormenshealth@gmail.com: “Dr. Mistry, I’m a 71 year old Caucasian male without any medical problems and not taking any medications. I do not have hypertension, diabetes, and no obesity.” He had an operation last year for hydrocele of his right testicle. Number 1: “Is linear focus compression a good therapy for erectile dysfunction. What is the cure rate? How many treatments? What does it cost? Does Medicare pay for it?” And Number 2: “What if anything can increase the emission volume of the semen? Is this associated with BPH and/or low testosterone?”

Donna Lee: 

You’re gonna spend 20 minutes on this answer, I can see it.

Dr. Mistry: 

I mean, a 71 year old guy asking me how to make…have a better sex life. That is like…

Donna Lee: 

Halleluja!

Dr. Mistry: 

…my favorite thing, right?

Donna Lee: 

That is your favorite guy.

Dr. Mistry: 

He’s healthy, he’s probably lived a real clean life, and he’s probably a little surprised that his erections don’t work when all the doctors are like, “We’re surprised that your erections work at 71 years old!” And so it’s because we come across so many men with so many other medical conditions that when we find one, a perfect specimen in the wild…

Donna Lee: 

He’s a unicorn!

Dr. Mistry: 

…yes, perfect specimen in the wild, that is surprised that his erections aren’t working–that gets me excited to be able to help that guy.

Donna Lee: 

Right.

Dr. Mistry: 

If you’ve gone 71 years and you’re not on any meds, and you feel pretty healthy and robust, me saying, “Oh well no worries, Sir, I’ve got a pill that is gonna fix you right up”–that is not an exciting thing for that person to hear.

Donna Lee: 

Right.

Dr. Mistry: 

So absolutely, part of our initial evaluation’s going to include something to do with underlying medical conditions. Make sure that his cholesterol is not high, make sure that his hormones are normal. If he has low testosterone, we can improve his erection in about 65% of the cases with 12 weeks of testosterone therapy. Now there are some side effects and downsides of testosterone, it’s not for everybody, but it may help impact other things that he may be experiencing at 71, including diminished muscle mass, maybe some issues with fatigue. And so that may be a one bullet that kind of takes care of several different problems.

Donna Lee: 

What about, this maybe dumb, but does the hydrocele have anything to do with this?

Dr. Mistry: 

Fortunately in his case, no. A hydrocele is fluid that collects around the testicle, it is a benign condition, and shouldn’t affect his testosterone or function.

Donna Lee: 

Okay. And let’s address the linear focus compression. That is also called…

Dr. Mistry: 

Totally. We call it shockwave, but we’re coming up with a different word around here, because nobody likes when you say “shockwave.”

Donna Lee: 

How about, “Gently Pulsing the Penis Therapy?”

Dr. Mistry: 

…ultrasound. And we use different terms because, and the reason we use shockwave is because for the longest time, when we use similar technology to break stones apart, the actual technology to create the ultrasound wave was like a sparke plug. And so you’ve got this idea that it was like a shock wave. But when you use it in relation to somebody’s penis, people are not excited.

Donna Lee: 

They don’t like the word “shock.” I think we should call it “Penis Pulsing Therapy–PPT.”

Dr. Mistry: 

PPT. So we are, what we do is we use an ultrasound machine that uses very low energy waves–ultrasound waves–that lead to a type of tissue reaction that leads to regeneration of nerves and blood vessels. For a 71 year old guy who otherwise was getting pretty good erections and now is not, it’s a wonderful treatment option for you. In an effort to both avoid medications as well as an effort to kind of regain your normal functioning. The treatment is usually 6 treatments, 1 week apart. Each treatment takes about 20 minutes, and the total cost in our office for all 6 treatments is $2,000. While you’re undergoing treatment in our office, this is not what everybody’s protocol is, in our office, you will also be likely put on a vacuum erection device trial to help maintain the length of your penis, which will also helps if you have Peyronie’s Disease, as well as at least 6 weeks of daily Tadalafil to increase blood flow to the penis so that those regenerative signals can actually result in regeneration of your penile tissue. Then that is all included in that $2,000 price.

Donna Lee: 

And Medicare does not cover it.

Dr. Mistry: 

Medicare does not cover it, getting to that next question. Now for someone who is trying to avoid lots of invasiveness, sometimes you worry that you’re underselling the degree of ED. So you know, the way the question is presented, it sometimes seems like, “Oh, I have mild ED and otherwise everything’s fine.” But a lot of times, it’s not the case. What somebody considers mild hardness could be really soft for another person. And so we offer the full array of treatments for advanced erectile dysfunction, whether they be medications, whether they be injection therapy, whether it be surgery, like an inflatable penile prosthesis. So if you have erectile dysfunction, absolutely get a second opinion from us. We’d love to be able to start with noninvasive treatments and work our way to whatever is gonna work for you. There was a second part of this question, wasn’t there?

Donna Lee: 

That’s right. Don’t forget the second part: “What if anything can increase the emission volume of the semen and is this associated with BPH and/or low testosterone?”

Dr. Mistry: 

The answer is yes. For sure, ejaculate volume does have a close correlation with worsening BPH symptoms, or medications for BPH, or surgery for BPH, or low testosterone. And semen is the fluid that’s produced that supports the growth and health of sperm, and that semen is made by the prostate. So anything that can affect the prostate, like prostate cancer, enlarged prostate surgery or medication therapy, can decrease or influence the amount of semen that’s made. But there’s also a natural decreases men age. And that’s because fewer of your resources are being put into reproduction. But a lot of times men that are complaining of it are not really complaining of the load volume.

Donna Lee: 

No?

Dr. Mistry: 

They’re not filming themselves. They’re, this is, what they’re really complaining about is that the intensity of their orgasm seems to have diminished–a condition called hypo orgasmia. And we actually have medications that can help with hypo orgasmia. But one thing that really, really helps is the introduction of pelvic floor physical therapy for men that have hypo orgasmia. We can, we have a physical therapist on staff that will teach you the exercises that you need to do when you’re not having sex and what to do when you’re having sex to be able to allow more full release, a better orgasm, and it’ll feel better, and that may make you not as worried about the actual ejaculate volume.

Donna Lee: 

Wow. I never thought of physical therapy is the answer to that.

Dr. Mistry: 

It is. It really is. And it’s a really good answer also for our younger patients who have difficulty maintaining their erection, they feel like they’re working hard, working hard, to keep an erection. So if you’re under the age of 40 and have that problem, don’t be surprised in our office if we do recommend a pelvic floor exercise regimen as something to help, and we also use it quite liberally in patients with premature ejaculation, because a lot of those guys don’t want to use medicine either.

Donna Lee: 

Right. Gotcha. What’d you say about that patient that was your favorite? He was like in his seventies, too.

Dr. Mistry: 

That’s right. One of my first patients was like an 82 year old Methodist preacher who came in saying, “I don’t know what happened, but in the last month, I’m having trouble getting an erection.” And we were like, “Oh my God, you have an erection still? That’s awesome. Let’s get this fixed up!”

Donna Lee: 

That’s amazing, good for him.

Dr. Mistry: 

For any patients looking for a little bit of help in the bed…

Donna Lee: 

That’s right!

Dr. Mistry: 

…and whatever else from a urological standpoint that we can help you with.

Donna Lee: 

We are here for you.

Dr. Mistry: 

We are here. Donna Lee is here for you.

Donna Lee: 

We put the “U” back in urology and back in “U bed.” All right, you can call us during the week at (512) 238-0762. Send us these amazing questions. We’ll get them answered. I’ll respond to you. We’ll go back and forth until we get the right answer, just for you. Armormenshealth@gmail.com, that’s armormenshealth@gmail.com. Listen to our podcast wherever you listen to podcasts–they’re free and they’re magical and they’re like little golden nuggets of knowledge from Dr. Mistry. We are in Round Rock, North Austin, South Austin, and Dripping Springs. And remember, our website is armormenshealth.com. Thanks so much, Dr. Mistry. That was an amazing hour.

Dr. Mistry: 

Thank you for joining us today!

Speaker 2: 

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 Armour men’s health.com.

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