Get EDucated Part 2: Dr. Mistry On Approaches to ED Treatment, Options

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.

In this segment,  Dr. Mistry and Donna Lee continue their discussion of erectile dysfunction, the many factors that can contribute to it, and the treatment options that are most beneficial in each case. The causes of erectile dysfunction can usually be classified as either physiological or psychological. Some of the most common physiological factors impacting erections are blood flow, nerve sensation, and hormonal imbalance. Psychological factors include things like low self-confidence or performance anxiety. Importantly, physiological and psychological factors often interact, producing a complicated situation in which achieving and maintaining erections becomes difficult, even with standard treatments. By carefully evaluating the unique causes of ED in each of their patients, the experts at NAU Urology Specialists can offer better, more effective treatment options...and at surprisingly affordable prices! Some of the tools in our ED toolbox include quality supplements, hormone therapy, prescription medications, Spark Wave treatment, and even penile implants.  So-called men's health clinics that specialize in one particular treatment modality, like shockwave therapy or testosterone supplements, can only offer that one solution--no matter what or how complex the problem may actually be. What's more, these "treatments" are often promoted with false guarantees and are vastly overpriced. Don't be fooled! If you or someone you love is experiencing symptoms of erectile dysfunction, no matter how severe, please give us a call today!

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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 0:09

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

Dr. Mistry 0:14

Welcome back to the Armor Men's Health Hour. I'm Dr. Mistry, your host, a board certified urologist, founder of NAU Urology Specialists, and a proud host. Co-host, really. The second host.

Donna Lee 0:26

Don't forget that part.

Dr. Mistry 0:27

You know, you know why co-host is appropriate? Cause there's like a pilot and there's a co-pilot.

Donna Lee 0:31

Oh.

Dr. Mistry 0:31

You're not both co-pilots.

Donna Lee 0:32

No, you're right. You're the, you're the host. I'm the co-host.

Dr. Mistry 0:35

I'm the co-host because you run the show without me sometimes.

Donna Lee 0:37

That's true. Yeah, because people like that. They like the Dr. Donna by herself.

Dr. Mistry 0:43

This is a men's health show. We have a urology practice that we treat both men and women for a number of urologic conditions. But this show is really dedicated oftentimes to issues that just affect men. Hormonal issues or erectile issues, although we discuss kidney stones and cancers that affect both sexes. We love your questions, and we love the discussion that we get. So please keep your questions coming via email and we'd love to answer them.

Donna Lee 1:07

Hey, Dr. Mistry. I saw, I heard that a patient was in the room with a doctor recently here, and the, the guy's really young, and he said, he came for to talk about ED problems, and the doctor said," Sir, you're gonna have to stop masturbating." And the guy said,"Why?" And the doctor said,"Because I need to examine you." It was a poor start, but I ended well.

Dr. Mistry 1:28

That was pretty good. I thought we'd continue our discussion on erectile dysfunction. And we discussed in the first part kind of what our evaluation is, how I subdivide the causes of erectile dysfunction when I approach a patient, and now we're talking about the real nitty gritty.

Donna Lee 1:42

The nitty gritty.

Dr. Mistry 1:43

We'll talk about, you know, what we do for treatment. First of all, a good evaluation is critical to understanding what the causes of the erectile dysfunction are gonna be, whether it be vascular, neurologic, psychological, or hormonal. If it's hormones, then we try testosterone. If we think it's predominantly vascular, so like the classic patient--a 57 year old man who is a little overweight, maybe a diabetic, one drug high...

Donna Lee 2:07

Are you talking about my husband?

Dr. Mistry 2:07

That's funny. Already had a heart attack.

Donna Lee 2:10

That's already exactly....

Dr. Mistry 2:11

I've already named, I've already, I'm envisioning your husband right now while I think, think about this patient...

Donna Lee 2:16

Sorry, Michael.

Dr. Mistry 2:16

...with some erectile dysfunction. And you know, he, a lot of times they'll come in and they'll already have tried pills. My favorite one are the guys that, that try pills that they bought at the gas station.

Donna Lee 2:25

Or Mexico.

Dr. Mistry 2:26

I mean, Mexico is fine. At least that's drugs, but I'm sure, I'm sure your gas station's not selling like, you know, approved pharmaceuticals. I have a guy that's like, like he swears by this thing called White Tiger."I love White Tiger. White tiger." It's$7 a pill.

Donna Lee 2:41

Oh. What is it?

Dr. Mistry 2:42

And I'm like,"That seems like a lot of money."

Donna Lee 2:44

Is it like a supplement?

Dr. Mistry 2:45

It's just fake, it, it's like somebody took it something, a supplement and then sprinkled a little Viagra in there and it works, but they think they're like subverting the system somehow because they're able to get White Tiger from the...please do not buy pharmaceuticals from your gas station.

Donna Lee 2:58

White Tiger. That sounds sexy.

Dr. Mistry 3:00

And there's, and, and these things come on the market and come off the market because the FDA goes around and tests them and finds out they really do have drugs in them. Well, just buy the real drug.

Donna Lee 3:08

Right. It's cheaper.

Dr. Mistry 3:08

It's easy enough. It's cheap. So...

Donna Lee 3:12

It's less confusing.

Dr. Mistry 3:13

And it, and it's safer. So when people are taking medications, it's critical that you take these medications properly. I speak about it often on the show. Viagra, it's optimal uses on empty stomach an hour before intercourse, and by empty stomach, I mean no food. So...

Donna Lee 3:29

They don't tell you that on the commercial.

Dr. Mistry 3:30

I know, but it's great for like a morning pill. So you roll out bed, pop the pill, next to your bed and then, you know, read the newspaper for an hour and then go for it.

Donna Lee 3:39

Oh, no. Sounds terrible to me.

Dr. Mistry 3:41

Newspaper quote, unquote.

Donna Lee 3:42

Newspaper?

Dr. Mistry 3:43

And then, Cialis, which we like on, in an on demand way needs to be taken four hours before intercourse. If you're still one of these folks that takes Levitra, not too many of you guys out there.

Donna Lee 3:54

I haven't heard that name in a long time.

Dr. Mistry 3:56

I know. It's, it's the same as Viagra. An hour before intercourse. Empty stomach. There's a medicine called Stendra that really puts itself out there as being a medicine that you can take after eating and only need 30 minutes to work. I assure you that if you want it to work really, really well, empty stomach, hour before intercourse. And the Cialis can be taken in two ways. One is four hours prior to intercourse. And the other one is daily, which is our favorite mechanism of using it. It's inexpensive, you know, less than 30 bucks a month. You take it every morning like your second vitamin C, vitamin Cialis. And you'll be able to have good spontaneity.

Donna Lee 4:29

From a great big dose of Vitamin D.

Dr. Mistry 4:31

... more function...your, your erections in the morning will be, will be more firm, and you'll feel a lot more confident, and that's really what we're trying to get out of it. Again, if it's a hormonal issue, then testosterone or fixing your thyroid or reducing your prolactin would be things that we would kind of do. If it's biomechanical, if it's difficulty in how your pelvic floor is relaxing or being overly strained, then we have, again, two pelvic floor physical therapists on staff.

Donna Lee 4:58

I'd like to suggest that 80% of the men listening who ED haven't thought that there's a pelvic floor component.

Dr. Mistry 5:04

I would agree with you. And that's why, you know, I, that's really one of the purposes of the show is so that when you come and see us...

Donna Lee 5:11

You're educated.

Dr. Mistry 5:12

...or you see any urologist, you have some kind of expectation of what's gonna happen. And if you're just going to one more pill popper, you know, pusher, then, then maybe the gas station is, is an appropriate alternative because, because you really want to have alternatives to treatment. A lot of men don't want to use pills. So we want to try to find a more natural way. We use lots of supplements. Although we don't get reimbursed or paid or sponsored by anybody, we use Arterosil quite a bit as a supplement. And if you're interested, you can email us more and we'll send you an email to that, that link.

Donna Lee 5:42

I am gonna get us a sponsorship from White Tiger, though.

Dr. Mistry 5:44

White Tiger. We like appropriately sourced horny goat weed, which I think is the one of the best named supplements that's out there.

Donna Lee 5:53

Horny goat weed.

Dr. Mistry 5:53

Yes.

Donna Lee 5:54

That you can also find at the convenience store.

Dr. Mistry 5:56

You can also find that, but, but we want good stuff.

Donna Lee 5:58

We'll buy it here.

Dr. Mistry 5:59

We want good stuff. L-arginine we use a lot as a supplement as well. We have a very close relationship with sex therapy, so especially, we get a lot of students from the University of Texas, believe it or not. We have a great relationship with their health department there. And you know, when a young kid comes in with erectile dysfunction, like, it perks some ears up. And it's probably beyond the, the usual kind of capabilities of just a traditional primary care doctor to deal with ED in a young person.

Donna Lee 6:24

And we're gonna have Dr. Vagdevi on the show. She's with the Center for Relationships, our partnered sex therapy group. So she's gonna be on our show in the next month or so.

Dr. Mistry 6:31

Well, that's perfect. Then what comes to the kind of specialty things that we offer, we offer PRP injections. It's also known as the P shot. It uses your own platelet rich plasma that gets spun down and then extracted and then injected into your penis. That doesn't sound great, but it's a one time thing. The P shot has been shown, especially in patients who have diminished sensation. We use it a lot there. Works for erectile dysfunction, and we want to see it also used for a condition called lichen sclerosis, which is a skin condition of the penis. We're using it increasingly in that. We then do the shockwave therapy. So shockwave therapy...

Donna Lee 7:08

Yeah. We need to talk about that.

Dr. Mistry 7:09

...uses ultrasound energy kind of in a way to cause microtrauma in the blood vessels and the nerves that kind of help innervate and, and allow blood flow into the penis. It then allows for a regenerative process. So that's where we're looking to kind of build you back better. And that's what the purpose of that...

Donna Lee 7:28

You went political all of a sudden.

Dr. Mistry 7:29

I build back better. It, it does, and I will say that it does not work in everyone. So if you are out there and you're, I hate when I see this, I see like a 75 year old guy who hasn't gotten an erection in 10 years, dropped$10,000 at some popup, you know, place, and come to me and say,"Well, it didn't work." Well, no kidding it didn't work, because it's not gonna raise you from the dead. It's not gonna, and it's not gonna like take something that hasn't worked for 10 years and then all of a sudden give it a new spark. What, what it's really designed to do is to improve firmness in people who are losing firmness. It's really ideally suited for the man, in my opinion, between 45 and 65 who has like 70% native erections. The pills are working, but is having side effects and wants to get off the pill. That's gonna be kind of your ideal kind of demographic. If the pills don't work, the shockwave doesn't work, then we have, we have other treatments. We have an injection that you can put into the penis called Trimix. This used to be kind of the only treatment that these popup ED clinics used to have, called like Boston Medical Group and things like that, where they would just, everybody would get the same thing. It's the treatment for premature ejaculation, it's the pre-, it's the treatment for erectile dysfunction. It's just the treatment. And...

Donna Lee 8:39

Everybody's walking around with hard-ons all over Austin.

Dr. Mistry 8:41

And when there was a problem, they'd have to call a real urologist.

Donna Lee 8:44

Right. To fix it.

Dr. Mistry 8:45

So they would call...to fix it. So, this injection, although very kind of mentally, something to overcome, these are the benefits. It works independent of your psychology.

Donna Lee 8:57

Yeah.

Dr. Mistry 8:58

So if you have severe performance anxiety...So I get a lot of young couples, especially from south Asia, in which they cannot have intercourse.

Donna Lee 9:04

Right.

Dr. Mistry 9:05

They're simply unable to. The man cannot maintain it. He's fearful. They can't even practice. They can't do anything.

Donna Lee 9:11

I should have married somebody from Southeast Asia.

Dr. Mistry 9:13

Yeah, you should've. You would've been two peas in a pod.

Donna Lee 9:17

"We don't have the sex."

Dr. Mistry 9:19

And, and, and they come to me when they want to have kids. And so these are people, you know, where the injection into the penis to give them an erection will help them overcome any performance anxiety, give them the time. And if you're, if you're out there and you erectile dysfunction is so severe that you're simply depressed, relationship's kind of crumbling, these are the kind of things in which you should, should be open. And you get the guys that are, that understand that, and are happy with it, with the treatment, and accept it and move on. And you get the guys that are tough to...some guys out there think that somehow I have some magic treatment that I'm keeping from them. I assure you, I assure you I'm not.

Donna Lee 10:00

You're not.

Dr. Mistry 10:01

If I have a way to help you, I will do that.

Donna Lee 10:03

We've had lots of patients, too, ask me if that's the last resort treatment, the Spark Wave. And I, I always say,"It's not the last resort. It's just one of the many tools in the toolbox that we have."

Dr. Mistry 10:11

Of course. And we want, we want it early in the system, not, not, not late. So Donna, a wonderful discussion. How do people get a hold of us? How do people send us questions?

Donna Lee 10:19

You can reach out to us to armormenshealth@gmail.com. You can call us at(512) 238-0762 during the week. And you can listen to our podcast wherever you listen to free podcasts.

Speaker 1 10:30

Dr. Mistry wants to hear from you. Email questions to Armor Men's health@gmail.com. We'll be right back with the armor men's health hour.