NAU's COVID-19 Policy
May 30, 2020

Yes, We Said ‘Ding-a-ling’: Dr. Mistry and Donna Lee Discuss Urology Care in Adolescents

Speaker 1: 

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

Dr. Mistry: 

Hello, this is Dr. Mistry, your host for the Armor Men’s Health Hour. Welcome back. I have my cohost, Donna Lee, the seventh funniest mom in America.

Donna Lee: 

Per Nick at Night.

Dr. Mistry: 

We need to put these…

Donna Lee: 

You forget the Nick at Night. That’s the important credibility. That’s my street cred.

Dr. Mistry: 

Nick at night.

Donna Lee: 

Nick at Night’s my street cred.

Dr. Mistry: 

Can we just say Nickelodeon next time?

Donna Lee: 

Oh yeah.

Dr. Mistry: 

A lot of people may not know that Donna Lee is a professional comedienne.

Donna Lee: 

That’s right.

Dr. Mistry: 

Mainly because she’s not that funny.

Donna Lee: 

I’m not that funny.

Dr. Mistry: 

Oh, that’s funny. Uh, she is trying to make me into a comedian. I am not funny either, but what I am is passionate about men’s health.

Donna Lee: 

Yes. But sometimes you’re funny.

Dr. Mistry: 

I try to be talk.

Donna Lee: 

Talks we have during the commercial breaks are pretty funny.

Dr. Mistry: 

That’s probably…you better not be recording.

Donna Lee: 

I’m starting to record those.

Dr. Mistry: 

That’s not right. This is the Armor Men’s Health Hour. This is a men’s health show. We are on the radio on KLBJ.

Donna Lee: 

News radio, KLBJ.

Dr. Mistry: 

If this is where you’re listening to this program, then thank you for listening. We absolutely love having your questions and your participation and your engagement. It’s a really big component of why we continue doing this. And if you’re listening to us on the podcast, well welcome to the 21st century.

Donna Lee: 

Send us an email if you’re far, far away, and we’ll send you a free t-shirt that, I mean, unless you’re in Sweden or something. But…

Dr. Mistry: 

I don’t know, maybe cash on delivery.

Donna Lee: 

Maybe if you’re like in Michigan. That’s right. C.O.D.

Dr. Mistry: 

That’s right.

Donna Lee: 

You know, I wanted to give a shout out to our super fan. Her name is Lori. She’s my new best friend cause she’s a super fan.

Dr. Mistry: 

She’s a super fan.

Donna Lee: 

She thinks we’re pretty cool.

Dr. Mistry: 

And you know what she proved to us? We probably need to make this show a little bit more appealing to women. I was told just today in fact that a man was like, “Well, maybe I should listen to the show because it won’t just be my wife telling me about my health.” A lot of what we do on this show has to do with being a man and men’s health problems that you kind of encounter. But you know, being a man starts before you’re 65, believe it or not. And we spent a lot of time in our practice doing men’s fertility and helping men become fathers. How about now you’re a father or a mother and you’ve got a little boy at home and that little boy has got some problems with his ding-a-ling?

Donna Lee: 

That happened.

Dr. Mistry: 

…and you don’t know what to do about it. It is a weekly scenario here.

Donna Lee: 

Did you say ding-a-ling?

Dr. Mistry: 

It is weekly here.

Donna Lee: 

It is, well daily.

Dr. Mistry: 

That we educate some parent on some aspect of their kid’s genitals education…

Donna Lee: 

On ding-a-ling education.

Dr. Mistry: 

…that they think is a complete mystery to them. “Ma’am, you didn’t realize that your son’s left testicle was 17 times larger than the right?”

Donna Lee: 

They don’t after a certain age. The teenage boys aren’t going to show it or talk about it.

Dr. Mistry: 

Oh boy.

Donna Lee: 

Like mine is 17 and he would probably never tell me if something was wrong, so…

Dr. Mistry: 

That’s why we have sports physicals because it’s good that somebody’s checking.

Donna Lee: 

Oh, I never thought about that. Is that a fake physical, they just call it sports physical so they check their ding-a-lings?

Dr. Mistry: 

I think that the only thing they’re checking is their ding-a-ling in fact, just to make sure that everything is working okay. A couple of topics that you may not get a lot of information on that may kind of kind of baffle you–one of them is disorders of puberty. I think that you know nowadays, you know when you’re growing up, especially if you’re the mother of a boy, you may not know what is normal. When are things supposed to be dropping, when our voice is supposed to be dropping, when his hair is supposed to be going in certain places, and you may be wondering kind of what the natural kind of course of puberty is. I’ll say that although it’s different for every young boy, if you’re 15 years old, if your boys 15 years old, his voice hasn’t dropped and he hasn’t started gaining muscle mass and he doesn’t, is not having facial hair, then I’d be concerned at age 14 and 15 that puberty may not be coming in. Now, a lot of times the body will naturally catch up. As you can all imagine, to be small and underdeveloped in your middle and high school years can probably play a very big role in your self confidence, in your, even your academic performance which is what I care about the most is people studying hard and working hard. But it can really play a big role. So pubertal kind of questions are certainly something that you can ask your pediatrician about. Don’t feel weird about it. That’s what everybody’s here for. If you want to a more in depth kind of male centered kind of exam, it’s something that we do all the time. We will actually kind of physically measure the testicles. We’ll make sure that they are where they’re supposed to be. We’ll check testosterone levels, we can check LH and FSH levels to make sure that the pubertal kind of machinery is coming on. And whether you have talked to your son about it or not, they’re thinking about it. They’re looking at each other, you know, on the playground or in the, in the gym. And they, they understand when they’re undersized or not going through puberty at the same time. So, you know, don’t wait until they’re 16 or 17 and half getting ready to go off to college.

Donna Lee: 

Right. And you’ll see kids.

Dr. Mistry: 

Oh yeah, of course.

Donna Lee: 

I think people don’t know that, you do see pediatrics? Conversely though, I’m kind of tired of the moms that call and they’re like, “Oh, I want to get my son in. Do you have room for a new patient?” And I’m like, “Sure what’s going on?” And they’re like, “Well, he’s having something wrong with his penis and he’s just so embarrassed. I need to bring him in.” And I’m like, “Oh, how old is he?” “27.” Stop it. Stop it, ma’am. You have enabled him and that is wrong.

Dr. Mistry: 

That’s funny from chief momma enabler herself, Donna Lee.

Donna Lee: 

Well, we do have a question though…

Dr. Mistry: 

You’re the enabler. Alright, what’s this question?

Donna Lee: 

Well this question is from a long time listener. He sent this in a little while ago. “Dr. Mistry, my 13 year old grandson is six foot one and having testicular pain into his stomach. He has been to the doctor and the emergency room. They have no diagnoses that they’ve given him.” That’s interesting. They live in Salt Lake City. This gentleman, the listener lives here. “I was hoping you might know of a urologist in that area. I listen to your show all the time and find it very informative. Thank you so much for your time.” What are your thoughts on that? No diagnosis.

Dr. Mistry: 

That’s a great question. You know, if that person has already been to see a urologist, I’ll just kind of cite briefly the multiple things that I see that lead to testicular and abdominal pain in that age group. So starting from the most worrisome is testicular torsion, where you get an acute twisting of the testicle that causes pain. Now that pain, if it’s a torsion, an official torsion, it’ll happen. It’ll be obvious it’ll be diagnosed immediately. The pain will resolve surgically when…

Donna Lee: 

Right. Does that feel like a kick in the cahones, or is it more gradual?

Dr. Mistry: 

It can feel, it’s severe pain, usually acute onset. Oftentimes wakes the patient up and they have nausea and vomiting almost always with it. The second thing that can occur, but that’s not going to be mistaken. The second thing that can occur is an infection of the epididymis or testicle called epididymitis. It can occur in children that age is often viral. It won’t, it will also not be terribly subtle, although it can be, but it’s usually going to be a sudden onset of pain and swelling. It’s usually not going to be mistaken and it usually self limited within a few days with just ibuprofen. And sometimes we’ll get back to them if we’re confused or concerned that this is infectious etiology. So now we’re getting into what are causes of pain that happen that are hard to spot? So a varicocele is a great example. A six foot one 13 year old–that kid’s got a lot of torso and that means the vein that that feeds blood or takes blood away from his left testicle is going to be really long. I could go through anatomical pictures, but if it’s a dull ache in the left testicle, especially with lots of physical activity lifting, that’s something that can be both repaired and very common cause of testicular discomfort. And it’s usually a very quick exam. An ultrasound can often find these things but not, not always. And if he’s been evaluated, he may have already had an ultrasound. So next comes the concept of intermittent testicular torsion. Just like the first one where I talked about it twisting and staying twisted. Intermittent torsion can twist and untwist and twist and untwist. And this is one of the hardest diagnosis to make because when they see you, they’re not hurting. And then when they go home or do something, then it twists and then untwist. Usually it will feel like a torsion severe onset pain, maybe associated with nausea. And then it will resolve almost as quickly as it comes on. Now if it keeps happening, they may have some residual pain. And this is all about a level of suspicion. Your doctor really has to be thinking that maybe this is happening. And then what we do is we just put a couple stitches in and keep it from twisting and that fixes it in most cases.

Donna Lee: 

That’s it? Really?

Dr. Mistry: 

If that’s what it is. That’s right. Next we’re going to go through it just because, you know, that’s how we do things here, a biomechanical cause. So the pelvic floor is a basket of muscles that has four holes in a man: one you pee from, one you poop from, and the other two are the holes that the testicular cords come out of. And so if that basket of muscles is not working, maybe the boy has a scoliosis or some other orthopedic issue that’s causing that muscle group to not function symmetrically. You can have either unilateral just on one side testicle pain or the other or both. That can also cause kind of abdominal pain. If the patient has ever had a hernia or a hernia repaired, then surgical complications from that can cause both testicular and abdominal pain. And so I’ve given you a long list because if it was easy, somebody would have figured it out already. Okay, so it’s not going to be torsion and it’s probably not going to be an infection, but a varicocele could have been missed by, you know, by…

Donna Lee: 

Tell everybody what a varicocele is again.

Dr. Mistry: 

….[inaudible] pediatrician, especially if the testicle wasn’t examined. A varicocele is just like a varicose vein in the legs. A varicocele is a large dilated vein, which is actually group of veins that are normally present like these veins are they should be there, but they shouldn’t be engorged with blood. You shouldn’t see what we call a bag of worms appearance through the testicle, through the scrotal skin. And this can lead to both delayed testicular growth, infertility, low testosterone, and the most dreaded, which is a dull ache in the testicle. And 13 to 16, I think is a very reasonable time to consider it. And then there are some testicular pains that just occur just as boys are going through puberty. But I wouldn’t just immediately call something a growing pain without actively going through the entire algorithm.

Donna Lee: 

Good to know.

Dr. Mistry: 

What a great question. Thank you so much.

Donna Lee: 

Instead of me Googling and making you mad again…

Dr. Mistry: 

Yes. Don’t Google.

Donna Lee: 

…I had you answer the question so people didn’t have to Google.

Dr. Mistry: 

For once. Thank you so much. How do people get ahold of us?

Donna Lee: 

You can call us at (512) 238-0762 you can ask for me. Our website is armormenshealth.com and our email address is armormenshealth@gmail.com. Email us and we will answer your questions on here. We’ll be right back.

: 

Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour.

Austin Digital Marketing And Development By Fahrenheit Marketing