NAU's COVID-19 Policy
April 18, 2020

When Severe Erectile Dysfunction Strikes Younger Men-Dr. Mistry and Donna Lee Talk About the Many Options for Diagnosing and Treating ED

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. I’m Dr. Mistry, your host, here with my cohost, Donna Lee.

Donna Lee: 

That’s right. Hello. Welcome.

Dr. Mistry: 

Donna, you think people are confused about what a urologist is?

Donna Lee: 

I know I was until I met you.

Dr. Mistry: 

What did you think I was before you met me?

Donna Lee: 

I thought it was just kidney stones and just bladder issues. I had no idea that your practice was this expansive and holistic and super impressive.

Dr. Mistry: 

Anybody wonders why I keep you around, it’s because you like to use the word “expansive.” More than just my waistline.

Donna Lee: 

That’s right?

Dr. Mistry: 

We are a men’s health show. I’m a board certified urologist. This show is brought to you by our urology practice called NAU Urology Specialists. We have four offices all throughout Austin. We are open for business. We take new patients. We take virtually all sorts of different kinds of insurances, including Medicare. And it is our pleasure and our honor to help take care of you, and we love those patients that trust their care to us.

Donna Lee: 

That’s right. And post-Covid-19, we will be able to get patients in. We’re getting them in now, very few. But new patients, we can get them in same day or next day.

Dr. Mistry: 

We, I was joking with a very busy reproductive endocrinologist yesterday about how usually he has like a 6 month waiting list, but now he’s got a one day waiting list.

Donna Lee: 

Oh boy. I bet that’s true.

Dr. Mistry: 

Because he can see you tomorrow, you know, because everybody’s…it’s like a ghost town in the medical [inaudible] right now.

Donna Lee: 

How are you liking the Zoom appointments?

Dr. Mistry: 

They’re okay. I think that for certain kinds of issues, it’s good to do the Zoom. Ironically, my experience is backwards than most. I like the followup visits in person, and I don’t mind doing the new patients, some of the new patient visits online, because those online visits, they take longer. So it’s nicer that you didn’t have to blow an hour by the time you’re in the office, you know–30 minutes is 30 minutes. But the followup visits, we have a little bit of a rapport. We’re really trying to get at what your issue is that we may not be fully addressing, even if you think he’s just for a refill, people are often like, “Well, can we just do a quick refill or can you just refill without seeing me?” Then I guess go to a monkey to do your medical care, because if you really want somebody to really review your labs or to give you alternatives to treatment, than see a medical professional that’s trained.

Donna Lee: 

And the followups are so important. We had a patient who was kind of upset. He wanted everything to be handled during the first appointment, and he was sedated. Like he wanted all the information, so we had to explain to him, “You’ll have to come back for the followup to go over the information.” He’s like, “Oh, okay.”

Dr. Mistry: 

He was sleeping!

Donna Lee: 

I know, that’s what I was trying…

Dr. Mistry: 

What was I supposed to tell him?!

Donna Lee: 

I was trying to be nice. I couldn’t say those words, “Well, you were sleeping…”

Dr. Mistry: 

My goodness! You were sleeping, and everything he says to you, you’re going to not remember…

Donna Lee: 

But, anyway, he’s fine.

Dr. Mistry: 

But we do remember and we love your questions.

Donna Lee: 

We do! We have so many questions every week, and they keep us fueled and going. Although I can tell when there’s a new listener, because every week we get a new Peyronie’s question. We’re getting less low testosterone because I think that it’s so marketed, but send your questions to armormenshealth@gmail.com. But this first one I thought was awesome, and it just is the perfect listener to this program. “Dr. Mistry, I was listening to the weekend show and had a question on erectile issues. I did the Swiss wave treatment, and it wasn’t that great of success. I also do TRT injections and take pills when needed, and was wondering if there’s anything else that can be done to get erections normally like at the age of 18. I’m only 41.”

Dr. Mistry: 

That’s a great question.

Donna Lee: 

Isn’t that good?

Dr. Mistry: 

So there’s so much packaged into there, I feel bad that I may not even get to the answer that the listener wants. So first of all, when we talk about Swiss wave, what we generally are referring to are the heavily marketed technologies that promise to give some type of ultrasound energy directed towards the penis, helps regenerate the erectile bodies so that they’re able to engorge with blood and sustain a firm erection. The success for that treatment can be anywhere between 60% and 80%, but it has to be the right machine.

Donna Lee: 

And the right candidate.

Dr. Mistry: 

I know it’s a self-serving thing to say, but we spent a tremendous amount of research on making sure that we had the European model. It’s a German model. So somebody says, Do you have a Swiss wave? I don’t know what that means. People just come up with names like Gainswave…

Donna Lee: 

Probably got holes in it.

Dr. Mistry: 

…and linear compression therapy. Swiss wave with holes in it. And so, for that technology, make sure that it’s a reputable provider. If you’re going to your chiropractor for your erectile dysfunction or your wife’s OB-GYN, or some plastic surgeon, I mean you’re just remember that person doesn’t treat erectile dysfunction. They sell you…

Donna Lee: 

A product.

Dr. Mistry: 

…ultrasound for your penis. That’s what they’re selling you. They’re not really trying to fix your erectile dysfunction, whereas…

Donna Lee: 

And not everybody’s a candidate, too.

Dr. Mistry: 

That’s right. TRT as an adjunct to the, what we call shockwave– you know, we’re trying to come up with a better name, if any marketing people are out there.

Donna Lee: 

I thought we were going to call it the penis pulsing?

Dr. Mistry: 

I don’t, I think we’re still working on that.

Donna Lee: 

That sounds so lovely–get your penis pulsed!

Dr. Mistry: 

In any case, it’s ultrasound energy directed towards regeneration. I like “Rejunawave.”

Donna Lee: 

Rejunawave?

Dr. Mistry: 

No, that doesn’t go good?

Donna Lee: 

No.

Dr. Mistry: 

Testosterone replacement therapy is absolutely an important adjunct in any erectile dysfunction program, and it usually fixes about 60% of failures for whatever treatment you have. And the final mentioned was pills. So pills are usually gonna include Sildenafil or Tadalafil…

Donna Lee: 

Which is Cialis, or no Viagara and Cialis.

Dr. Mistry: 

That’s right. Those medicines for our caller or listener and for all of you out there, they have some peculiarities to them when it comes to timing. You have to take the Sildenafil on an empty stomach.

Donna Lee: 

That’s Viagra.

Dr. Mistry: 

That’s right. An empty stomach, an hour prior to intercourse. If you’re a man with you know moderate erectile dysfunction, there’s really no dose that’s going to work under 50 milligrams. And nowadays people buy generic ones that come in 20’s, so remember that’s 3 of those. When it comes to the Tadalafil, if you’re going to take it on an on demand-basis, you have to take it 4 hours beforehand for it to work.

Donna Lee: 

So Tadalafil is the Cialis, so people know.

Dr. Mistry: 

Thta’s Cialis. If you’re taking the daily, which is what our suggestion is for many patients, you don’t have to worry about timing, and you can just consider it your vitamin C…Vitamin capital C!

Donna Lee: 

That’s right.

Dr. Mistry: 

But out of all of that being said, the most worrisome thing that I heard in that question was that he’s only 41 years old!

Donna Lee: 

I know!

Dr. Mistry: 

And if somebody, if somebody has not done a thorough tip-to-toe kind of evaluation of your cholesterol, your cardiovascular risk, maybe a heart-saver CT scan to look for calcium in the, in your coronary arteries, they’re doing a big disservice. If you haven’t had nerve testing, I would even say that a penile artery Doppler test would be a valuable test in somebody as young as you are. And then, you know, these are really to try to get to the undersurface. You know, you’re so young that we would even start entertaining whether or not an underlying psychological issue or a medication interaction was going on. But certainly you need somebody to dig into what’s going on, because if you’re having such severe ED that pills are no longer working at 41, then you’re probably gonna end up with the next 3 options that I’m going to talk about. The first option is going to be a vacuum erection device. It’s a suction device that’s placed over the penis, uses a vacuum that brings blood flow into the penis, and then a constricting ring at the base of the penis to keep that blood flow in. The second thing that we can offer is something called intracavernosal injection therapy. It’s a mixture of 3 medicines that bring blood flow into the penis. It’s an injection into the side of the penis, gives you a very robust erection. You know, it’s not very expensive either. It’s something in the order of $4 to $7 a dose. Whereas if you go to one of these penile injection clinics, you could expect to pay hundreds of dollars a month for the same thing. And that’s all they offer, it’s a one trick pony. It works for everything. It works for premature ejaculation, it works for anejaculation, it works for, you know, not getting an erection–they just use it for everything because it just gives you, you know, an erection that lasts for an hour or 2. And then, but, I would say…

Donna Lee: 

Do you ever get immune to that? Like if the patient’s doing that a lot, does that cause a problem?

Dr. Mistry: 

Usually, people do find they’re having to use higher and higher doses, but that’s in people who are getting worse and worse problems. So why we know that is because in spinal cord injury patients who are don’t have an underlying cardiovascular problem–so it’s not like their atherosclerosis is getting worse because they’re 22 year old men in wheelchairs–those guys, even just a little bit of it works and that little bit will work for many, many decades, because they’re not getting a worsening of the hardening of their arteries. But if you’re a 68 year old man with cardiovascular disease, that underlying cardiovascular problem is probably worsening.

Donna Lee: 

Gotcha.

Dr. Mistry: 

And so, requiring higher doses isn’t surprising. But I don’t think that you’re becoming immune to the medicine or else, like I said, the spinal cord injury or the young patients, they would have to get also accelerated dosing, but they don’t. Usually the same small dose works.

Donna Lee: 

That makes sense.

Dr. Mistry: 

The inflatable penile prosthesis is probably the way that’s going to make men feel the most natural. It’s spontaneous. It’s a 3 piece silicone device place completely within the confines of the body. Nothing is externalized. There’s a pump in the scrotum similar to a third testicle that transfers fluid from a reservoir into the cylinders and gives you a robust erection, great orgasm, over 90% satisfaction rates. And you know, as luck would have it Donna Lee…

Donna Lee: 

We have somebody who can do that.

Dr. Mistry: 

Christopher Yang.

Donna Lee: 

Dr. Yang.

Dr. Mistry: 

Dr. Christopher Yang, our partner, spent an entire year as a fellowship…you really have to think about a guy who spent an entire year doing nothing but that.

Donna Lee: 

The prototype that we have in the office is pretty impressive.

Dr. Mistry: 

And it’s pretty well used.

Donna Lee: 

We play with it all the time.

Dr. Mistry: 

Oh boy. We would love to take care of things like that for you and if you are a young man under the age of 45 with severe erectile dysfunction, please come in. You know, give us a chance to make sure nothing else more serious is going on and make sure that we tailor an approach that’s best for you. Donna Lee, why don’t you to tell people how to get ahold of us?

Donna Lee: 

Please send us your questions to armormenshealth@gmail.com. We will answer them anonymously on air. That’s very important. Armormenshealth@gmail.com. Our website is armormenshealth.com. And you can call us during the week at (512) 238-0762. We are in Round Rock, North Austin, South Austin and Dripping Springs. And we’ll be right back.

: 

The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at Armour men’s health edge, gmail.com.

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