EP 609: Stomach Cramps or Diverticulitis? Dr. Thiru Lakshman on the Most Common Colorectal Symptoms and How to Rectify Them!

In this episode, Dr. Mistry and Donna Lee are joined by Dr. Thiru Lakshman of Central Texas Colon and Rectal Surgeons--the largest, most experienced group in town. Dr. Lakshman is a proctologist who treats a variety of conditions affecting the colon, rectum, and anus. Today, he explains the difference between diverticulosis/diverticulitis and hemorrhoids/anal fissures. While no one wants to have any of these conditions, some are significantly worse than others. Listen in to find out what your stomach cramps, rectal bleeding, and anal pain are trying to tell you, as well as how to rectify them! To schedule an appointment with Dr. Lakshman, visit Central Texas Colon and Rectal Surgeons online or call 512-220-7002 today.

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Speaker 1: 0:07

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 2: 0:12

Hello and welcome to the Armor Men's Health Show. I'm Dr. Mystery, your host here, as always, with my incredibly resourceful, I cannot live without her sidekick Donna Lee.

Speaker 3: 0:21

That's right. You cannot live without me. Dr. Donna, the co-host

Speaker 2: 0:25

Certified, she's not a doctor. I have to reiterate that. This is a men's health show.

Speaker 3: 0:29

I have a piece of mail that comes to me. It says Donna McBride md

Speaker 2: 0:33

My Lord. This is a men's health show. This show's brought to you by N AAU Urology Specialist, the Specialty Urology Clinic that I started in 2007, 15 years in the making. We treat all the issues between the nipples and the knees. We think we have a great holistic approach to your needs. So when it comes to your urologic needs, whether they be kidney stones or bladder leakage, or dripping from dripping springs or wherever it is, that's, we'd love to take care of you.

Speaker 3: 0:56

Mm-hmm.<affirmative>, and you can reach out to us during the week, and you can even ask for me 5 1 2 2 3 8 0 7 6 2. Our website is armor men's health.com. We're in Round Rock, north Austin, south Austin, and Dripping Springs, Texas.

Speaker 2: 1:08

Many of you may know that Donnel Lee is a professional comedian, and of course, most of you are aware that Indians are amongst the most humorous of all ethnicities. And today we are so honored to have the second funniest Indian

Speaker 3: 1:21

<laugh>

Speaker 2: 1:21

In Austin, in all of Austin. Hey, it's a contest. Dr. The Lman, thank you for joining us today, Dr. Lman.

Speaker 4: 1:26

Thank you for having me. I'm gonna immediately protest the second place ranking

Speaker 3: 1:31

<laugh>. No, you

Speaker 4: 1:32

Should. It depends on who's the judge. Right.

Speaker 3: 1:34

I'll be the judge today. Oh

Speaker 2: 1:36

My gosh. So my whole life has been phole and his whole life is butt holes. And it has been an absolute strong desire of me to have you on the radio. Thank you so much for joining us today.

Speaker 4: 1:45

Of course. My pleasure. Just, and we're, and we're also both doctors. We

Speaker 2: 1:48

Are. Oh, wait, that's great. Oh, there's also that too. It, it's almost like, it's almost like God gave us too much.

Speaker 4: 1:54

Yes, it's true.

Speaker 3: 1:55

Oh my God, it's so true. Just the text in between you two has been a lot. So here we

Speaker 2: 1:59

Go. So, Dr. Lman, you work for central Texas, colorectal surgeons. You are butt hole surgeons. Oh,

Speaker 4: 2:05

Yes. The technical term is a proctologist, uh, I think is the term you're looking for. Uh, but that's really one of many

Speaker 2: 2:12

Things. There was a Seinfeld episode on this whole thing.

Speaker 4: 2:14

Wasn't the proctology? Yeah, the As man As man. Yeah. I actually have an as man, uh, license plate in my office. Oh,

Speaker 2: 2:18

I, I have, I have no doubt

Speaker 4: 2:20

That's true. We do, uh, work with butt holes as you so eloquently put it. But, uh, we also cover basically all of the sort of lower GI tract, uh, healthcare from a surgical standpoint. So whether that's from butt holes, meaning like hemorrhoids and constipation and abscesses and things like that, to very complicated things like colon and rectal cancer and inflammatory bowel disease and all sort of colitis and things like that. We do major abdominal operations as well as lots of minor procedures, and then a lot of day to day even, you know, non-surgical care.

Speaker 2: 2:47

Now, what's really cool about what you do is you, even though you're dealing with large segments of bowel, you do a lot of robotics and laparoscopic surgery. One of the areas that you and I frequently kind of, uh, overlap work is gonna be be in a condition called diverticulitis. Maybe you could explain to our listeners what is diverticulitis and, uh, what can it do? Like what kind of symptoms do people have when they, when they get it?

Speaker 4: 3:08

It's a great topic to discuss and it's really quite common actually, particularly here in the United States, our sort of western meat and potatoes die. We, we really see a lot of diverticulitis until no, about diverticulitis. You have to know about diverticulosis or diverticular disease. And basically what that is, is in our large intestine, also known as the colon, uh, you can develop these little pockets, almost like weakenings in the wall of the colon itself. The colon is just a big flexible tube, our intestine that basically reabsorbs water and creates, uh, solid waste from liquid waste. And then we poop it out. Essentially with diverticular disease, you develop these little pockets or weakenings in the bowel, and now many people have those. If I took a hundred Americans and, uh, over the age of 50 and I did a scope or a skin, we'd see diverticulosis. Diverticulitis

Speaker 2: 3:52

Is, and these are different than polyps, even though our brain, you think of it as a, a something. That's right. It's different than a polyps.

Speaker 4: 3:58

I would actually say, if you want to think about it, conceptually, polyp is like a growth on the inner lining of the colon. A diverticulum is like a little pocket, it's almost like popping out the other direction. Right.

Speaker 3: 4:08

More dangerous than the other.

Speaker 4: 4:10

They're two very different sort of disease processes. Polyp, which is an abnormal growth, and the lining of the colon can develop into a cancer. Okay. Uh, and so when we talk about colorectal cancer screening and colonoscopies, the primary reason is we're looking for polyps because polyps can develop into cancer. Diverticular disease diverticulosis is these little pockets, which also we can find during a colonoscopy. Mm-hmm.<affirmative>. But the risk there is, is if you get a little perforation or a localized inflammation of one of these pockets, then you can get diverticulitis medical terms. You hear a lot of, I right. Prostatitis, gastritis I is basically Latin for inflammation, right? Mm-hmm.<affirmative> diverticulitis is an inflammation or a localized infection of these little

Speaker 2: 4:51

Pockets. Are there more likely to occur with certain dietary things or can you get a peanut stuck in one of these things?

Speaker 4: 4:56

Yeah, that's a common, I don't know, we'd call it a, a folklore, A wives tale that

Speaker 2: 5:00

Because you can't get a peanut all the way through your mouth. Are you not chewing the peanut? Like how do you get a peanut

Speaker 4: 5:05

In the I can, I have, I have done many a scope and suctioned out many a peanut, my friend<laugh> many a pumpkin seed peanut. I think I just, for real? Oh yeah. Are people not chewing? I guess not. I guess it's so delicious that they have to just,

Speaker 3: 5:20

I'm taking that tip and we're making a commercial out of what you just said, that little snippet.

Speaker 4: 5:25

So yes, you, you know, there's this theory that, well, if you have these pockets in the colon, if you get little nuts or seeds in there that'll block off that pocket, it can cause it. But really that hasn't really been proven to, to a great effect that that's actually true. But what we know is, to your question, it is very specifically diet related. So a low fiber, high fat, high red meat diet is directly correlated with more incidents of diverticulitis, and for that matter, colon cancer as well too.

Speaker 2: 5:50

If you get one episode of diverticulitis, if somebody has it, tell me how they're gonna present.

Speaker 4: 5:55

Great question in gen, and it varies a lot from person to person, but in general, uh, somebody who has diverticulitis will have abdominal pain, usually left-sided, sort of left lower quadrant abdominal pain. The reason being is the most common area we get diverticulitis is in the descending or left colon or the sigmoid colon. Right. The theory being is that's where more solid stool is, and that's putting more pressure on the colon. So left-sided pain, crampy discomfort, uh, a lot of people will have either a low grade or even a high fever. Some people will have changes in their actual bowel habits, meaning more constipated or difficulty going. A lot of people don't have any changes, but the most common symptom is pain and then some signs of an infection.

Speaker 2: 6:32

And sometimes they'll go to the hospital, right? Yeah,

Speaker 4: 6:34

For sure. So if the pain is significant enough, they'll go to the hospital. Like most things, when you walk into the emergency room, they're gonna get a scan on you. A CT scan. That's right. And

Speaker 2: 6:42

It's not forbid somebody put their hands on you.

Speaker 4: 6:44

Yeah, yeah, that's right. It'll, you know, several thousand dollars of lab work and a several thousand dollars CT scan, and then you'll see the doctor<laugh>. So they'll do a CT scan and what you'll see is, is you'll see thickening and inflammation of that colon, so it'll confirm it. Then

Speaker 2: 6:55

If you're inflamed like that, that is not the time to do a colonoscopy. Right.

Speaker 4: 6:59

That's exactly right. Not the time to do a colonoscopy or, and if you can help, but not the time to do any sort of surgery either too, because you're at risk with a colonoscopy of causing a perforation of the colon because to do a colonoscopy, we actually insulate fill the colon with air or CO2 so that it opens up the, the colon so we can get a good look

Speaker 2: 7:16

Within it. And you don't wanna pop that really, you don't wanna pop that. And so if you are looking at the treatment for that is traditionally going to be something like antibiotics, anti-inflammatories and bowel rest, right?

Speaker 4: 7:26

Yeah, that's correct. So that this has been sort of going back and forth and the paradigm has shifted back and forth. You know, 50 years ago if you came into the hospital with a significant episode of diverticulitis, they take to the operating room, they'd removed that section of your colon, uh, and they would most likely give you a, um, colostomy bag, a temporary diversion. Oh, yeah. Nowadays the great majority of diverticulitis, particularly your first episode, uh, will be treated conservatively. And so that means, you know, dietary rest, you know, either not eating anything or very little, no solid food, just liquids. Uh, and then, uh, generally a course of antibiotics and in the great majority of cases that will, will cool it down and, and, and solve that

Speaker 2: 8:05

Episode. Now, if somebody keeps getting diverticulitis, you'll remove that part of the colon,

Speaker 4: 8:09

Right? That's right. So the, um, the indications for surgery is obviously if it's an emergency, right? The colon bus open's perforated in their septic and then you poop everywhere. That's right. So that we don't want that, and that's bad. So that, that's obviously an indication. But then recurrent repeated episodes, increasing frequency, increasing severity of the episodes, and then where sometimes you and i, our paths crosses, if you develop a, a certain, uh, complication related to the diverticulitis, specifically where the colon that's become inflamed or infected gets stuck to another adjacent structure

Speaker 2: 8:44

And it can get stuck to the vagina, to the uterus that's right. To the, uh, to the, to the bladder in our case. What else can get stuck to, can it get stuck to other parts

Speaker 4: 8:51

Of bowel? It can get stuck to another piece of the colon that's adjacent, another piece of, of small intestine that may be down in there. The most common, the two most common areas are usually the bladder, particularly in men, and then in the, the sort of top or the cuff of the vagina in women.

Speaker 2: 9:05

And so when this happens, if, if it ha if you have one episode of diverticulitis, are you like for sure destined to have that part of your colon removed? Or can you make those dietary and lifestyle changes to keep that from happening again?

Speaker 4: 9:17

Now, actually, the majority of people will have just one episode and not require surgery. Um, so with that first episode, if they find it out, they do the scans, they do a follow-up colonoscopy when things have cooled down and they prove it is indeed divert particular disease, the treatment is a high fiber diet really. So it's just lifestyle changes. Um,

Speaker 2: 9:36

So if you have one episode of diverticulitis, you should eat high meat diets, no fiber, so that way we can operate on them. Right.

Speaker 4: 9:42

No, that's, uh, that is

Speaker 2: 9:44

Incorrect. Is that the opposite?

Speaker 4: 9:45

That's the opposite. Oh,

Speaker 2: 9:46

Man,

Speaker 4: 9:46

That's my whole diet. I know. That's what you've been telling yourself

Speaker 2: 9:49

Because so many of our patients think that we're trying to keep them sick so we can operate on them again and again. Right. And so now I want you patients to understand how ridiculous that sounds. Right. We're

Speaker 4: 9:57

Telling you, I suppose if you're looking to increase your medical practice, you can then suggest somebody

Speaker 2: 10:01

To do that. Try try the sunny ministry, the Luxon diet for diverticulitis. That's right. It's nothing. Atkins<laugh>

Speaker 4: 10:08

100, 100% guaranteed diverticular disease or your money back<laugh>

Speaker 2: 10:12

Nothing but pumpkin seeds and meat.

Speaker 4: 10:16

That's right. Well, you can smoke and drink. You can smoke and drink.

Speaker 2: 10:20

Right. Well, thank you so much for joining us for this first segment. We're gonna take a small break and come back. I have Dr. The Lman with Central Texas colorectal surgeons with us. This is Dr. Mystery, your host, board certified urologist. Joined by my co-host Donnel Lee. A lot of our patients and listeners will call us and ask for Donna in particular. She will be happy to talk to you if you call our office, get a free shirt, make sure your questions are answered. Mm-hmm.<affirmative>, we love answering your questions. The show is brought to you by AAU urology specialist, the urology clinic that I started in 2007. Old man walking, old man. Welcome. I'm mid-career, they say,

Speaker 3: 10:54

Are you? Yeah. Mid-life crisis.

Speaker 2: 10:56

That's right. The garage definitely looks like midlife garages right now.<laugh>, uh, once again, we're joined by one of my really good friends in town here in Austin, Dr. Theu Luman with Central Texas colorectal surgeons. Part of what makes our job so interesting is that the kinds of organs that we deal with are so like unappealing to talk about it parties.

Speaker 4: 11:14

That's very true.

Speaker 2: 11:15

But somehow we managed to do it. It's true. You know, like it's really amazing.

Speaker 4: 11:19

It's amazing. I've never seen anybody have the skill like you do to bring up penises in, uh, normal everyday conversations as well as you do. It's

Speaker 2: 11:26

Really, it's really, it's really a gift and a curse. It's a gift, you know, you know, as a gift. It's a gift and a curse. Just a curse.

Speaker 4: 11:32

Yeah. Although I tell patients that I'm, I'm always the guy that when they see me in the grocery store, they all turn around and walk the other direction. No one else is like, Hey, there's my, hey Hemorroids,

Speaker 2: 11:41

My hemorrhoid

Speaker 4: 11:41

Doctor, honey, come meet the guy who dis impacted me<laugh>.

Speaker 2: 11:46

So, you know,

Speaker 4: 11:47

Could go so many different ways.

Speaker 2: 11:49

Yes. So there's, it's interesting, you know, with women and vaginal issues, men, men and penile issues and everybody and issues, we just know that something's wrong, right? We can't sit right. It just doesn't feel right. What are all the things that cause us pain in our?

Speaker 4: 12:01

Oh gosh, how much time do you have

Speaker 2: 12:03

<laugh>? You have 11 minutes<laugh>

Speaker 4: 12:05

And go. I think there's lots of things and I think there's a lot of misconceptions about it. And then sort of like what we were joking about earlier is that people don't want to talk about it, right? Because it's embarrassing. And the fact of the matter is, is things like hemorroids or rectal pain, anal pain, constipation is affects a great majority of our population.

Speaker 2: 12:23

So we see people complaining of anal fissures and things of that nature. What, what are they talking about? Yeah. And what causes,

Speaker 4: 12:29

It's a great question. So just to, to level set right, A hemorrhoid is something that, first of all, we all have every, everybody with normal anatomy has hemorrhoids

Speaker 2: 12:37

Two on the right, one on the left.

Speaker 4: 12:38

That's correct. That's right. Yeah. Three sort of anatomic columns of hemorrhoidal tissue. And they're basically, I describe them as like varicose veins of the anal canal. Um, and they line the distal part of our, the most, you know, the most lowest part of our colon or rectum, uh, right near the anal opening. And they provide actually some support and cushioning and blood supply. But with s screening, with pushing with hard bowel movements, with um, heavy strenuous lifting like you do in the gym every day, yes, sunny, uh, you can increase the blood flow to that area and it can cause sort of engorgement and swelling of those hemorroids and that can cause pain, bleeding and uh, you know, difficulty with bowel movements. That's those, that's heidal

Speaker 2: 13:13

Disease. That's why all those meathead have to wear real, real, uh, real baggy pants because there's, there's a big hemo sticking out. There's

Speaker 4: 13:19

Huge hemorroids hanging out. That's right. Yeah, that's right. So that's hemorrhoidal disease, right? And then there's lots of sort of delineations of it, internal hemorroids, external hemorroids, a thrombo hemorrhoid, which is like a blood clot on the outside that stretches the skin, which can be very painful. And the most common symptom is, is swelling and bleeding with bowel movements. A fissure is a completely different thing, but a lot of times it gets confused. Uh, for hemorroids or hemorrhoidal disease, a fissure is a cut in these fi muscle, right? So if your anal canal, that sort of opening right there at the bottom has a sphincter muscle complex, that's what keeps you from, you know, pooping your pants and helps you to have, have a normal bowel movement. That sphincter muscle complex sometimes can be very tight and sometimes with a difficult hard bowel movement, you can actually cause a tear in it. Uh, and that's what a

Speaker 2: 14:03

Fissure is. Well, those fissures come up overnight, like they come up pretty quickly.

Speaker 4: 14:06

They will come up almost instantaneously. In fact, I'll see patients in the classic sort of description is they'll, they can tell you the exact moment. Yeah. Oh, d I was out partying on sixth Street and, and I was super dehydrated the next day and I sat on the toilet and, and all of a sudden I felt, and they, and they, it's almost to a t they'll say it just felt like something ripped and then it's severe, exquisite. That's a terrible excruciating

Speaker 2: 14:31

Pain. I didn't think that's how it was gonna start. When you said they partied on sixth Street, that's something else was gonna happen. No, that's, I blacked out. Next thing you know, it happened at 6 0 2.

Speaker 4: 14:38

Well that's a whole different radio show I think.

Speaker 2: 14:41

No, that is this radio show.

Speaker 4: 14:43

Oh, right. That

Speaker 2: 14:43

Is exactly the video. So, so an anal fissure occurs like almost instantaneously. Does it need to be repaired surgically?

Speaker 4: 14:48

We always try to manage it conservatively at first. And so I'm, I'm describing the classic onset, you know, of it. Now there are some sort of chronic anal fissures and there's other disease processes that can lead to you getting fissures as well too, both superficial and, and deep fissures. But a classic anal fissure is brought on by hard stool, constipation and straining. It's a cut. We generally always try to treat it conservatively at first. Uh, and the majority of cases can be managed conservatively. There's some special ointments that you can use really working on your, what we call your bowel regimen, right? To make sure your bowel movements are easy to pass and they're more regular and you're not straining and pushing and sort of really working on that. And then about, you know, 60 to 75% of the time those cure with conservative treatment. And if they do not, then there are, um, surgical options that are actually really quite successful. 95 to 99%, is

Speaker 2: 15:34

That where you put the cton in there?

Speaker 4: 15:35

No, that's something different. That's for a fistula. Okay. Uh, yeah, a fistula is an abnormal connection between the sort of outside of the anal canal. Inside the anal canal. And that usually forms once you've had, uh, an abscess, which is an infection. So imagine having pus pocket or like a boil, but within the, you know, the sort of perianal tissue sort of in between the inside and the outside. And then what happens is it'll drain both internally and externally and then you form an abnormal connection. And

Speaker 2: 16:03

Then if that abnormal connection does not heal on its own, then sometimes you need surgery to cut it, cut into it. That's correct. What's the surgery for a fisher? The

Speaker 4: 16:09

Surgery for a fisure is something called a lateral internals finc te otomy. And basically what you're doing is, is it seems it's a little counterintuitive because you have a cut in the muscle already, but you're making a relaxing incision sort of adjacent to where the actual fissure is. And what that does is, is it relaxes the muscle, uh, and increases the blood flow and that's what gets it to

Speaker 2: 16:29

Heal on physical exam. Can you actually see a cut in the, in the specter?

Speaker 4: 16:33

You can when you, if you can get them in the appropriate position, it's, it sometimes can be difficult to see because it's very painful. But one

Speaker 2: 16:39

Of the, it takes two glasses of wine.

Speaker 4: 16:40

That's right.<laugh>. That's exactly right. Two glasses of wine and some lu That's right. Just another Saturday night at Sonny's house.

Speaker 2: 16:47

<laugh>,

Speaker 4: 16:49

If they can tolerate it, you can just sort of, essentially, for lack of a better word, you spread the butt cheeks and you can sort of, not only can you some, you can sometimes see it, but more than that is it elicits exquisite pain.

Speaker 2: 16:59

You know, in my, in my mind as I take care of a lot of people with functional pelvic floor issues, uh, I feel like that once you get a fissure once, once you tear it, once you're more likely to tear it again. Is, is, is that that the right way to think about it or

Speaker 4: 17:14

Not? I think a better way to think of it is, is that if you get a fissure once and you don't sort of definitively take care of it, that same fissure sort of reopens again and again, it's not like it opens not you could get a separate fissure in another location. Usually the most common location is sort of right at the, you know, if we're looking at the anus like a clock face, uh, it's like right at the 12 o'clock position because that's the most tone with the least blood

Speaker 2: 17:39

Flow in urology. We see a lot of pelvic flus, vent taric abnormalities in patients who tend to carry a lot of anxiety or tend to be kind of tight ast and high strung. Yes. Would you say this happens with, with fissures

Speaker 4: 17:49

Too? Uh, yes. It happens with fissures and just sort of, um, anorectal issues in general, uh, in the sense that, um, stress, uh, high anxiety, uh, can lead to just like you're describing almost like pelvic floor spasm, anal spasms and patients have a hard time going and then they strain and push more and then that leads to hemorrhoids and fissures and things like that

Speaker 2: 18:12

Too. When should somebody seek out the care of a colorectal surgeon versus a gastroenterologist versus something else PCP to, or, or, you know, for, for anal pain?

Speaker 4: 18:22

Yeah, so that's, uh, it's a good point. So I think it's always, you know, it's easiest to start first with their primary care physician. I would say that any significant anal pain or bleeding should not be sort of dismissed. Um, cuz obviously what we're really concerned about is, is potentially there being like a cancer or tumor or something

Speaker 2: 18:40

Because that can happen, right? Anal and rectal cancer can certainly present in

Speaker 4: 18:44

This for sure. In fact, the majority of the, of the rectal, you know, in colon cancer cases I see is patients have been sort of managing with it for months because they were told, oh, you're bleeding because it's just hemorrhoids, right? So,

Speaker 2: 18:54

And that's the real danger of today's, you know, uh, medical environment is that everybody's so busy and overworked and so many times, uh, regular complaint really isn't something super serious. So it's really incumbent upon you as an individual or you as a patient to kind of take control of your care. So if you have recurrent bleeding, if your pain's not getting better, I mean you need to seek out the right kind of care.

Speaker 4: 19:18

Absolutely. Yeah. Start with your primary care physician. If some initial evaluation treatment doesn't get it better, then you gotta bump it up, you know, and go see a specialist. So issues like hemorrhoids and fissures, you know, acute pain, bleeding, things like that. A colorectal surgeon, this is what we sort of manage and we can sort of, uh, cut to the chase in the sense that we can manage it conservatively, but then also it doesn't need to be referred to somebody else for the surgical treatment. We can go directly to

Speaker 2: 19:43

That. So if somebody's trying to bump it up to you, Dr. Laxman, how do they get ahold of you?

Speaker 4: 19:48

Uh, so my office number is 5 1 2 2 2 0 7 0 0 2. Our website is, uh, central Texas crs.com. We have offices in North central and south office, um, uh, with multiple board certified colorectal surgeons. We sort of cover the whole city from, you know, south of Austin, Kyle area all the way up to Round Rock and points North. Um, everybody's board certified, we all do from minor to major cases. Uh, so whether it's a fissure or hemorrhoids or something big like a colon cancer or recal cancer that requires surgery, minimally invasive surgical techniques, uh, we, we can handle all of that. Um, and, uh, we're sort of the largest most experienced group of colon re surgeons in the area.

Speaker 2: 20:30

Well, thank you so much for joining us, Donna. How do people get questions to him or get questions to us?

Speaker 3: 20:35

That's right. You can reach out to us at arm men's health.com and our number is 5 1 2 2 3 8 0 7 6 2.

Speaker 1: 20:40

The Armor Men's Health Show will be right back to submit a question for Dr. Mystery, visit armour men's health.com.