Armor Men's Health Show

EP 643: Cardiac Canary In the Coal Mine: Why ED Can Indicate Heart Health Problems and How Dr. Nathan Pekar of Victory Medical Can Help With a Heartwise Physical

• Dr. Sandeep Mistry and Donna Lee

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In this segment,  Dr. Mistry and Donna Lee are joined by friend of the practice, Dr. Nathan Pekar of Victory Medical Center in South Austin, Westlake, and Cedar Park. Today, Dr. Pekar and Dr. Mistry discuss the importance of advanced cardiac health screening for middle age men. Victory Medical is proud to offer the Heartwise Physical--an intensive cardiac workup that offers patients a full and detailed picture of their heart health and is covered by most commercial insurances. If you or a loved one is concerned about cardiac health or are experiencing symptoms of erectile dysfunction (which may be an early indicator of vascular disease elsewhere in your body), please call Victory Medical today at (512) 462-3627 or online at victorymed.com.
 
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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Speaker 1:

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

Speaker 2:

Hello

Speaker 3:

And welcome to Men's Health Hour. I'm Dr. Mr , your host here as always, with my incredibly computer savvy and competent co cohost

Speaker 4:

<inaudible> . Uh , for those of you who don't know when I make a boo boo before we start talking, that's why he makes that reference.

Speaker 3:

If you have, if you have an opening for an information technology expert, <laugh> , send us your, send us your job listing. We'll send you John ,

Speaker 4:

Me . It should , I can barely touch the record button, but I do produce it sometimes.

Speaker 3:

That's right. I'm a board certified urologist. This is a men's health show. Um, and this show is brought to you by the urology practice that I started in 2007. Mm-hmm . <affirmative> , n a u , urology specialist.

Speaker 4:

That's right. And your name is Dr . Mystery . M i s t r y. Not like mystery novel.

Speaker 3:

It has been mis thought of called Gimmicky .

Speaker 4:

Yes. Somebody thought it was fake.

Speaker 3:

Oh , if you thought I was gonna come up with a name, you think that that was the one I was gonna come up

Speaker 4:

With. <laugh> misspell the word Mystery <laugh> .

Speaker 3:

That's right. Let me tell you what name I would've come up with. Oh, oh , Dr . Pecker <laugh> .

Speaker 5:

Oh no. Oh no.

Speaker 4:

Speaking of, we have a special guest today,

Speaker 3:

But before we enter to that special guest, Donna, why don't you tell people about our practice and how to go to ahold ?

Speaker 4:

That's right. Our practice is lovely and it's all over Austin and Round Rock. North Austin. South Austin, dripping Springs. Uh, we have four MD surgeons. We have five mid-level , uh, sex therapy, sleep coordinator, what am I forgetting?

Speaker 3:

Two p pelvic floor

Speaker 4:

Physical , two pelvic floors . You

Speaker 3:

Better not forget them .

Speaker 4:

I know they lovely . Stabbing in the heart . Two pelvic floor physical therapists. You can reach us at 5 1 2 3 8 0 7 6 2 during the week. You can ask for me. I talked to a lot of our radio listeners now .

Speaker 3:

Absolutely. And we wanna see you . That's right . So if you , if you have a , a problem, come on , don't delay your care. Come on in. We'd love to take care of you.

Speaker 4:

That's right. We're here for you. Um , and then our website's, arm men's health.com. Send us your questions to arm mens health gmail.com.

Speaker 3:

And today we have a guest that , uh, we've had on the show before, and I really thank you for coming back to us. Uh, you Dr . Nathan Pekar .

Speaker 4:

That's right. Not Pcca . P

Speaker 3:

P K A R

Speaker 4:

P E K A R . That's right.

Speaker 3:

And he's a , uh, physician at Victory Medical. How long you been with the group?

Speaker 5:

Got to Austin in 2009 with Victory, was a physician for 10 years with the Air Force before that, hope to , uh, be in Austin for at least another 20, 30 years practicing

Speaker 4:

<LAUGH> forever. Well, good . You

Speaker 5:

For you. Well , uh, you know , someday I might die.

Speaker 4:

<laugh> <laugh> . No , no, no, no, no.

Speaker 3:

So when I started at my medical practice, I did general urology and I started doing a lot of hormonal therapy. And then I started noticing that the way that men were getting testosterone out there was really not fully thought out. And , uh, one of the big reasons I thought that is because the cardiac implications of having low testosterone and just being overweight and lethargic and things like that in general were not, a lot of people were doing it then. I had a very good friend in his early fifties, and he had a heart attack when he was supposedly under good care by a competent , uh, cardiologist, and then a very well known infectious disease doctor up north. He dropped dead at 48 from a heart attack. Mm . And you start wondering yourself and what are you supposed to do? I already went to the doctor, I got my cholesterol done. Is there anything more else I can do to make sure that I don't get hit by a cardiac event? And so I thought that you could give us some insight into that.

Speaker 5:

I'm so glad you brought that up. What a good ,

Speaker 3:

Uh , segue .

Speaker 5:

A great segue <laugh> . Uh , so Victory has had this program for about four years now called the HeartWise Physical. It's basically an executive style physical that any patient can do. Uh, you don't have to be an executive covered by insurance. It's covered by most insurances. Some mm-hmm . <affirmative> , most commercial insurances. Mm-hmm. <affirmative>. Um, so what we're able to do with the HeartWise that you're gonna get beyond a normal physical is a much more advanced cardiac workup. The, obviously it's everything starts with the heart on the HeartWise, where you start with the heart echo. We look at the heart before and after doing a treadmill test, and , uh, we're able to pick up valve issues, major heart related issues that wouldn't be picked up on a normal physical. And

Speaker 3:

You're looking to see if the heartbeat, the look of it changes with exercise, which could be a sign that some parts aren't getting blood when you're exercising, which you would start seeing even before chest pain.

Speaker 5:

That's correct. Yeah. So a lot of the early signs of heart disease aren't gonna show up on a blood pressure or even an

Speaker 3:

Symptoms

Speaker 5:

Or anek or an ekg . Yeah . So let's say the heart echo itself looks fine. Then we also look at the arteries themselves too, on the , uh, physical. And that's much more advanced than what you're gonna get on a normal physical between the big arteries and also the small arteries of the body. So the heart pumps the blood, it goes to the big arteries first, and then that blood will then go to the small arteries. What a lot of people don't realize is that a lot of times it's the small arteries that will show the disease well before the large arteries do. And the small arteries will often show disease before the blood pressure gets elevated. You

Speaker 3:

Know, who knows that the small arteries cause problems before the big ones. All those guys out there with erectile dysfunction.

Speaker 5:

That is exactly right.

Speaker 3:

Because the smallest artery that has importance for us is the one that go to our penis. Then , then the neck size is the one that goes to our heart. Oh . So when your , when your penis goes out, you gotta be a little worried that your heart may go out. That is

Speaker 5:

Exactly right. So , uh, we have something called the cardiovascular profiler, and , uh, it's actually, it's actually used on the wrist, but it basically, computers are able to analyze the waveform of the , uh, without getting a bunch of computer jargon, but , uh, the wave forms of the arteries to interpret how, how well the arteries are able to expand or how elastic they are. That's really the best way we have for detecting small artery disease. First. There is a pretty high correlation with small artery disease and erectile dysfunction like you mentioned. So I see that a lot in my young males , uh, let's say 30 to 40 range where they're having ed issues. And we'll see , uh, that on the , uh, HeartWise physical, what

Speaker 3:

An important thing. Right. So, I mean, it's one thing to fail on a date <laugh> , but it's something else entirely to drop dead from a heart attack, you know, 10 years later when the erectile dysfunction could have been very important telltale sign of something to come. So for us , um, when we find somebody like this and we put 'em through a cardiac evaluation, oftentimes even with a cardiologist, we'll be disappointed that they didn't do more than just kind of like talk to 'em. Because, because I sent them there to get like an advanced, you know, invasive executive style, physical is literally what I want. And you have to go to a special program and know what you're missing out or you won't know what what's even available to you.

Speaker 5:

That's exactly right. So let's say they do have early small vessel disease, that's definitely gonna get missed even on a carotid ultrasound. You , you might see plaque on a carotid ultrasound, but you're not gonna see that loss of elasticity of the arteries like you will with the profiler. So profiler is probably the best way to pick up early erectile issues , uh, or potential erectile issues in a young male that

Speaker 3:

They are vascular in origin. And that could be the sign of something going on. And, and why I tell people it's important is that let's say you have a borderline cholesterol and somebody has decided not to put you on drugs, but now it ends up that you're either your CT scan of your heart is abnormal, or this type of profile is abnormal. We might have lower thresholds for what our target cholesterol is for you. Is that right?

Speaker 5:

That's exactly right. And also blood pressure. Let's say their blood pressure's one 30 s over eighties , consistently, maybe I would've just done lifestyle changes, but now I'm seeing that profiler showing obvious small vessel damage or loss of that , uh, elasticity of the arteries. I'm probably gonna more aggressively treat that. Maybe still try lifestyle, but my, my threshold for going to perhaps even medicine, it's gonna be a little faster in that mill . It,

Speaker 3:

It's so important, and I'm gonna just reiterate this, there's normal and then there's normal for you as an individual patient. Just like when it comes to testosterone levels or thyroid levels or exercise levels or whatever levels, you can publish normal blood pressure levels. There are levels that as a physician you tolerate for people who are diabetic and people who are non-diabetic, because, you know, the diabetic is more at risk for heart disease. So by doing a more advanced invasive cardiac evaluation, you're able to establish a new normal for that person and make sure that you're not kind of skirting the importance of cholesterol and blood pressure.

Speaker 5:

That's, that's correct.

Speaker 4:

It's almost like you know what you're talking

Speaker 3:

About. I'm telling you it makes me angry. How does that sound? <laugh> , you know, because I think that these kinds of things are exactly what you should do. Mm-hmm . <affirmative> . And so when people, people call me up all the time, they say, I'm 40, what should I get done? I tell 'em this. I tell 'em, you should, you should figure out if your heart's gonna poop out at 48. Mm-hmm. <affirmative>.

Speaker 4:

Well now they can go to Dr. Piar . That's right . For a HeartWise physical <laugh> . That's

Speaker 3:

Right. And so as part of the HeartWise physical , uh, you mentioned the screener, you mentioned an exercise , uh, echocardiogram. Correct. What else do you include even including lab work for

Speaker 5:

The , uh, big arteries? We, we do the carotid arteries to look for plaque there. That's an , obviously, it's one of the easier arteries to see in the neck. And then also the aorta and the a , uh, in the abdomens. So

Speaker 3:

You do an abdominal ultrasound or carotid ultrasound, carotid ultrasound. And when you do labs, do you do advanced lipids? Do you look for the different size little cholesterol levels?

Speaker 5:

Unfortunately, a lot of the commercial insurances aren't covering that yet, although , uh, we can definitely do it as an add-on. It's not standard yet. Although in the near future, we're hoping that's a standard lab that insurances will cover. There's a lot of labs unfortunately, that , uh, insurance coverage can be an issue. But we definitely do a very thorough liver, kidney electrolytes. We look at all the hormones, all the vitamins , uh, of course prostate screening and things like that. Anything that we can get through insurance, we , we can make it as advanced as possible. And

Speaker 4:

The patients can pay for a specific test. If you recommend the test and it's not covered by insurance, they can pay a nominal fee Yeah . To have that test done.

Speaker 5:

Absolutely. We don't like to surprise patients with any right fees, obviously, but at , at the , uh, visit, we can discuss other advanced options as well .

Speaker 3:

But I would encourage those patients, there are some things that are worth a few bucks, right? Mm-hmm . It's never as expensive as you think it's gonna be. Right. You know, it might be

Speaker 4:

20, 30 bucks for

Speaker 3:

All you know, it may , maybe a cup . You can probably get all these tests out of pocket for less than a thousand dollars and give yourself a great piece of mind mm-hmm. <affirmative> that things are gonna be fine for you. So Absolutely . Right . If they want a HeartWise test, how do they get ahold of you? They

Speaker 5:

Would , uh, just call our main line . It's five one two four six two docs. D O C s . Mm-hmm . <affirmative> 3 6 27 . Right. So , uh, or they can go online. Uh , we're available through zoc doc , uh, victory medical.com as well.

Speaker 3:

Well, thank you so much, Nathan . Thank you . That was great . Dr . Piar .

Speaker 5:

Thank you for having me . Dr .

Speaker 3:

Bakar . My name Syn

Speaker 5:

<laugh> ,

Speaker 4:

You two should go into business together. We should, Dr . Mystery , mystery Piar and Dr . Piar . Um , you can read us of us 5 1 2 2 3 8 0 7 6 2 our website's, arm men's health.com . Thank you so much. Listen to our podcast. Thanks Dr . Piar .

Speaker 5:

Thank you very much.

Speaker 1:

The Armor Men's Health Show is brought to you by N A U Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online@armormenshealth.com.