The Armor Men's Health Show

EP 660: ED Evaluations: What Should My Urologist Look For When Diagnosing/Treating My ED?

• Dr. Sandeep Mistry and Donna Lee

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In this segment, Dr. Mistry and Donna Lee answer a listener question about a diagnostic testing for erectile dysfunction. This listener's urologist has recommended a pharmaceutical penile Doppler ultrasound to help identify the cause of his ED, and he's wondering whether that kind of testing is normal. Dr. Mistry explains that a variety of factors might come into play, including those that are psychological, hormonal, neurological, and/or vascular. Penile Doppler ultrasounds can help determine which blood flow concern is causing your ED, but beware any claims that "results are guaranteed," especially by pop-up men's health clinics that only offer one type of treatment for ED. Normal ultrasounds can be manipulated to give the impression of lower or higher blood flow/volume; thus, it is easy to fake vascular changes to justify overpriced ED treatments. True Doppler ultrasounds can help your urologist identify both the cause of your ED and the best treatment options for you. To learn more about all of our ED treatments, including penile Doppler testing, or to schedule your consultation, give us a call 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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Speaker 1:

<silence>

Speaker 2:

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

Speaker 3:

Hello and welcome to the Armor Men's Health Show. This is Dr. Mystery , your host, board certified urologist. Amazing presenter, awesome voice. I've heard that 12 times now. <laugh> in my entire life. Did , you've said it joined always with my co-host, Donnelly. That's

Speaker 4:

Right. I'm your more humble and sweet co-host. Not bragging about myself like Dr. Mystery does every time .

Speaker 3:

Sometimes you do this show without me, and when I hear it I get kind of jealous. You

Speaker 4:

Told me to get some content and sometimes you're not available,

Speaker 3:

So Well, I don't think I like it. It still makes me jealous, <laugh>,

Speaker 4:

When I'm interviewing our , our employees at work . That's right. Our physical therapists. That's right. Okay . I'll , I'll include you

Speaker 3:

Next time. This is a men's health show. We are brought to you by NAU Urology Specialist, the urology group that I started in 2007. We are located all over the central Texas area. Mm-Hmm . <affirmative> . We have Mm-Hmm . <affirmative> Four amazing physician providers, two of which were voted best , best in Austin. That's right.

Speaker 4:

You might have been one of the two.

Speaker 3:

It didn't cost that much. <laugh>, <laugh> ,

Speaker 4:

You and Dr. Ong , by the way. Very good.

Speaker 3:

You know what I love? I love the fact that many of the guests that we've had on this show have been in that magazine. Austin makes me feel like I got a lot of good friends.

Speaker 4:

You do a lot of smart

Speaker 3:

Friends. How do people get ahold of us?

Speaker 4:

You can call us during the week at 5 1 2 2 3 8 0 7 6 2 . Our website is armor men's health.com, where you can see our smiling shiny faces on that website. You can submit your questions there as well, that we'll answer anonymously every time. And I'll shoot you the podcast link when , when we answer that question.

Speaker 3:

Awesome. Uh, you know , uh, we don't get a lot of professionals on this show. <laugh>,

Speaker 4:

No

Speaker 3:

<laugh> . No. I mean , between me and you. We're the most amateurish people I've heard Infantile also. Thank you so much. Female listener, juvenile. She said number one , juvenile. Yeah . Yeah. I don't know why she kept listening once she heard the opening credits, but anyway, we don't get a lot of professionals and we're joined by the original man himself. Dr . Pradeep Kumar from Aston Gas , Austin Gastroenterology. Thank you so much for joining us today,

Speaker 5:

Pradeep . Thank you. Glad to be here. Such a thrill

Speaker 4:

man .

Speaker 3:

He's an man . Dude, I didn't know that. You didn't know that. No. Yeah .

Speaker 4:

I mean, I get it. But

Speaker 3:

Dr. Kumar, tell us what you do for a living.

Speaker 5:

I am an man . <laugh> , I'm a gastroenterologist. All things related to the gi track , top to bottom, inside and out. That's what we take care of.

Speaker 4:

That's right. I knew you was gastro. I don't know. I didn't connect for some reason as man . Well,

Speaker 5:

That's where you poop out of . Yeah,

Speaker 4:

That's true. I like the Dr . Deep thing though that we talked about before.

Speaker 3:

Show you haven't heard her bomb on stage. She poops out of her mouth sometimes too.

Speaker 4:

<laugh> only , only when you're heckling me drunk.

Speaker 3:

Well, that does happen.

Speaker 4:

Kelly was there.

Speaker 3:

Dr. Kumar, why don't you tell us what a gastroenterologist does and what their primary areas of interest are?

Speaker 5:

Yeah, so I think gastroenterology is pretty fascinating, right? I mean, like all species on the planet, we have to convert one form of energy to another and then get rid of the waste, right? You think about plants and photosynthesis, they take energy directly from the sun. They convert that energy and they use it for their life processes, right? Mammals, humans what we have to eat. We eat food, we take energy from the outside and we put it in our mouth and we have to break that energy down, store that energy, and then get rid of the waste. And that's what gastroenterology is. Mm-Hmm . <affirmative> . We take food from the outside, put it into our mouth, it goes down our esophagus. We have our pancreas, our bile ducts, things that help us , uh, secrete enzymes and compounds that break down, those molecules safely absorb into the, the , to the vascular system, take 'em to the liver to be detoxified and spread throughout the body. But then all this toxins, waste, bacteria, viruses, all this other crazy stuff that we ingest , we have to get rid of safely. And that's why it comes out the other end. And so that's what we do. So it's a vital function for all life, is to be able to convert one energy to the other. And when you do that, certainly problems arise. You know? And so we take care of those problems.

Speaker 3:

So when the gen , gastro-intestinal system works well, we are all happy. Yes, we are. When it doesn't work well, it universally makes us unhappy.

Speaker 5:

Absolutely.

Speaker 3:

And, and , um, there are two very interesting parts about what you do. Uh , for me, number one is how much we take for granted. Well-functioning gastrointestinal system, which depends on more than people might imagine. It requires bacteria that work in conjunction with our body, muscles, nerves, hormones. But also that what we ingest is the one thing that we actually have control over that can affect our health. Besides just screening colonoscopies. What are the most common problems people come to you for? You're

Speaker 5:

Right. Uh , when, when you're , the GI tract isn't working well, it's not fun, you know, and people, that's what keeps us in mink really, you know, a lot of things go wrong. You know, there's 330 million Americans and there's a fraction of them that aren't feeling well from the perspective of their gastrointestinal tract. And they come. And so the common things that we see are acid reflux for sure. You know, when heartburn, chest pain regurgitation, irritable bowel syndrome, and that's kind of like this grab bag that we put into one little container when it is really a diverse kind of problem, where the underlying issue is the nerve supply to the GI tract. It's kinda like having a seizure disorder or the GI tract. The nerves aren't working well, so the muscles aren't working well. So it can cause any symptom, nausea, vomiting, diarrhea, constipation, abdominal pain, bloating. So irritable bowel syndrome is clearly one of the, the most common things we see. Of course, we see cancers, what you were talking about. We try to prevent them with screening colonoscopy because gastroenterologists also take care of the liver. We see hepatitis and particularly nowadays we're seeing fatty liver disease, which is now the leading cause of liver transplantation. And then we see the routine , uh, things that cause abdominal pain like gallstones and peptic ulcers and things like that. What

Speaker 3:

Do you think the common condition that you see people delay treatment for, that you have easy fixes for?

Speaker 5:

It's probably reflux. You know , um, 20% of the population is affected with acid reflux and they'll have some mild heartburn. And that's why when you go to the store, you see a plethora of medications over the counter medications are galore, you know, zantax and Pepys and prosec and prevacid and egress , and they have all of these medications, Malo and Tums, right? Because a lot of people have heartburn and it's a multi-billion dollar industry. And we have very sophisticated medications and many of them are, are truly over the counter , but people have hesitance of taking them, or the doses in which you can get them over the counter , sometimes inadequate. And people just suffer, you know, they just suffer with heartburn for a long time because they're scared about seeing a doctor. And you know, that's me . We could really kind of , kind of up their dose and teach 'em about how to , uh, treat reflux and , and make 'em feel better . And that's why

Speaker 3:

Donna , do you have heartburn? I

Speaker 4:

Always have heartburn.

Speaker 3:

You give heartburn,

Speaker 5:

<laugh> heartburn.

Speaker 4:

Uh , what was the one that was taken off the market recently? Nexium? No,

Speaker 5:

No, that was Zantac. Zantac. And so that's just like , uh, you know, Valsartan and other things. It has nothing to really to do with the Zantac had to do with the pharmacy. The , the , the drug company, the , that was making it, it was the generic Mm-Hmm. <affirmative> . And the physical factory was contaminated by this carcinogen. Oh . And so, and that happened with another drug, I think it was Valsartan at some other plant. Right. And so they went back there and it , it was in India, right? That's where a lot of these generic drugs are made. Mm-Hmm . <affirmative> . And you can't tell once you make 'em like which lot country they get to. So they went back there and they kind of cleaned up those factories and got rid of those. And , and the amount was very minimal, but it's a known carcinogen

Speaker 3:

Now. Uh, but reflux is a known kind of thing that bothers us. But it's also could be something that turns into something dangerous, right?

Speaker 5:

Oh, absolutely. You know, it can be a pre-cancerous condition for one, it can, you know, it can lead to Barrett's esophagus and , and Barrett's esophagus, which is a change in the lining of the esophagus, usually affects Caucasian men above 60 most commonly. But then that can progress to cancer. And if you find that early and , and take biopsies and watch it, treat it before it progresses, you can prevent esophageal cancer that way.

Speaker 3:

Besides obesity, what are some risk factors for reflux?

Speaker 5:

Yeah, the number one is just really genetic. You know, it's just the way you are. 20% of the population has reflux. That's why there's all those drugs over the , over the counter . The way you're made, you know, the , we have a protective mechanism at the bottom of the esophagus called the lower esophageal sphincter. It's supposed to act like a one-way valve, relax, allow food and saliva to go down, but then tighten up and prevent gastric contents, stomach contents from coming up into the esophagus for whatever reason. It's loose in many, many people. Could be because of a hiatal hernia where a little bit of the stomach is above the diaphragm. So the, the diaphragm, which is the muscle that separates the chest from the abdomen that caused , allows us to breathe. It lends strength to the lower esophageal sphincter. And if that isn't exactly well placed , you could lose that contribution of strength. Hidal hernias are common. That's not cause of reflux, but it's associated with it. If the sphincter loose gastric contents come up, mainly acid, and when it comes up, it causes heartburn, chest pain, regurgitation. If you look at H-R-Q-O-L health related quality of life, and you ask people with reflux, how bad does your reflux make you feel? These guys compete with cancer, cancer makes a cancer patient feel as crummy. Oh wow . As reflux makes a reflux patient feel. They just, it's just uncomfortable.

Speaker 3:

What's your go-to medicine for somebody with kind of mild to moderate symptoms and when should they visit with a gastroenterologist?

Speaker 5:

So it's a great question because you don't have to come in, you know, with your first sign of heartburn, you can, you know, these over the counter medications are largely safe, you know, so first thing is lifestyle, right? If you know your triggers, spicy foods, acidy foods, tobacco, alcohol, you know , uh, mints and chocolate, and if you know that that's your trigger, just

Speaker 3:

Sounds like all the great things,

Speaker 5:

<laugh> , oh yeah. They are like, why would you avoid those things right now ?

Speaker 3:

You gonna see sex crap

Speaker 5:

<laugh>? Yeah , no, no, no. I think that's good for no sex for you. You know , you , you avoid those kind of, you know , those factors. But if it's not that easy, if you can't, if it's not just a one thing that you go to or you, like you said you enjoy eating spicy foods, you are unwilling to stop eating spice foods, like it would be me. Mm-Hmm, <affirmative> . Then you take your over the counter medications, your tums, your bowel , those are, that's bicarbonate, neutralizes acid works immediately, but the least potent. Then you go to your histamine type two blockers, like your Pepcid , your Zantax, your ments , right? Work within 15, 20 minutes. Last about an hour. Um , but it's mild. Then you go to the next step, which are what we call proton pump inhibitors. This is your Prilosec, your Omeprazole, your Prevacid. These are also available over the counter , but they're at doses of 20 milligrams, 30 milligrams, which is, you know , bottom rung and they're safe. They've been studied and that's what used to be prescription. And you can take those and they , people usually take those for two weeks at a time. They don't work immediately. You gotta take 'em regularly every day. It'll kick in two or three or four days later. Um, but it works better than anything else. And if you can just stay on those. Um, but if that doesn't work, then you need to come see us. Or if you have a quote alarm symptom, if you have difficulty swallowing, if you have unintended weight loss, if you vomit blood, you don't wait, you come in , you

Speaker 3:

Don't wait. And if people do need to come to see you, how do they get ahold of you?

Speaker 5:

Well, you can go to www.austingastro.com. We have over 40 physicians throughout the Austin Central Texas area. My personal office is in South Austin, right behind South Austin Medical Center on James Casey. And , uh, at that website you can get ahold of me as well as any of my very well qualified partners as well.

Speaker 3:

Well, thank you for joining us. We're gonna be right back.

Speaker 2:

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