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June 6, 2020

Use Your ‘Radio Voice’: Dr. Mistry and Donna Lee Answer Listener Questions about Concerns ‘Below the Belt’

Speaker 1: 

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

Dr. Mistry: 

Hello, and welcome back to the Armor Men’s Health Hour. This is Dr. Mistry, your host, a board certified urologist here with my always funny and effervescent co-host and practice manager, Donna Lee.

Donna Lee: 

That’s right. Did we mention, I have a hot, buttery biscuit voice this week yet?

Dr. Mistry: 

When I heard this recording later, it made me cringe also.

Donna Lee: 

Cringe? You were supposed to be super excited that I have a hot, buttery biscuit voice.

Dr. Mistry: 

My own natural voice has lowered to octaves since we started the program.

Donna Lee: 

I know you sound like a child in the clinic.

Dr. Mistry: 

Now I always sound like I’m on the radio. I’m a board certified urologist. This is a men’s health show. For the last year, we’ve enjoyed bringing you this here on KLBJ news radio, as well as available on podcast, wherever you podcast. There’s a number of topics that we have in archive that we’ve discussed, virtually the entire span of urology and men’s health issues.

Donna Lee: 

Everything you ever wanted to know.

Dr. Mistry: 

And a lot of stuff you didn’t.

Donna Lee: 

That’s true.

Dr. Mistry: 

We’ve gotten some wonderful compliments from other physicians who actually listen to the show. They’re surprised they’ve learned something.

Donna Lee: 

Yeah, like the cardiovascular surgeon who told me she learned everything she ever wanted to know about epididymitis in one hour while driving through Lakeway, Texas.

Dr. Mistry: 

And the primary care doctor that learns about hormones, even though they do hormones, or the urologist out there that learn something.

Donna Lee: 

Do you think the urologist is sitting in like a closet in his house?

Dr. Mistry: 

Maybe.

Donna Lee: 

Like so his family doesn’t know he’s learning stuff. There’s a visual.

Dr. Mistry: 

There you go. Thank you so much. So…

Donna Lee: 

And we are the second largest in town.

Dr. Mistry: 

That’s right. And if you have questions, we would love to hear them. That’s at armormenshealth@gmail.com. The name of our practice is NAU Urology Specialists. Our website is northaustinurology.com. I know lots of different things to remember, but I’m Dr. Mistry, M-I-S-T-R-Y. It’s my real name. [inaudible] We have four amazing physician providers, three amazing nurse practitioner and PA providers. We have pelvic floor physical therapy, nutrition, in house sleep testing, sex therapy…I mean, we’re here to take care of you from…

Donna Lee: 

Head to toe.

Dr. Mistry: 

Tip to toe.

Donna Lee: 

It depends on what tip.

Dr. Mistry: 

Well, you know, it is a urology practice. Questions are definitely what drive us on this show and keep us with fresh material. So, Donna Lee, why don’t you go through the question?

Dr. Mistry: 

I have a brand new question just for you, Dr. Mistry. You can send the questions. We’ll answer them anonymously. Then I respond to your email to let you know when we’ll talk about the question, and then I’ll also send you the podcast as well, so you can share it with your friends and family or not at all, if it’s embarrassing. “Dr. Mistry, for several years periodically, I experienced swelling and tenderness in my right testicle. The overall shape is not irregular, but it swells and is especially tender where the tube connects. About a year ago when it happened, my general practitioner gave me an antibiotic and antiinflammatory, which seemed to take care of it. Now it seems to have started up again, and I’m wondering if I should go to a urologist for a more in depth exam. Looking forward to your thoughts. Thank you.”

Dr. Mistry: 

That’s a great question. It’s a topic that we have discussed in different kinds of forms in the past. And this is a conversation about chronic epididymitis or recurrent acute epididymitis. One of the two. Anatomically, if you have swelling or irregularity of your testicles, you should be seen by a healthcare professional. A primary care doctor would be a great person to tell you if it’s a tumor, a urologist of course could do that. Oftentimes imaging is not necessary, but certainly could be helpful. But as a general rule, any time you notice a irregular shape or mass or feeling of the testicle area, it needs to be evaluated by a medical professional for sure. Now, if you have an acute swelling, so all of a sudden change in how things are looking and it’s tender, than an infection is more likely. And since you have an episode that occurs regularly, you know, once or twice a year, this is what we call recurrent epididymitis. I see recurrent epididymitis in patients who’ve had a vasectomy. It’s actually something that I do tell people is a potential risk factor of having a vasectomy. Although very rare, if you have had a vasectomy and get, you know, a few of these episodes, especially if you’ve had more than three in one calendar year, then sometimes you would benefit from some kind of surgical intervention here. In that case, what we’re doing is removing the epididymis so it can’t get infected. If you’ve not had a vasectomy and you’re getting these recurrent episodes, in our practice, we treat these as though it was a urinary tract infection. That’s a surprise to many people. And the reason is the vas deferens, which carries sperm from the testicle to the prostate is actually connected, you know, to the urinary system. I mean, we evacuate out of the same hole that we pee from. So the two systems are connected. If you are developing recurrent episodes of epididymitis, we consider that a urinary tract infection and treat you as though you have recurrent urinary tract infections. Sometimes that means prostate medicines or bladder medicines, where you have the three horsemen of recurrent UTIs that we use in our practice often: d’mannose, an ellura cranberry supplement it’s called, and then always a probiotic. We use probiotics very, very consistently with a number of different conditions, including cancer diagnoses. And so that’s kind of what we, how we would treat somebody that had recurrent epididymitis, who didn’t want to get it surgically corrected, which is completely understandable. I mean, the idea of taking a knife to your yum yums is pretty…

Donna Lee: 

Yum yums!

Dr. Mistry: 

…something a lot of people aren’t too excited about.

Donna Lee: 

And the primary care doc might not know all of that to handle for the yum yums.

Dr. Mistry: 

Well, that’s right. I think, more importantly is this idea that if you don’t go to a surgeon, you may, that doctor may not use surgery as a regular treatment option. But if you’ve had more than three epididymitis episodes in one calendar year, in our practice, in my mind, it is a surgical disease at that point. Because these things can get really bad. If you’re a diabetic and you’re 60 and you get epididymitis, sometimes the thing takes six weeks to resolve, and you’ve got a big testicle and you can’t sit right, and your pants don’t fit right. We have actually had patients that get really, really ill have to go to the hospital because of really bad epididymis, although that’s not the norm, and I’ll see more than most because that’s what we do around here–we take care of bad things that happen to your yum yums. You know, so we will see this probably once every month at least I’ll have to see somebody in the hospital that has been admitted with a really bad epididymitis, usually a diabetic.

Donna Lee: 

I’m sorry, I can’t get past the yum yums comment. Last week, we were talking about the ding-a-ling. Now we’re talking about the yum yums.

Dr. Mistry: 

Well, I don’t know. You know, we try to tell parents not to use funny words for your genitals when you talk to your kids, but for some reason…

Donna Lee: 

It’s more fun when it’s as an adult?

Dr. Mistry: 

…on the radio, yes. And I don’t need people cringing when they’re listening to this with their kids in the car.

Donna Lee: 

Well, we have another question about yum yums.

Dr. Mistry: 

Yes, let’s go for it.

Donna Lee: 

“Dr. Mistry, I’m emailing you guys because I’ve been listening for about six months and I’ve been worried about the growth of my penis and testicles,” also known as ding-a-ling and yum yums. “I’m 26 years old, and was never really shown how to care for my genitalia. I have an abnormally small sack and penis and listening to your show helps.” He said he’s 6’1″, 300 pounds. “I know my weight is a major issue, but I have seen guys my size with larger genitalia.” He said, he’s really worried about his sex life.

Dr. Mistry: 

Well, I think that’s a great question and great concern. And we are definitely going to answer this question more in depth next time, because this is an 11 minute question.

Donna Lee: 

Oh, ok.

Dr. Mistry: 

But if you have abnormally small testicles and penis, you could have an abnormality in hormonal development that leads to something called a micro penis, as well as another condition called Kleinfelter Syndrome, which we see that is often associated with very small testicles. You’re concerned about your sex life, which is definitely something you should be concerned about, but I’m also concerned about your fertility, and whether or not an underlying genetic or hormonal condition could be leading to other problems. Having a very low testosterone level or having a testosterone level that didn’t turn on right at the right time during puberty can lead to a number of other health effects, including cardiovascular, including neurologic, maybe a part of your weight issue is the fact that you have a low testosterone. We have a number of pituitary and adrenal disorders that can also lead to abnormalities in both weight as well as genital size. But if I was just in general going to answer a question on somebody who was reporting kind of small phallic length or small penile length when they’re 300 pounds and 6’1″, you really worry about something called a buried penis. And that’s not everyone who’s big will have a buried penis, but some people who are big will have a buried penis. And it’s where the mons fat pad will actually invert the penis, and if, it’s a great point, you make there about not being taught, how to take care of your genitals, because if you don’t routinely pull the skin back and clean the head you could be having, what’s called a phimosis where it’s a real tightening of the head of the skin that over the foreskin that’s over the penile head. And if you have a phimosis, which is the tightening of that, and that large fat pad, it’ll actually suck your penis in. So you’ll be only three inches on the outside, but eight inches on the inside.

Donna Lee: 

Holy moly!

Dr. Mistry: 

And it’s probably going to get worse if that condition gets worse. So this is the kind of thing that we can easily figure out in a one minute physical exam. We can measure your penile length and your testicles and your testosterone, and it’s such an easy, easy thing for us to get to the bottom of. And if it is a buried penis, we have some amazing techniques to help get, you know, your length back. That’s right. I mean, none of these things are easy…

Donna Lee: 

But they’re doable.

Dr. Mistry: 

…but everything from nutrition to, you know, plastic surgery to all the hormone stuff, that’s what we do here. And certainly we’d like to get this off your mind. We’d love to see you as a patient. And I think we’re going to talk about this next week more in depth, as this is a very deep and involves…

Donna Lee: 

Well, ironically, you brought it up during the week, and now here’s the question.

Dr. Mistry: 

There it is. There it is. Well, thanks a lot for that question. Thank you for joining us this week on the radio or on the podcast. We love your questions even more and more. It keeps the show fresh and keeps us on our toes.

Donna Lee: 

Honestly, it just keeps us going. So…they might fire us at KLBJ if we don’t have questions, but you can call us during the week at (512) 238-0762. Send your questions to armormenshealth@gmail.com and our website is armormenshealth.com have a wonderful rest of your day.

Dr. Mistry: 

Bye bye.

Speaker 3: 

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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