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, Donna Lee is joined by NAU Urology Specialists' wonderful pelvic floor physical therapist, Dr. Angela Treadway for Part 2 of a previous podcast, "PT for Your ED: Dr. Angela Treadway Discusses Pelvic Floor Physical Therapy and Erectile Dysfunction" (aired 8.8.20). Dr. Treadway explains what a pelvic floor physical therapist does and some of the many benefits male urology patients can gain from PT. In particular, Dr. Treadway explains how erectile dysfunction can be treated through physical therapy. She points out that in order for the erectile tissues to engorge, the musculature around those tissues have to be loose enough to allow the blood to flow, but not so loose that the tissues empty prematurely. Using biofeedback monitors, Dr. Treadway helps "coach" patients to do exercises that improve the function of affected musculature and thereby improve "game performance" in the bedroom. There is also a cognitive component that can affect blood flow--when the brain and body go into "fight-or-flight" mode, blood is redirected toward the thighs to enhance one's ability to flee from a dangerous predator. All of these issues can be addressed through physical therapy and sometimes sex therapy to address the cognitive components of ED.
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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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Speaker 1:
Welcome back to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.
Donna Lee:
Welcome to the Armor Men's Health Hour. Today, Dr. Mistry has stepped away for a moment. So we brought in our super amazing special partner in health and sometimes in crime, Dr. Angela Treadway! Welcome, Dr. Treadway.
Dr. Treadway:
Thanks. Good to be here.
Donna Lee:
Not ever in crime. I'm just kidding.
Dr. Treadway:
Not out loud.
Donna Lee:
Always in wellness and health, for sure. You can visit our website and see Dr. Angela Treadway's beautiful, smiling face at armormenshealth.com. You can send her questions or me questions, or we'll get them answered anonymously at armormenshealth@gmail.com. Our phone number during the week is(512) 238-0762. You can catch our podcasts wherever you listen to podcasts. Dr. Treadway, you can hear Dr. Treadway. You can actually Google us,"Armor Men's Health" and"Dr. Treadway," and she has--we've done like 500 podcasts--yours is the third most downloaded podcast that we have, which is a lot. It says a lot.
Dr. Treadway:
That, that's really gratifying.
Donna Lee:
Thank you so much. I think, we also feature you in our series called"That's What She Said!" So we wanted to have her back. Thank you so much, Dr. Treadway, for being here.
Dr. Treadway:
I am so happy to be here.
Donna Lee:
So that first one was called, we talked about erectile dysfunction.
Dr. Treadway:
We did that's the third most downloaded.
Donna Lee:
Right. It was like"PT for your ED.
Dr. Treadway:
"PT for your ED." And this will be"PT for your ED: The Sequel."
Donna Lee:
Part 2. That's right. So let's take it away. What do you want to talk about? Let's, let's inform all the listeners: what you do, how you fix the erectile dysfunction--because guys don't think about pelvic floor physical therapy sometimes.
Dr. Treadway:
No, no, it's not actually promoted a lot like the medications are and such. It doesn't have as much advertising time.
Donna Lee:
Pizzaz.
Dr. Treadway:
Right? Not so much pizzaz because it's not a pill. It's not magic. It doesn't, it takes a little effort.
Donna Lee:
A little bit of work.
Dr. Treadway:
PT is, physical therapy is like training. I am your coach, you are the athlete. You get the gold medal and I'll show you how to get it. So things to think about with erectile function--how does it work? You got to have blood flow and you got to have appropriate pressure. Got to get closer to the microphone and stay in my video. Those of you watching this video--I'm actually videoing this right now--you will be my beta testers. I've never done this before. Maiden voyage.
Donna Lee:
That's right. You can see Dr. Treadway, but not me. Thank goodness.
Dr. Treadway:
You don't love me anymore. Okay. So blood flow, blood pressure, strength. The, if you think about the chambers of the penis that have to be able to engorge, they have small arterials and those arterials have smooth muscle around them. Now smooth muscle is very affected by the autonomic nervous system, which is the part of the nervous system which does fight or flight, rest and digest. This is why, if you're running from a tiger, you don't want to make babies. So if stress is in your life...
Donna Lee:
You're not getting an erection when you're running from some death.
Dr. Treadway:
Pretty much, you kind of hope not. But that's a thing to think about. It's a cause effect, and you've got to be in the right chemistry to get things going, number one. Number two, you've got to have enough patency, openness, compliance in the tissues that have to engorge. So they have to not be tight because you're in fight or flight, smooth muscles have to let go and allow the blood in. Now as the blood comes in, as long as you don't have any, any blockages, any plaques and things like that, as the blood comes in, you can actually do a couple of things to help it, hasten it to stay there to cause more rigidity. There are muscles underneath the penis. One is called the bulbocavernosus, it's directly underneath. So if you were to do a penis lift, you're contracting it. That muscle will take the blood from the vascular compartment and push it into those little arterials. And by doing that, it's not just that one. There's another set on the side that are ischiocavernosus--you don't need to know the names, there won't be a test--but essentially what you try to do is a penis lift, and you will bring those into play. And what they'll do is take the blood from the vascular compartment, put it into the cavernous tissue. The anterior fibers of the bulbocaversnosus will also compress the vein. There's a vein on the penis that is the drain vein. It'll make it not drain. So you get to have rigidity and you get to keep it. And one of the cool things that those muscles do for the geeks in the audience is that they increase the blood pressure in those arterials to go above diastolic blood pressure, which is what they have to do to get the rigidity. So there's blood pressure issues, that's tricky. But that is the mechanism. So what physical therapy, what pelvic floor physical therapy has to contribute to this whole situation is that we have apparatuses called biofeedback that you can get right up there by that muscle that does the penis lift so that you can look on a screen and see when you're doing it when you're not, because really that part of the body, our brain and our pelvic floors, don't really talk to each other a lot after we're potty trained. So it's been a lot of years. So if they don't know how to do it, or I've never practiced that I've got, I have got the equipment to help them see, measure, get feedback immediately in real time and then go home and practice. The magic's in the homework. It really is. I'm just the coach.
Donna Lee:
And what are they doing when they're at home with them?
Dr. Treadway:
When they're at home, they're going to practice what they did with the biofeedback. They're going to practice the penis lift and the let go of the penis lifts so that they have complete mastery of that. And...
Donna Lee:
It was so going to insert a joke, but I did not. Go ahead. Mastery of the penis. Go ahead.
Dr. Treadway:
That is what they're going to do. Oh. And practice. If fight or flight is a problem in the equation, then I will also teach them mindfulness techniques. I've got, I've got an apparatus for that too. I like the widgets, regenerate wires, anybody who comes to see me is going to know this about me. So I do have a geek side. But I have an apparatus that will measure what's called heart rate variability, which gives you an indicator of coherence in your organ systems. And that is a lot of fancy words to say, getting you to be able to on your own on purpose balance from fight or flight to rest and digest so that you can actually get feedback and see how you're doing. And what you'll see, what you'll always notice on that monitor is what it is that went through your mind, that flashed through your mind that took you out of coherence. And you'll realize that your thoughts have a lot to do with your chemistry.
Donna Lee:
It sounds like therapy too, not just physical therapy. You're doing some therapy in there.
Dr. Treadway:
Well people tell me a lot. People tell me an awful lot of stuff, and of course I can, I can, refer to the appropriate place if they need some, some in-depth trained, you know, help with that. Cause you know, we all have somthing.
Donna Lee:
Right. And we have sex therapy onsite as well. So I'm sure that some of your patients could benefit from both. A little bit of mine therapy, a little bit of pelvic floor physical therapy.
Dr. Treadway:
Well, it's a body mind thing. And really our sexiest organ is our brain. It really is. A little more so with females because females are super complicated when it comes to arousal and whatnot and males aren't as complicated. But still it's the brain, it's the brain, the eyes, you know, all of that.[inaudible]
Donna Lee:
Right. Gotcha. If I am a man with ED and I'm seeing Dr. Treadway or Dr. Lipe in our clinic, what does it look like for a typical patient with ED? Is that a weekly visit with you? Or is it every couple of weeks? Like how do you, how often do you want to see that patient?
Dr. Treadway:
I want to start by seeing them weekly for four to six weeks, depending on their mastery of that muscular area. If they've got some mastery, we can start with four and make sure that they have adequate training to do that home program without any apparatus, without any feedback. And then from there we can do two week, three week follow-ups to see how it's going. Because you know, they got to home and practice. I need some feedback I need to know if the intervention that the coach is doing is making a difference in the bedroom, and that way we can tweak it over the first four weeks. Four to six weeks is the physiological timeline for a neuromuscular slash musculoskeletal change to take you from the level that you're at to the next level of function. So that's why I choose the four weeks. It's because of the physiological timeline.
Donna Lee:
Right. So it's not, you know, you can't, it's not a one and done kind of thing, guys. If you're, if you've been scheduled to see a physical therapist for your pelvic floor function for your ED issues, I don't want guys to go,"Oh, I'm going to go see Dr. Treadway one time and I'm all done."
Dr. Treadway:
We can try that and see how it works. Let me know. I mean, you know, I'm willing. I'm willing to, I will give what you ask for. If you're not willing to put in the time or you can't put in the time, I will do my best to give you the home program and give you the education that I can give in an hour in that first visit. I mean, I understand, you know, if, if stress is your problem, then likely you don't have time. But I am, I'm here to give what I have to serve you. And, where we meet with this give and take of information and of basically neuromuscular training, motor pattern training, where we meet is where your benefit's going to be. Right. But I understand if you don't have time, I, you know, I'm not going to judge you. I'm not gonna judge you.
Donna Lee:
So, and Dr. Treadway is a pelvic floor physical therapist. And where did you go to school real quick?
Dr. Treadway:
For PT? I did my masters at Arcadia University in Philadelphia--or actually Glenside, Pennsylvania. And I did my doctorate at Temple University in Philadelphia.
Donna Lee:
Gotcha. And we also have our lovely Dr. Lipe so you will have one of these two amazing humans treating you. Dr. Treadway, thank you so much for coming in for"PT to fix your ED Part 2." And, and that's what she said. So you can find Dr. Treadway at our website, armormenshealth.com. You can also send questions on the specific topic or whatever else you might have for Dr. Treadway to armormenshealth@gmail.com. And you can listen to our podcasts. They're free. They're amazing. They are just as informative as a Joe Rogan podcast, but shorter and maybe even funnier. I'm just kidding. Maybe not anyway. Call us. Thanks so much, Dr. Treadway.
Dr. Treadway:
You're welcome. This is fun.
:
Dr. Mistry wants to hear from. You email questions to armormenshealth@gmail.com. We'll be right back with the Armor Men's Heath Hour.