Armor Men's Health Show

Bonus Episode: Colorectal Surgeon Dr. Miller on Diagnostic Screening for Happy, Healthy Hineys!

• Dr. Sandeep Mistry and Donna Lee

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In this episode, Dr. Mistry and Donna Lee are joined by Dr. Andrew Miller of Texas Colorectal Specialists to discuss all things colon, from hemorrhoids and anal fissures to ulcerative colitis and colon cancer. Indeed, as a colorectal surgeon, Dr. Miller knows the importance of preventative health screenings like the dreaded colonoscopy. He has witnessed firsthand the alarming rise in colon cancer rates in younger and younger adults! While companies like Cologuard offer the privacy and convenience of testing at home, Dr. Miller points out that colonoscopies are the only kind of colon cancer screening that is both diagnostic (finds polyps) and therapeutic (removes them). It is also the best test for early detection, especially in at-risk patients (older patients, those with a family history of colon cancer, those with personal medical histories of colon issues, etc.). Tune in to hear why regular preventative colonoscopies can save your life! Call 512-238-0762 or go online to learn more.

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 and founder of NAU Urology Specialist. That is the urology group that is sponsoring this show. It's where I work, it's where I see patients. It's where you can come and see me as your doctor. I'm joined as always by my co-host, Donna Lee. Hey

Speaker 4:

Everybody, welcome to the show. Thank you so much for listening.

Speaker 3:

Donna Lee, professional comedian, and recent purvey or partaker of a colonoscopy.

Speaker 4:

This guest has seen my bootie hole .

Speaker 3:

This guest has

Speaker 4:

Seen anybody , and I would like to apologize on air about that <laugh> . So

Speaker 3:

Thank you, <laugh> . I'm sorry, all

Speaker 4:

<laugh> . He's , he's like, please don't talk about it .

Speaker 3:

It's on his Instagram <laugh> . I saw it. Donna, how do people get ahold of us and become our patient ? You

Speaker 4:

Can call us at (512) 238-0762. Our website, as you know, is armor men's health.com and listen to our podcast wherever you listen to free podcasts. And we are in Round Rock, north Austin, south Austin and Dripping Springs. And we are gonna lecture Dr . Mystery today 'cause it's colonoscopy time <laugh>.

Speaker 3:

So we have Dr. Andrew Miller with Texas colorectal specialist joining us. Once again, a very good friend. And you know, colorectal surgeons, what people would consider, you know, colorectal surgeons and urologists have a very similar sense of humor. We tend to get along really well and , uh, I

Speaker 4:

Don't know. Dr. Miller's very professional

Speaker 3:

And it's very hard to take us to parties. That's all . That's all I'm gonna say. That's true. True . But what's nice is nobody's ask asking you about their medical problems at a party, I don't think, you know, my does this. Yeah. People tend to walk away. Yeah. They tend to walk away. <laugh> . Well, thanks a lot for joining us. Donna. Do you have some kind of special story you wanna share?

Speaker 4:

So I've watched Schitt's Creek many, many times and I started it over and this morning I was watching it as I was getting ready to come here and record with you all . And Roland, the mayor of the show , he was saying on the phone, oh my God, I can't wait to see you too. It's been too long. I really look forward to seeing you. And then somebody walked in, Johnny walked in and he looked at Johnny. He goes, oh, sorry Johnny. I was just rescheduling my colonoscopy, <laugh>. And I laughed out loud because I was like, we're gonna have Dr. Miller on the show. Perfect .

Speaker 3:

Perfect. That is perfect. Yep . So Donna, you recently went through a colonoscopy?

Speaker 4:

I did. I am Dr. Miller's patient and I broke every hipaa, but I'm the patient so I can do that. Right. That's right. You can do that. The process was amazing. The day prep beforehand is not a party, but getting it done was absolutely extraordinary. The nurses were amazing. Dr. Miller's the most professional doctor I've seen because I hang around you too much. And it was really amazing. The process was easy . How easy was it? It was so easy. And the propofol is kind of magical for the two seconds that you feel it. Right . And then all of a sudden you're waking up and somebody's like, it's over. And I went directly to Whataburger. I know you said not to do that, but I did that and it was delicious.

Speaker 5:

Well , no , I tell all my patients to, you know , we take the first meal easy, and then I had my colonoscopy last year and I went and got oysters and a burger and champagne. So, because you're

Speaker 4:

Bougie, I went to Whataburger

Speaker 3:

<laugh> . That's , that's pretty bougie. And so as a colorectal surgeon, your may maybe describe to us kind of what you do and how you're trained. Sure.

Speaker 5:

So colorectal surgeons, we start out general surgery, five years general surgery residency, and then we do a one year colorectal fellowship. So we specialize in this field and we see the full breadth of colorectal surgery from benign anal rectal disorders like hemorrhoids and fissures to inflammatory bowel disease like Crohn's disease and ulcerative colitis all the way up to malignancies, cancers of the GI tract of colon cancer, rectal cancer, anal cancer. So

Speaker 3:

Colon anal rectal cancer. These are the things that we're trying to screen for. Mm-Hmm . <affirmative> when it comes to , um, uh, our regular colonoscopies. Right. And what you really impressed upon me last time, which is a message that I would like to continuously share Mm-Hmm. <affirmative> , is that this is a preventable disease. Correct. That you're not just doing a colonoscopy to find cancer, but by removing polyps that are there, you are actually preventing them from turning into cancer. Correct.

Speaker 5:

Yeah. About 30% of us, even with no family history are polyp growers. And so those polyps can progress on a slow pathway, but a pathway towards colorectal cancer. And so by going in and doing colonoscopies at regular intervals that are not frequent, you can remove those polyps and prevent 90 plus percent of colon cancers. Wow . Do

Speaker 3:

You think that colon cancer is on the rise?

Speaker 5:

It is. And you're seeing it a lot in the news. We're seeing younger and younger patients diagnosed with colorectal cancer, and that's the trend overall. Colorectal cancer , uh, has been on a downtrend over the last few decades. Uh, but in those patients who are getting it, it's at younger and younger ages. And so we shifted that screening age for patients who have no family history from 50 to 45 in order to try to capture those patients who are growing polyps at younger ages. But , uh,

Speaker 3:

And those recommendations are based upon population based data sets . Correct . It's not just somebody trying to go for a cash grab. Correct. And so , um, when it comes to the screening colonoscopy, it just is so off-put to think about. Mm-Hmm. <affirmative> that, that you would've, it's one of those things where you're like, haven't they come up with a better way to do this? Well,

Speaker 5:

This is the problem. You know , colorectal cancer is one of the most preventable cancers, but it's one of the least prevented cancers because of that thought process.

Speaker 3:

Mm-Hmm . And so it's really that just kind of , um, this, this mental hurdle to get over Mm-Hmm . To keep yourself healthy. Now there's some, there's some non-invasive tests that are available kind of in the marketplace. Sure . But just this week I had a patient who had kind of an equivocal Cologuard and , um, it wasn't diagnosed early enough and then ended up with a really bad disease. So maybe just talk to me a little bit about, you know, you don't, you don't get something for nothing. So <laugh> if you're just putting poop on a, on a stick and sending it into the mail. Right. It's not as accurate as looking at it visually. Uh, but maybe talk to me about some of the pros and cons of these non-invasive tests.

Speaker 5:

Sure. So Cologuard is the commercial you see with the dancing box that you , uh, send a stool stamp in through the mail, and they run test for abnormal DNA that is shed from polyps, advanced polyps and cancers. And so it is for patients who are of average risk, no family history, no abnormal symptoms of the GI tract like bleeding or altered bowel function. And , uh, it's pretty decent at picking up advanced polyps or colon cancers. It is not good at picking up just small polyps. And so when it goes positive, when that test returns positive, you're already behind the eight ball there to a degree. Because at that point you need a colonoscopy.

Speaker 3:

You're no longer preventing, you're kind of just diagnosing something that's already catching . Right . Catching up.

Speaker 5:

And so you need a colonoscopy anyway when it becomes positive to go find why it became positive. And at that point you may have a polyp that's too big to be removed at colonoscopy, so you need an operation to remove it, or it could be a cancer at that point. And now we're really playing catch up and trying to stage and figure out where you are in the process of having developed a colon cancer.

Speaker 3:

Are there any other technologies that are either available today or becoming available to help with colon cancer screening?

Speaker 5:

Uh, there's CT colonography, which is basically like a virtual colonoscopy. So this is things that when patients do research online, they find these things and you still have to do a bowel prep, which is the hard part of doing a colonoscopy Don .

Speaker 3:

Mm-Hmm . <affirmative> . Right , right. That is going the sleep is the easy part .

Speaker 5:

Yeah. The colonoscopy's a breeze. Right . Um , but you still have to do a bowel prep. You gotta clean out the colon. So then when they do this, you know, CT scan, which comes with radiation, you know, that has the potential for downstream negative side effects in the future , uh, albeit low. But , uh, when you find something positive on a CT colonography, you gotta do a colonoscopy. So colonoscopy is the only screening , uh, modality for colon cancer that is diagnostic and therapeutic in that we find what is abnormal and we remove it at that time or we biopsy it if it's too big to remove.

Speaker 3:

And , uh, why do you need a bowel prep? Like, are you just putting us through like, like just hell for no reason?

Speaker 5:

No, you gotta clean the colon out so I can see the lining. Can you

Speaker 4:

Imagine if they didn't clean the colon out? That would be

Speaker 3:

Gross. Yes. He ha he has to deal with it all the time. I hear him complaining about a non world complains about a dirty butt hole all the time. <laugh> , <laugh> .

Speaker 5:

In my world, if I never see poop, that's perfect. Right .

Speaker 3:

So that's

Speaker 5:

My goal is to never have to see it, but Right . Yeah. You gotta clean it out so we can see the lining.

Speaker 3:

I decided to become a urologist because I could, I could certainly touch urine with my bare hands. Right . And not , and not have a problem. Sure. But I can't touch poop or sputum that, that's actually how sputum for me, I can't do . That's exactly how you decide what kind of surgeon you're gonna be. They put you in a room Mm-Hmm . With several barrels of fluid <laugh> and whichever one you can put your hand in and you chose poop.

Speaker 5:

Yeah. Yeah . The , I can't do ENT . Right .

Speaker 3:

None of us can do, that's one commonality for anesthesia amongst urologists and colorectal surgeon, general surgeons. Like we all hate sputum. Oh my gosh.

Speaker 4:

We have an ENT doctor on

Speaker 3:

Later . I know the coughing and the ugh . Oh man . Oh my gosh. Those hospitals. And so , um, what you , you mentioned that the colonoscopy is both therapeutic as well as , uh, diagnostic meaning that you can treat something Mm-Hmm . <affirmative> not just see it. Right. Uh, what are the current recommendations on how frequently people should get things done? So

Speaker 5:

If your average risk , no family history, no symptoms, and you get a screening colonoscopy at 45 and it is clean per the current guidelines, you're not due for 10 years. Now, that changes. If your family history changes, it turns out your parents had a polyp or your brother got , had a polyp, well then you would be shrunk down to five years even if you had a colonoscopy. If we find polyps in you, depending on the size and the number and what they look like under a microscope when we send them to the pathologist, the type of polyp that then will change how frequent your colonoscopy is one year, three year , five years, depending on , we see.

Speaker 3:

And mine's 10 years . Exactly . It's

Speaker 5:

Not something that's frequent.

Speaker 4:

Don't come back for 10 years because I ain't got nothing going on up in there. People ,

Speaker 5:

People are worried that it's something we're doing every year. It's not. Right .

Speaker 3:

So with CID , like, I feel like the time timeliness of getting a colonoscopy really got screwed up. Mm-Hmm. <affirmative> . Mm-Hmm . Like, it's just taking so long and so I I I feel like we're just now catching up. Yeah . We

Speaker 5:

Are with , with everything. Yeah. 2022, we saw a lot of backfill and a lot of people who came in with more advanced disease because their colonoscopies were put off because of the pandemic. Mm-Hmm .

Speaker 3:

<affirmative> is, is screening colonoscopy something that you do quite a bit of? Yeah . And so a colorectal surgeon would be somehow, in some cases appropriate to, to go to if you wanted your screening colonoscopy. Right .

Speaker 5:

Your, your local gastroenterologist or colorectal surgeons can perform screening colonoscopy.

Speaker 3:

And, and do you have to have a pre-op visit first and then you get it? Or can you just call up

Speaker 5:

And just No . Get it ? No , we typically , we like to see , uh, to see you, to review your medical history and make sure there's nothing that puts you at to high risk for the procedure or any blood thinners or anything that we need to alter or change for the procedure.

Speaker 3:

And there's no way just putting a garden hose up there to clean me out. Right. Yeah .

Speaker 5:

It's frowned upon

Speaker 3:

<laugh> . Okay.

Speaker 4:

It's frowned upon well

Speaker 3:

How , how

Speaker 5:

<laugh> some things do exist like that.

Speaker 3:

<laugh> , how do people make an appointment with you, drew?

Speaker 5:

Uh, you can call our office (512) 220-7002. Our website is T TCRs doctors.com.

Speaker 3:

Well thank you so much for joining us.

Speaker 5:

Thank

Speaker 3:

You. Hello and welcome back to the Armor Men's Health Show. I'm Dr . Mystery , your host, board certified urologist and founder of NAU Urology Specialist. That is the group that I started in 2007. We have six urologists, one interventional radiologist, two pelvic floor physical therapists, six advanced practice providers that are NPS and PAs. We have a health coach, we have a sexual coach. We do sleep apnea testing and management in the office. And I'm joined by my co-host Donnel Lee . That's

Speaker 4:

Right. Welcome to the show everybody.

Speaker 3:

Donnel Lee's our official T-shirt , uh, designer <laugh> . Uh, if you are in the mood for a urology themed t-shirt, please call her and take one of the 10,000 T-shirts off my hands. You

Speaker 4:

Know, we have some fun marketing giveaways and one of them says, nuts for urology. That's a T-shirt you can own. I think the most popular is Make America Pee again Mapa . And then we have snipped but still equipped for the vasectomy patients as we also have snip snip hooray. So call me for your T-shirt (512) 238-0762 and our website armor men's health.com.

Speaker 3:

They can also call you for an appointment if they want to become a patient of ours. Right, right. Yeah. Yeah . Would that be okay? That's true . Thank you. You

Speaker 4:

Get a free T-shirt in the way on the

Speaker 3:

<laugh> . And I'm joined , uh, once again. We are joined once again by Dr. Andrew Miller with Texas colorectal Specialist. He's been a friend of mine for a number of years. He's a colorectal surgeon. Drew, thank you for joining us. Thanks. So you do a lot of things with the surgical robot. Mm-Hmm. <affirmative> . And , um, when it comes to just colon health , uh, you do a lot of surgeries for , uh, for colon health, what are some of the most common colon surgeries that you perform?

Speaker 5:

So we do robotic colectomies quite a bit , uh, for various , uh, disease processes. Diverticulitis is a really common one. Colorectal is treated robotically with , uh, colectomies. And that can vary from a partial colectomy, like a sigmoid resection for diverticulitis to a total colectomy for ulcerative colitis. Uh, so kinda we run the full spectrum

Speaker 3:

Now. You don't have to just take it out, you gotta put it back together. Right. That's right. <laugh> . And so sometimes the putting it back together can cause , uh, difficulties and problems. And having a good healthy colon is probably , uh, something that is important to us. But many of us may not know what that means.

Speaker 5:

So a good whole healthy colon, that could be a big spectrum of things. It could be either the, the gut flora of the bacterial flora that you have. Uh , it can be the fact that you're eating a good high fiber diet so that your colon is moving things downstream appropriately and that you're getting screened for colon cancer to prevent colon polyps and colon cancer.

Speaker 3:

So when it comes to advanced colon cancer , uh, removing the colon piece that has it in there Mm-Hmm . <affirmative> is kind of important. But these diseases can be quite dangerous, right? They can.

Speaker 5:

Yep . And so you gotta catch 'em early and try to treat 'em , uh, quickly and appropriately.

Speaker 3:

And so , um, if somebody is trying to prevent any of these cancers from happening, we talked about the most important preventative strategy, which is the colonoscopy. Correct. Now what are some other preventative strategies that, that you counsel your patients on to maintain good gut health and to even potentially reduce their risk for, for, for colon cancer? Sure.

Speaker 5:

Yeah. High fiber diet's. Uh, really important. So making sure you're getting all the, you know, the , the things you hear about fruit , good fruits and vegetables and what we're seeing in the data in terms of colorectal cancer development, the one thing we can put our finger on from a diet standpoint is red meat consumption. So making sure that we're having one to two servings per week, kind of at a maximum of red meat or high processed foods per week . That's the recommendation

Speaker 4:

Per week. Dang. That was mine per day. That

Speaker 3:

36 ounce tomahawk that I have for lunch, breakfast every day . Breakfast. That's gonna be a couple of ,

Speaker 5:

Yeah , exactly. Right. So , uh, you know, I don't tell people don't eat a cheeseburger, but

Speaker 3:

What do you think it is about the red meat?

Speaker 5:

So it's the nitrates and the nitrates that , uh, get converted in our colon, which are carcinogenic to the lining of the colon and can help prevent colon or help cause colon cancer.

Speaker 3:

So you think that's from the cooking process or do you think that's actually inherent to the meat? It's

Speaker 5:

Inherent to the meat and the cooking process can make it , uh, more significant. And then if you're eating foods that have added nitrates and nitrates, it makes it worse.

Speaker 3:

Like those hot dogs ? Correct.

Speaker 4:

Oh my goodness. Bacon

Speaker 3:

And bacon. My favorite. Do they have nitrates and bacon?

Speaker 4:

Yeah. 'cause I buy no nitrates bacon. Oh, okay.

Speaker 3:

<laugh> .

Speaker 4:

It's still delicious.

Speaker 3:

And so , um, you know, we talk about good diets and many urologic cancers are worsened, especially prostate cancer by just being overweight. Yep . What would you say about obesity and colon cancer?

Speaker 5:

Yeah. Obesity certainly is a risk factor for colon cancer. Colorectal cancer development

Speaker 3:

Independent independently. So , so even if you were a vegetarian, but if you were obese Yep . You would have a higher risk for,

Speaker 5:

For colon . Same with alcohol consumption too. It increases colorectal cancer,

Speaker 3:

So And so , um, there are recommendations in regards to how much red meat to have Mm-Hmm. <affirmative> . Are there just even general recommendations on alcohol consumption, other things like that?

Speaker 5:

Uh, you know , I , my take on it is everything in moderation. Like I said, I don't tell people, don't eat a hot dog, don't eat a cheeseburger. Keep it in low volumes, keep your alcohol and intake it low volumes and exercise and reduce obesity is gonna be your best chance.

Speaker 3:

So if somebody was trying to use their bowel habits as a marker of how much fiber they're eating Mm-Hmm . <affirmative> if they were trying to figure out if they were doing a good job or not. Yep . When I counsel a patient, I tell 'em they should go to, they should poop every couple of days. Yeah.

Speaker 5:

What do you say ? You know, my spectrum of normal would be , uh, a couple of times a day to every other day of a formed normal soft .

Speaker 3:

There are people that poop multiple times a day. Oh yeah. Really? Yeah. Wow . How satisfying.

Speaker 4:

We had a health coach once that said, you should poop every time you eat. And I was like, that's like five times a day. That doesn't happen. The

Speaker 3:

Problem is , so that makes more sense. I'm not problem with me and my phone and TikTok , if I poop twice a day, I'd be gone for an hour. That's true. You

Speaker 4:

Know what I'm saying? You're gone for an hour.

Speaker 5:

We talked about that on the last episode.

Speaker 3:

I'd be gone. You ,

Speaker 4:

That's why he doesn't have an office. That's why

Speaker 3:

Office , he's

Speaker 4:

On Facebook

Speaker 3:

All day. My legs are so numb. I need to get him more orthopedic toilet cushion.

Speaker 5:

Yeah. Please See the podcast about hemorrhoids. That's right .

Speaker 3:

<laugh> . <laugh> .

Speaker 4:

Right.

Speaker 3:

And so , um, you know , uh, you, you , you brought up the issue of hemorrhoids once again. So you talked about anal, anal rectal disease. Yep . So you're talking about fissures. Mm-Hmm. <affirmative> you're talking about hemorrhoids. What else kind of affects things down there? Uh , skin wise , disease wise ? Are

Speaker 4:

Hemorrhoids dangerous?

Speaker 5:

No. Unless you get into significant bleeding from hemorrhoids. But you know, in and of itself, the hemorrhoids, we all have 'em. They're born , we're part of our normal anatomy. We're born with 'em . Mm-Hmm . <affirmative> one on the left to on the right. Other issues that we see a lot is anal itching typically from over cleaning. Really? Yeah. The, the, the dude wipes the wet wipes. Oh . Stripping the oils from the skin, breaking the skin down, causes itching, and you get this bad feedback loop and then it just gets worse and worse.

Speaker 3:

Those wet wipes are not good for us when we're using our. Yeah.

Speaker 4:

<laugh>.

Speaker 5:

I mean, if you're not itch,

Speaker 4:

It's no wipes for you .

Speaker 5:

If you're not having itching problems, it's probably five . But if you get into a situation and then you just keep going and going, it can really downward

Speaker 3:

Spiral you Isn't funny because when my butt hole itches, I use a wet wipe. Well , there you go. And I'm going

Speaker 4:

And you're going against the green .

Speaker 3:

I'm just making the cycle get worse. Exactly . Right . You know, not only are they bad for the, like the sewage system. Yeah . Now , now they're bad for our own private sewage system . Right ,

Speaker 5:

Right .

Speaker 3:

Yeah . I was , I never would've thought that excess cleaning would've caused that problem. Yep .

Speaker 4:

That makes sense. You're making all

Speaker 3:

That . What about fissures? Like what, what causes a fissure?

Speaker 5:

Fissure is a tear in the lining of the really sensitive skin inside the anal canal. The skin folds on the inside for a couple of centimeters. And so it's a physics problem. I mean, if you pass a stool that is larger than what the anal canal can open and accept, you rips the skin. And so right in the front and right in the back, the blood supply is not real great. And so things don't heal well. So you get this chronic wound and it's like having a paper cut on your knuckle and just every bowel movement, you're opening that wound and it can be exquisitely painful. Right . And cause bleeding. And, and so you gotta get back to having normal size , soft, easy bowel movements. And then there's some topical ointment treatments that we can get you back on track.

Speaker 4:

I have a question. Yep . What is the difference for the lay people between a fissure and a hemorrhoid?

Speaker 5:

So a fissure is a tear in the skin. This , the tear a hemorrhoid or is a collection of blood vessels called hemorrhoidal veins that over time with downward pressure such as sunny , sitting too long on the toilet. Mm-Hmm. <affirmative> , uh, or straining or constipation. Then those get larger and they , they're fragile and they bleed and they stick out. So.

Speaker 3:

Gotcha . Not, not only are the Chinese stealing our data and, and, and, and poisoning our children, they're also giving me hemorrhoids. They're giving hemos . That's right. I feel like that this , they're keeping l

Speaker 4:

Man

Speaker 3:

Down. This lunacy needs to stop.

Speaker 4:

They're keeping the brown man down.

Speaker 3:

Lunacy needs to stop. That's right. And so as people get older , uh, obviously people notice often that their bowel habits are changing, but one of the most embarrassing things that can start happening is when people start losing their stool. Sure. Nobody wants to think about themselves pooping their pants. Yeah. What are some of the most common reasons that people start , uh, developing fecal incontinence? So ,

Speaker 5:

Uh , one is just time. Um, as we get into our seventies and our eighties, the, the muscle function is not as strong as it was, but you have a lot of risk factors that can set you up from making that worse. Such as prior surgery, such as hemorrhoid surgery or in our female patients . Pregnancy and delivery or having injury to the muscle during delivery can be common. It's much more common in the female population than the ma the male population. But we do see it in men. And for , for probably 60 to 70% of people, it's an easy fix. And it all comes back to fiber. You can see that's like the foundation for so many of the things that we see. But fiber and bulking your stool with like a fiber supplement like powdered metamucil, cilium husk, once a day, every day will create more form and bulk so it's easier to hold onto and you feel like you're more fully evacuate. So there's less leakage in between. And you know , I'd say probably 70% of people come back and say they're done. They're happy.

Speaker 3:

Well, that means that we don't get to operate on 70% of people. Mm-Hmm . <affirmative> , uh, Dr. Miller, I feel like you're really going against the grain here. <laugh> , I don't appreciate what you're doing for us. Right . We just can't operate on every fecal leaker.

Speaker 5:

No. There are options. There's things like sacral nerve stimulation therapy, which you do in the urology world. We do in the colorectal world for fecal incontinence. Uh, there are sphincter overlapping procedures called overlapping sphincter plasty where we repair a , uh, identified defect in the ring of the muscle, but we're moving away more towards the sacral neuromodulation or basically, you know , pacemaker for your butt to improve the communication from your spinal cord to the pelvic floor muscle to help , uh, improve fecal incontinence. And it's got a lot of really good success in the data.

Speaker 3:

And there's a lot of roles for pelvic floor physical therapy in many of your patients as well. Sure . When you were here last time, I have , uh, since that time I have initiated a lot of Metamucil in my own practice. I'm also looking for a sponsorship agreement with Metamucil <laugh> . Yeah . Tag me on <laugh> . How do people get visit you for an appointment?

Speaker 5:

Yep . So call at (512) 220-7002 or you can visit our website@tcscolondoctors.com.

Speaker 3:

Dr. Miller, thank you so much for joining us again. Thank you.

Speaker 2:

The Armor Men's Health Show is brought to you by NAU Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.