In this segment, Donna Lee is joined by NAU Specialists' own Dr. Christopher Yang and special guest, Dr. Vamsi Krishna. Dr. Krishna is an interventional cardiologist who has been with the Seton Healthcare system for the last 5 years. Today, he answers questions about the relationship between cardiovascular and sexual health. Many of our urology patients are worried that hormone therapy to treat the symptoms of erectile dysfunction might increase their risk for heart disease. Dr. Krishna addresses this concern as well as the importance of weight management, smoking cessation, and blood sugar management in the role of both sexual and cardiovascular health. To learn more about Dr. Krishna or interventional cardiology, call Ascension Seton at 512-504-0860 or visit them online 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.
We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode.
Phone: (512) 238-0762
Email: Armormenshealth@gmail.com
Website: Armormenshealth.com
Our Locations:
Round Rock Office
970 Hester’s Crossing Road
Suite 101
Round Rock, TX 78681
South Austin Office
6501 South Congress
Suite 1-103
Austin, TX 78745
Lakeline Office
12505 Hymeadow Drive
Suite 2C
Austin, TX 78750
Dripping Springs Office
170 Benney Lane
Suite 202
Dripping Springs, TX 78620
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Speaker 2 (00:09):
Welcome back to the Armor Men's Health Show with
Dr. Mystery and Donna Lee.
Speaker 3 (00:16):
Back to the Armor Men's Health Hour. This is
Donna Lee. Dr. Mystery steppedaway. I think he likes to go
visit with the K L B J radioguys and , um, talk about stuff
that he doesn't wanna talkabout on the air. So I brought
in a couple of special gueststoday. So , um, I wanted to
introduce everybody. We haveDr. Krishna with Seton. He's
got several locations. We'regonna ask him a whole bunch of
(00:36):
questions, but I also wanted tolet everybody know that we have
our special partner, Dr. Yang,back today. Hey, Dr. Yang. Hey
Speaker 4 (00:42):
Donna. Glad to be back.
Speaker 3 (00:43):
And Dr. Krishna, thank you for coming. We
appreciate your time. Thank
Speaker 5 (00:46):
You for having me.
Speaker 3 (00:47):
Of course. So , um, I wanted to ask Dr. Krishna a
few questions. Um, he is acardiologist, an interventional
cardiologist. So , uh, firstlemme tell you, he's with Seton
and we'll talk about hislocations and how to get in
touch with him . He's acceptingnew patients and you all are
gonna be blown away by howawesome he is. But Dr. Krishna
, why don't you explain to thelisteners what's the difference
between a cardiologist , uh,conventional and interventional
general.
Speaker 5 (01:07):
Cardiologists see patients and are able to do
basic non-invasive testing.
Interventional cardiologistsare able to then see the
patient and able to doprocedures such as heart
attacks, strokes , uh, able tosuck out, clot from people's
legs, har hearts, and , uh,lungs, kind of treat patients
both in the office and in thehospital.
Speaker 3 (01:25):
Okay, awesome. And how long have you been with
Seton?
Speaker 5 (01:27):
I've been with Seton for five years now.
Speaker 3 (01:28):
Gosh, I bet you've seen a few a thing or two. Yes.
Yeah , yeah. scared.
Yeah , exactly.
Speaker 4 (01:34):
Let's just leave it at that . Yeah .
Speaker 3 (01:35):
Let's not talk about any patient issues. I know that
you've got, you're located inWestlake, Kyle, and Luling
mm-hmm . Through Seton . Sowe'll talk a little bit more
about that, but I'd like toturn over the , uh, discussions
to you and Dr. Yang. Uh, we geta lot of questions about people
having heart attacks orcardiovascular issues and
testosterone. Why don't youguys talk about , um, is it
safe to be on testosterone withcardiac issues and to what
(01:56):
extent?
Speaker 4 (01:57):
You know, that's definitely a lot of a good part
of, you know, my conversationwith patients when we start
testosterone is mm-hmm .
had been somestudies out in, you know ,
2013, 2014 range, suggestingthat maybe taking testosterone
increases the risk of heartattack and stroke. American
Neurological Association.
That's the overall, you know,association for urologists have
(02:19):
actually guidelines that say,you know, for patients who you
know, well , it saysspecifically clinicians should
inform testosterone deficientpatients that low testosterone
is a risk factor forcardiovascular disease. So
wanted to get kind of your ,uh, your thoughts on that.
Being , uh, on the other side,
Speaker 5 (02:35):
You know, you raised a great point. If people have
low testosterone, what is theirrisk? And is there risk being
able to be mitigated withtestosterone replacement? I
would say the way I address lowtestosterone is typically it's
a multifactorial things . Dopatients that have low
testosterone also have otherrisk factors that play a role
that may also increase theirrisk of cardiovascular issues?
(02:56):
And the answer is typicallyyes. Most of those patients may
be obese, low physicalactivity, diabetes, smokers, et
cetera. So I think when itcomes to cardiovascular risk, I
think low testosterone may playa factor, but I think risk
factor modification probablyplays a bigger role overall.
When we talk about risk, mainlywhat we've seen in the studies
is the first two years , um,there's a slight increased risk
(03:18):
of stroke based on the fin riskstudy, which showed that about
a 15,000 patients who weregetting testosterone
replacement over the age of 45,there was a slight increased
risk of stroke in the first twoyears. And then after that,
that stroke risk is actuallymitigated. They actually had a
decrease in all causemortality. The data is still
kind of out there as mixed. Andthe way I counsel my patients
is really, if you'resymptomatic and you're
(03:40):
modifying your other riskfactors, decreasing alcohol,
removing tobacco, improvingyour diabetes, and you're still
symptomatic, you know, andunder the right professional
care, it should be treated foryour symptoms and not
necessarily to decrease yourcardiovascular mortality.
Speaker 4 (03:53):
Bottom line, you know, from what I'm hearing is
studies are still mixed, but itis safe, you know, to take
testosterone for, you know, eto replace a testosterone to ,
to help some of your symptoms.
Speaker 5 (04:06):
Absolutely. I think T R T has a role and I think ,
uh, you know, under urologicalcare and, you know, in
partnership with cardiology andthe more complicated patients,
I think it could safely bedone.
Speaker 4 (04:16):
I guess we had a question a couple of weeks ago
from a patient mm-hmm.
, who said thathe had had a heart attack
mm-hmm. , is itstill safe to do testosterone?
And kind of what we answered atthat time was, as long as his
cardiologist was okay with it,then it's fine from your
standpoint. Yeah. What type oftest would you do to, to say
that patient's okay to usetestosterone?
Speaker 5 (04:35):
You know, that's a great, first great question you
asked is, what is a heartattack? People come around and
tell us they've had a heartattack. You know, I tell 'em
there's actually five differenttypes of heart attack and
without boring, the audience isout there. The premise really
everyone wants to know is theheart attack where you're
clenching your chest acutelygoing to die, that is what we
call a type one heart attack.
And that's one where peoplelike me would come in, suck out
(04:57):
the clot and put a stent inthose type of patients where
you actually had a stent andare on dual PL therapies,
typically, if you have nosymptoms six weeks after this
procedure, it's safe to resumetherapy under your guidance of
urology. Okay. If you had aheart attack where you were
just treated in the hospital,did not need any real
procedures, typically that's atype two heart attack. And in
those cases, you know, you'reable to safely resume the
(05:19):
therapy at any point that the,your urologist , uh, urologist
discretion, does
Speaker 3 (05:24):
That change though , uh, with age? Like, do you do
the same testing for a 30 yearold that had a heart issue
versus a 60, 65 year old whohad a heart
Speaker 5 (05:32):
Attack? The testing, you know, right now a lot of
people get stress tests andvarious different types of
stress tests . We typicallybase it on symptoms. So if
someone comes and tells me theyhave a heart attack, but then
they're not having anysymptoms, we typically don't
order test irrespective age.
Mm-hmm. , ifsomeone comes in and they say,
Hey, I have a family historyand there's multiple other
issues, we typically order ,you know, a stress test. A
(05:53):
stress test again, onlyindicates if there's an
obstruction of 70% or more.
Mm-hmm. , that'swhat it's guessing, but does it
not tell you it's notpredictive if you're going to
have a heart attack? So I telleveryone, again, back to that
risk factor modification mm-hmm. and being
connection. So Dr. Yang and Ishare patients together, if
there's any concern, pick upthe phone and say, Hey, Dr.
Yang, I had these, I'mconcerned about this patient's
(06:14):
X, y, and Z issues. Can weoptimize them before starting
something? And I think that'sthe most collaborative way of
going around this type offield. Gotcha.
Speaker 4 (06:22):
Okay. And now what about patients who are taking
aspirin, who are taking othertypes of blood thins who want
to do testosterone injections.
Is there any issues as far asthe performing injections,
doing the needles, things likethat?
Speaker 5 (06:35):
Hopefully they're coordinated , uh, , uh,
uh, but no, there , there is noissues with the intramuscular
subcutaneous injection.
Speaker 4 (06:43):
Anything you want to tell them about being
coordinated enough to put it in ? Yeah .
Speaker 5 (06:46):
Well, you know, we , we , we have a few friends ,
uh, who I'll not name who Iprobably would not recommend
getting injections from. Yeah .
.
Speaker 4 (06:55):
Um, okay. Some of the other patients that we see,
you know , who come in to usinitially as a urologist, they
come in because they haveerectile dysfunction. You know,
they probably hadn't seen adoctor for 10, 15, 20 years.
Mm-hmm. , youknow, they might be a little
bit overweight, you know, theymight actually have diabetes ,
uh, high blood pressure othother types of , uh, issues.
(07:17):
You know, when we first seethem, what we typically, we ,
what we typically do is get,you know, some of their blood
tests as far as testosteroneand other hormones mm-hmm.
. Um , but wetypically try to get them
hooked up with primary docs orcardiologists. Um, you know,
and you know, for most, for alot of men out there, the first
thing that they ever, you know,the first symptoms they ever
(07:39):
have that they actually want toget treated is erectile
dysfunction. Right. So, youknow, gets them in the door.
Yeah, exactly. Tell us kind ofwhat your thoughts are thus far
as, you know, men who haveerectile dysfunction and the
risk with, with heart disease.
Now, we probably don't have toomuch time. We might need to go
into the next segment. Mm-hmm .
.
Speaker 5 (07:57):
Yeah. So that , that , that's a fantastic question.
Um, and one that is actuallygrowing because, you know,
erectile dysfunction definitelycreates , uh, you know, a
conundrum for, for patients.
And usually that's thepresenting sign. And most of
these patients with erectiledysfunction, a a as you said ,
uh, it's , there's an arterialissue going on that's di
decreasing flow, hence whymedications like Viagra and
(08:18):
Cialis work and usually if youhave artery issues in the
microvascular system in nearthe penis, you're also gonna
have microvascular issues inthe heart and brain and other
areas.
Speaker 4 (08:27):
Yeah. And that's kind of exactly what I tell
them when I see 'em in the , inthe office. , I tell
'em the , the blood vessels andthe penis mm-hmm .
are just as smallas the blood vessels in the
heart. So if you have problemswith one, you probably have
problems, problems with theother . Good
Speaker 5 (08:39):
Point. And so point , and so it usually causes a
poly disease. It way I kind ofput this is that , um, you
know, there's a lot of data,including this wonderful
meta-analysis published thisyear, 154,000 patients being
evaluated. And they basicallylooked , if you had erectile
dysfunction, there's asignificant increase risk of ,
uh, having cardiovascularevents mm-hmm . .
And basically if you're overthe age of 55 , uh, you've had
(09:01):
ED for less than seven years,smoker and diabetes, you have
significant increased risk ofcardiovascular mortality. And
that if you treat your ED andtreat those symptoms, you'll
definitely decrease yourmortality. Gotcha.
Speaker 3 (09:11):
Well, we definitely need to continue this
discussion with the nextsegment. Wrapping up for this
segment though, Dr. Yang, Iwanted to make sure everybody
remembered he's our urologist.
He's one of our partners withurology specialists, and we
have Dr. Krishna here. So whatwe're gonna do is go take a
commercial break. Uh , we areurology specialists and armor
men's health.com is ourwebsite. You can send us any
(09:32):
questions to Armor men'shealth@gmail.com. That's Armor
Men's health@gmail.com . If youhave a question for Dr. Krishna
or Dr. Yang in the future, wewill answer those questions and
we will be right back.
Speaker 2 (09:42):
The Armor Men's Health Show will be right back
to submit a question for Dr.
Mystery , visit armor men'shealth.com.
Speaker 1 (10:08):
Welcome
Speaker 2 (10:08):
Back to the Armor Men's Health Show with Dr.
Mystery and Donna Lee.
Speaker 1 (10:15):
Donna Lee .
Speaker 3 (10:15):
Again, Dr. Mystery has stepped out, but I wanted
to continue the discussion wewere having with our urologist,
Dr. Yang. Christopher Yang.
Welcome back . Hey,
Speaker 4 (10:23):
Thanks again.
Speaker 3 (10:23):
Um, and Dr. Krishna, the cardiologist from Seton. So
you guys continue thatdiscussion. It's fascinating.
Then we wanna keep talkingabout more , um, testosterone
and cardio.
Speaker 4 (10:32):
Yeah, yeah. So basically we were , what we
were talking about was the linkbetween erectile dysfunction
and cardiovascular disease.
Mm-hmm. , youknow , a lot of men who have
heart disease have erectiledysfunction. A lot of men that
have ed have heart disease aswell.
Speaker 5 (10:46):
A lot of the patients present with erectile
dysfunction as their firstsign. And so this gives a , a
multi-specialty way of beingable to, you know, help prevent
what's the number one leadingcause of death in our country,
which is cardiovascular death.
Speaker 4 (10:58):
It's not because of the penis, is it? It's
Speaker 5 (11:00):
Not because the penis, but the penis brings you
there, you know, . So ,uh,
Speaker 3 (11:05):
It does have a mind of its own does its you to the
doctor .
Speaker 4 (11:08):
It's kind of up in the air. Which one is more
important. Right.
Speaker 3 (11:10):
. Right.
Speaker 5 (11:11):
And you help them get up in the air. . Uh
, so, you know, , therewas a wonderful study performed
, uh, in 2019 and meta-analysisof multiple trials put together
154,000 patients. So , uh, youknow, a small study , uh, joke
, jokes , jokes aside, itbasically looked at .
If you had erectile dysfunctionversus not erectile
dysfunction, what is your riskof, of death , uh, stroke and
(11:34):
overall coronary heart disease?
And overall it's around a 30 to60% increased risk if you have
erectile dysfunction and if youhave erectile dysfunction and
you're over the age of 55 orsmoker diabetic and have a
shorter duration of ed,typically those are the most
severe risk factors for havinga hard endpoint , uh,
cardiovascular event. Hence,it's important to treat these
risk factors as well as treaterectile dysfunction. I think
(11:57):
it's, it's important as a, amultimodality approach that we,
we screen these patients andscreening would typically
include, you know, coronarycoronary artery, calcium
scoring, EKGs, and just a basicpanel with most , uh, primary
physicians can do as well ascardiologists.
Speaker 4 (12:14):
Basically what you're saying is that patients
who have bad erectionsshouldn't be mad if we send you
to the cardiologist or aprimary doc to look for
diabetes, to look for highblood pressure, to look for
high cholesterol. Right.
Speaker 5 (12:28):
Absolutely.
Speaker 4 (12:28):
And then also patients who have had heart
attacks and strokes, they mighthave other things going on.
Mm-hmm . , butyou know, a lot of them
probably have , uh, poorerections that need to be
treated mm-hmm .that can be treated.
Speaker 5 (12:39):
And that's usually my number one question. I get
62 year old, I fixed theirheart, they came up with a
heart attack, they're in fortheir two week appointment,
they feel great. And then whenthe wife or partner leaves the
room, they say, doc, when can Ihave sex? And then, and then
the next question is like, goahead, . Uh , if you're
not having any symptoms in theAmerican Heart Association,
they recommend like six weeksdoing a sub maximal stress
(13:00):
test. You know, I currentlystate if a patient's able to do
cardiac rehab or participateand walk one mile, you're good
enough in cardiovascularcondition to have sex. But then
they come back and say, welldoc, I can't get it up. Mm-hmm.
, and then thisis where we have the
conversation, so I'm gonnathrow it back to you, Dr. Yang,
what is your algorithm fortreating erectile dysfunction?
Speaker 4 (13:19):
I wanted to comment first on what you just said.
From what I'm hearing, if theyattempt to have intercourse,
that's a pretty good stresstest right there. Right. Okay.
. So probably not asgood as the stress test that
you order. Right. But , butmore fun. Yeah. But having
other courses is a , is astress test.
Speaker 5 (13:34):
It's not one that I can prescribe. Okay . Which
many men probably would want meto. Yeah . But , uh,
Speaker 4 (13:38):
A note from their doctor, no , that would be be
good to prove to their wifethat it's okay. Alright . For
men who come in with erectiledysfunction, I think we've
talked about it before on thisshow, there's kind of a lot of
different potential causes. Youknow, one, one thing, we look
at hormones, you know,including testosterone and
estrogen, some others, we lookat the vascular disease to
basically look at if there'sany diabetes, any high blood
(14:00):
pressure, high cholesterol thatcan be, you know, contributing
to erectile dysfunction. Wealso look at structural issues
of the penis and then we lookat kind of psychological social
issues as well treatment wise .
You know, typically I look atmedications like Viagra,
Cialis, things like that.
Speaker 5 (14:16):
How do you decide, like, so let's say , what would
be a typical starting dose andhow do you decide between
Viagra and Cialis now that bothare generic, right ? Sure.
Speaker 4 (14:23):
Yeah. Yeah. You know, and kind of depends on
the patient's preference. Somethey work a little bit
differently in that Cialis isin your bloodstream for a
little bit longer. So patientswho are younger who might want
to have multiple, you know,multiple episodes of
intercourse over the course ofa weekend. Sometimes Cialis
works better. People who don'treally wanna think about it too
much, you know, we canprescribe a low dose Cialis
(14:46):
that you take every day , butyou know, some people, since
Viagra is the one that's beenaround the longest, some people
prefer that. Mm-hmm .
. So it's, it'sbasically a discussion as well
as patient preference mm-hmm.
Speaker 3 (14:57):
and
it's really inexpensive now.
Right.
Speaker 5 (14:58):
Yeah. And from a cardiology standpoint, I , I
typically go with Viagra onlybecause , uh, a lot of my
patients are on multiplemedications that may drop their
blood pressure mm-hmm.
. And we knowthat being one of the side
effects of , uh, this class ofdrugs is that this in
conjunction with other smoothmuscle relaxers can really drop
someone's blood pressure.
Mm-hmm. . So Itypically go with a lower dose
and use a shorter acting agent, um, as my , most of my
(15:22):
patients are, you know ,elderly and on other
combinations of therapies thatmay affect their blood
pressure. So you , you know, Iget the question all the time
where, you know, is it safe forme to take these drugs? And I
tell them, these are safe,well-studied drugs, it just
matters the pharmacology of ,uh, of , of all your
medications put together andthis is why you come see
specialists like Dr. Yang andmyself. Yeah. Now,
Speaker 4 (15:41):
One of the other things that we had talked about
before is one of the othertests that we do here in the
office is a penile duplexultrasound where we're looking
at the actual blood flow intothe penis. There's an artery on
each side called the cavernosalartery that actually fills out
the penis with blood when youget an erection. So one of the
tests that we do is called apenile duplex ultrasound.
Basically we're looking at theblood flow in, and that ties in
(16:04):
with Dr. Krishna here 'cause hedoes a procedure , uh, where he
actually can put a stent inthere. Is that
Speaker 5 (16:09):
Correct? That's correct. Yeah. Pudendal artery
stenting topic that has beenhot for the last seven, eight
years. And , uh, the, the howit works is you have iliac
arteries and you have aninternal iliac artery that
gives off the arteries to thepenis. And so, like we were
talking about before, theytypically range anywhere from
two to four millimeters andthey get, they can get disease
(16:31):
depending on the risk factorsthat you have, there's
approaches that you can engagethe internal iliac artery and
then put a wire and able to puta stent that is metallic and
tell the
Speaker 3 (16:40):
Listeners what a stent is. Yeah . Because
Speaker 5 (16:42):
You don't know, most of the stents that we use
currently for this would be acobalt chromium metal stent.
And they typically soundsfancy. Yeah . It's painful.
Speaker 3 (16:50):
It sounds fast.
,
Speaker 5 (16:50):
Uh , it is very fast. It's mounted on a , it's
crimped on a balloon mm-hmm .
. And when youexpand the balloon, the stent
goes onto the wall and becomespart of the artery within 45
days. Wow. And the DR and thenit has a drug coating on it so
that it prevents new tissuefrom regrowing inside the
stent.
Speaker 4 (17:06):
Now , uh, after they get a stent like that, do they
set off the x-ray detectorswhen they go to the , the Air
Force
Speaker 5 (17:12):
? No. No. As
much as guys like to say that,
you know, they have a metalrod, I have a giant stent .
Right . Exactly. , um,unfortunately they, they, they
will not, or fortunately theywill not be , uh, setting off
any metal detectors. Mm-hmm .
Speaker 4 (17:25):
.
Okay. Now, you know, from, fromwhat I've seen as far as, you
know, the times to do thisstent, it seems like it works
better with younger patients.
It works better with patientswho had this issue because of
trauma. Right. Not the olderpatients who's had a heart
attack and things
Speaker 5 (17:43):
Like that.
Absolutely. So the, the premiseof this is that typically if
you wait later in life, youdon't generally have more
diffuse disease. And so whenyou have diffuse disease, you
can't put stents throughout theentire penis artery. And so
that becomes a, that's too bad . Yeah. It becomes a ,
it becomes a problem. Right. Soyour point is, when you have
trauma, you're typically havinga focal spot where there is ,
(18:05):
uh, there's a change in flowand that's typically where
stents work best anywhere inthe body. And when you're
dealing with diffused diabetesor elderly age and the arteries
really become narrowed,stenting is not the optimal
option. And again, this isstill not something that's, you
know, I would say everydaypractice. It's, this is one
where, you know , you'd wannasee , uh, specialists who are
(18:26):
endovascularly trained and ,and partner with a urologist on
this topic, not one that , uh,is just performed on an
everyday basis.
Speaker 3 (18:32):
Um , I wanted to take a minute too to
reintroduce Dr. Krishna and letyou guys know where he's at.
He's accepting new patients.
Yes. Uh, seton.net is thewebsite where you can find ,
um, Dr. Vasey Krishna . Mm-hmm.
, um, you can seehis handsome face on the
website there. Mm-hmm .
. So just searchfor him. The number's 5 1 2 5 0
4 0 8 6 0. Uh, he again, is atWestlake, Kyle and Luling at
(18:55):
the Seton locations. Thank youso much for coming in today.
Thank
Speaker 5 (18:57):
You guys for having me. That
Speaker 3 (18:58):
Was awesome. Thanks Dr. Yang for popping in and
saving the day. 'cause Dr. Mr.
Disappeared. Yeah. Yeah.
Speaker 4 (19:03):
I'll , I'll gladly take over the co-host roll from
him . .
Speaker 3 (19:06):
Awesome. You can send us your questions at Armor
men's health@gmail.com. Um ,armor men's health.com is our
website. We're located inAustin, north Austin, round
Rock, south Austin, and inDripping Springs. Um , but we
wanna hear your questions, soif you have a question for Dr.
Krisna , um, send it over tome. Is it okay if I reach out
to you and say, Hey, thispatient had a question?
Speaker 5 (19:26):
Absolutely. Awesome.
Speaker 3 (19:27):
Well, we appreciate your time and thank you guys so
much again, and we'll be rightback after this commercial.
Speaker 2 (19:32):
The Armor Men's Health Show is brought to you
by N a U Urology specialist.
For questions or to schedule anappointment, please call 5 1 2
2 3 8 0 7 6 2 or online atarmor men's health.com.
Speaker 2 (00:09):
Welcome back to the Armor Men's Health Show with
Dr. Mystery and Donna Lee.
Speaker 3 (00:16):
Back to the Armor Men's Health Hour. This is
Donna Lee. Dr. Mystery steppedaway. I think he likes to go
visit with the K L B J radioguys and , um, talk about stuff
that he doesn't wanna talkabout on the air. So I brought
in a couple of special gueststoday. So , um, I wanted to
introduce everybody. We haveDr. Krishna with Seton. He's
got several locations. We'regonna ask him a whole bunch of
(00:36):
questions, but I also wanted tolet everybody know that we have
our special partner, Dr. Yang,back today. Hey, Dr. Yang. Hey
Speaker 4 (00:42):
Donna. Glad to be back.
Speaker 3 (00:43):
And Dr. Krishna, thank you for coming. We
appreciate your time. Thank
Speaker 5 (00:46):
You for having me.
Speaker 3 (00:47):
Of course. So , um, I wanted to ask Dr. Krishna a
few questions. Um, he is acardiologist, an interventional
cardiologist. So , uh, firstlemme tell you, he's with Seton
and we'll talk about hislocations and how to get in
touch with him . He's acceptingnew patients and you all are
gonna be blown away by howawesome he is. But Dr. Krishna
, why don't you explain to thelisteners what's the difference
between a cardiologist , uh,conventional and interventional
general.
Speaker 5 (01:07):
Cardiologists see patients and are able to do
basic non-invasive testing.
Interventional cardiologistsare able to then see the
patient and able to doprocedures such as heart
attacks, strokes , uh, able tosuck out, clot from people's
legs, har hearts, and , uh,lungs, kind of treat patients
both in the office and in thehospital.
Speaker 3 (01:25):
Okay, awesome. And how long have you been with
Seton?
Speaker 5 (01:27):
I've been with Seton for five years now.
Speaker 3 (01:28):
Gosh, I bet you've seen a few a thing or two. Yes.
Yeah , yeah.
Yeah , exactly.
Speaker 4 (01:34):
Let's just leave it at that . Yeah .
Speaker 3 (01:35):
Let's not talk about any patient issues. I know that
you've got, you're located inWestlake, Kyle, and Luling
mm-hmm . Through Seton . Sowe'll talk a little bit more
about that, but I'd like toturn over the , uh, discussions
to you and Dr. Yang. Uh, we geta lot of questions about people
having heart attacks orcardiovascular issues and
testosterone. Why don't youguys talk about , um, is it
safe to be on testosterone withcardiac issues and to what
(01:56):
extent?
Speaker 4 (01:57):
You know, that's definitely a lot of a good part
of, you know, my conversationwith patients when we start
testosterone is mm-hmm .
2013, 2014 range, suggestingthat maybe taking testosterone
increases the risk of heartattack and stroke. American
Neurological Association.
That's the overall, you know,association for urologists have
(02:19):
actually guidelines that say,you know, for patients who you
know, well , it saysspecifically clinicians should
inform testosterone deficientpatients that low testosterone
is a risk factor forcardiovascular disease. So
wanted to get kind of your ,uh, your thoughts on that.
Being , uh, on the other side,
Speaker 5 (02:35):
You know, you raised a great point. If people have
low testosterone, what is theirrisk? And is there risk being
able to be mitigated withtestosterone replacement? I
would say the way I address lowtestosterone is typically it's
a multifactorial things . Dopatients that have low
testosterone also have otherrisk factors that play a role
that may also increase theirrisk of cardiovascular issues?
(02:56):
And the answer is typicallyyes. Most of those patients may
be obese, low physicalactivity, diabetes, smokers, et
cetera. So I think when itcomes to cardiovascular risk, I
think low testosterone may playa factor, but I think risk
factor modification probablyplays a bigger role overall.
When we talk about risk, mainlywhat we've seen in the studies
is the first two years , um,there's a slight increased risk
(03:18):
of stroke based on the fin riskstudy, which showed that about
a 15,000 patients who weregetting testosterone
replacement over the age of 45,there was a slight increased
risk of stroke in the first twoyears. And then after that,
that stroke risk is actuallymitigated. They actually had a
decrease in all causemortality. The data is still
kind of out there as mixed. Andthe way I counsel my patients
is really, if you'resymptomatic and you're
(03:40):
modifying your other riskfactors, decreasing alcohol,
removing tobacco, improvingyour diabetes, and you're still
symptomatic, you know, andunder the right professional
care, it should be treated foryour symptoms and not
necessarily to decrease yourcardiovascular mortality.
Speaker 4 (03:53):
Bottom line, you know, from what I'm hearing is
studies are still mixed, but itis safe, you know, to take
testosterone for, you know, eto replace a testosterone to ,
to help some of your symptoms.
Speaker 5 (04:06):
Absolutely. I think T R T has a role and I think ,
uh, you know, under urologicalcare and, you know, in
partnership with cardiology andthe more complicated patients,
I think it could safely bedone.
Speaker 4 (04:16):
I guess we had a question a couple of weeks ago
from a patient mm-hmm.
mm-hmm.
And kind of what we answered atthat time was, as long as his
cardiologist was okay with it,then it's fine from your
standpoint. Yeah. What type oftest would you do to, to say
that patient's okay to usetestosterone?
Speaker 5 (04:35):
You know, that's a great, first great question you
asked is, what is a heartattack? People come around and
tell us they've had a heartattack. You know, I tell 'em
there's actually five differenttypes of heart attack and
without boring, the audience isout there. The premise really
everyone wants to know is theheart attack where you're
clenching your chest acutelygoing to die, that is what we
call a type one heart attack.
And that's one where peoplelike me would come in, suck out
(04:57):
the clot and put a stent inthose type of patients where
you actually had a stent andare on dual PL therapies,
typically, if you have nosymptoms six weeks after this
procedure, it's safe to resumetherapy under your guidance of
urology. Okay. If you had aheart attack where you were
just treated in the hospital,did not need any real
procedures, typically that's atype two heart attack. And in
those cases, you know, you'reable to safely resume the
(05:19):
therapy at any point that the,your urologist , uh, urologist
discretion, does
Speaker 3 (05:24):
That change though , uh, with age? Like, do you do
the same testing for a 30 yearold that had a heart issue
versus a 60, 65 year old whohad a heart
Speaker 5 (05:32):
Attack? The testing, you know, right now a lot of
people get stress tests andvarious different types of
stress tests . We typicallybase it on symptoms. So if
someone comes and tells me theyhave a heart attack, but then
they're not having anysymptoms, we typically don't
order test irrespective age.
Mm-hmm.
Hey, I have a family historyand there's multiple other
issues, we typically order ,you know, a stress test. A
(05:53):
stress test again, onlyindicates if there's an
obstruction of 70% or more.
Mm-hmm.
not tell you it's notpredictive if you're going to
have a heart attack? So I telleveryone, again, back to that
risk factor modification mm-hmm.
connection. So Dr. Yang and Ishare patients together, if
there's any concern, pick upthe phone and say, Hey, Dr.
Yang, I had these, I'mconcerned about this patient's
(06:14):
X, y, and Z issues. Can weoptimize them before starting
something? And I think that'sthe most collaborative way of
going around this type offield. Gotcha.
Speaker 4 (06:22):
Okay. And now what about patients who are taking
aspirin, who are taking othertypes of blood thins who want
to do testosterone injections.
Is there any issues as far asthe performing injections,
doing the needles, things likethat?
Speaker 5 (06:35):
Hopefully they're coordinated , uh,
uh, but no, there , there is noissues with the intramuscular
subcutaneous injection.
Speaker 4 (06:43):
Anything you want to tell them about being
coordinated enough to put it in
Speaker 5 (06:46):
Well, you know, we , we , we have a few friends ,
uh, who I'll not name who Iprobably would not recommend
getting injections from. Yeah .
Speaker 4 (06:55):
Um, okay. Some of the other patients that we see,
you know , who come in to usinitially as a urologist, they
come in because they haveerectile dysfunction. You know,
they probably hadn't seen adoctor for 10, 15, 20 years.
Mm-hmm.
bit overweight, you know, theymight actually have diabetes ,
uh, high blood pressure othother types of , uh, issues.
(07:17):
You know, when we first seethem, what we typically, we ,
what we typically do is get,you know, some of their blood
tests as far as testosteroneand other hormones mm-hmm.
hooked up with primary docs orcardiologists. Um, you know,
and you know, for most, for alot of men out there, the first
thing that they ever, you know,the first symptoms they ever
(07:39):
have that they actually want toget treated is erectile
dysfunction. Right. So, youknow, gets them in the door.
Yeah, exactly. Tell us kind ofwhat your thoughts are thus far
as, you know, men who haveerectile dysfunction and the
risk with, with heart disease.
Now, we probably don't have toomuch time. We might need to go
into the next segment. Mm-hmm .
Speaker 5 (07:57):
Yeah. So that , that , that's a fantastic question.
Um, and one that is actuallygrowing because, you know,
erectile dysfunction definitelycreates , uh, you know, a
conundrum for, for patients.
And usually that's thepresenting sign. And most of
these patients with erectiledysfunction, a a as you said ,
uh, it's , there's an arterialissue going on that's di
decreasing flow, hence whymedications like Viagra and
(08:18):
Cialis work and usually if youhave artery issues in the
microvascular system in nearthe penis, you're also gonna
have microvascular issues inthe heart and brain and other
areas.
Speaker 4 (08:27):
Yeah. And that's kind of exactly what I tell
them when I see 'em in the , inthe office.
'em the , the blood vessels andthe penis mm-hmm .
heart. So if you have problemswith one, you probably have
problems, problems with theother . Good
Speaker 5 (08:39):
Point. And so point , and so it usually causes a
poly disease. It way I kind ofput this is that , um, you
know, there's a lot of data,including this wonderful
meta-analysis published thisyear, 154,000 patients being
evaluated. And they basicallylooked , if you had erectile
dysfunction, there's asignificant increase risk of ,
uh, having cardiovascularevents mm-hmm .
And basically if you're overthe age of 55 , uh, you've had
(09:01):
ED for less than seven years,smoker and diabetes, you have
significant increased risk ofcardiovascular mortality. And
that if you treat your ED andtreat those symptoms, you'll
definitely decrease yourmortality. Gotcha.
Speaker 3 (09:11):
Well, we definitely need to continue this
discussion with the nextsegment. Wrapping up for this
segment though, Dr. Yang, Iwanted to make sure everybody
remembered he's our urologist.
He's one of our partners withurology specialists, and we
have Dr. Krishna here. So whatwe're gonna do is go take a
commercial break. Uh , we areurology specialists and armor
men's health.com is ourwebsite. You can send us any
(09:32):
questions to Armor men'shealth@gmail.com. That's Armor
Men's health@gmail.com . If youhave a question for Dr. Krishna
or Dr. Yang in the future, wewill answer those questions and
we will be right back.
Speaker 2 (09:42):
The Armor Men's Health Show will be right back
to submit a question for Dr.
Mystery , visit armor men'shealth.com.
Speaker 1 (10:08):
Welcome
Speaker 2 (10:08):
Back to the Armor Men's Health Show with Dr.
Mystery and Donna Lee.
Speaker 1 (10:15):
Donna Lee .
Speaker 3 (10:15):
Again, Dr. Mystery has stepped out, but I wanted
to continue the discussion wewere having with our urologist,
Dr. Yang. Christopher Yang.
Welcome back . Hey,
Speaker 4 (10:23):
Thanks again.
Speaker 3 (10:23):
Um, and Dr. Krishna, the cardiologist from Seton. So
you guys continue thatdiscussion. It's fascinating.
Then we wanna keep talkingabout more , um, testosterone
and cardio.
Speaker 4 (10:32):
Yeah, yeah. So basically we were , what we
were talking about was the linkbetween erectile dysfunction
and cardiovascular disease.
Mm-hmm.
heart disease have erectiledysfunction. A lot of men that
have ed have heart disease aswell.
Speaker 5 (10:46):
A lot of the patients present with erectile
dysfunction as their firstsign. And so this gives a , a
multi-specialty way of beingable to, you know, help prevent
what's the number one leadingcause of death in our country,
which is cardiovascular death.
Speaker 4 (10:58):
It's not because of the penis, is it? It's
Speaker 5 (11:00):
Not because the penis, but the penis brings you
there, you know,
Speaker 3 (11:05):
It does have a mind of its own does its you to the
doctor .
Speaker 4 (11:08):
It's kind of up in the air. Which one is more
important. Right.
Speaker 3 (11:10):
Speaker 5 (11:11):
And you help them get up in the air.
, so, you know,
, uh, in 2019 and meta-analysisof multiple trials put together
154,000 patients. So , uh, youknow, a small study , uh, joke
, jokes , jokes aside, itbasically looked at
If you had erectile dysfunctionversus not erectile
dysfunction, what is your riskof, of death , uh, stroke and
(11:34):
overall coronary heart disease?
And overall it's around a 30 to60% increased risk if you have
erectile dysfunction and if youhave erectile dysfunction and
you're over the age of 55 orsmoker diabetic and have a
shorter duration of ed,typically those are the most
severe risk factors for havinga hard endpoint , uh,
cardiovascular event. Hence,it's important to treat these
risk factors as well as treaterectile dysfunction. I think
(11:57):
it's, it's important as a, amultimodality approach that we,
we screen these patients andscreening would typically
include, you know, coronarycoronary artery, calcium
scoring, EKGs, and just a basicpanel with most , uh, primary
physicians can do as well ascardiologists.
Speaker 4 (12:14):
Basically what you're saying is that patients
who have bad erectionsshouldn't be mad if we send you
to the cardiologist or aprimary doc to look for
diabetes, to look for highblood pressure, to look for
high cholesterol. Right.
Speaker 5 (12:28):
Absolutely.
Speaker 4 (12:28):
And then also patients who have had heart
attacks and strokes, they mighthave other things going on.
Mm-hmm .
probably have , uh, poorerections that need to be
treated mm-hmm .
Speaker 5 (12:39):
And that's usually my number one question. I get
62 year old, I fixed theirheart, they came up with a
heart attack, they're in fortheir two week appointment,
they feel great. And then whenthe wife or partner leaves the
room, they say, doc, when can Ihave sex? And then, and then
the next question is like, goahead,
not having any symptoms in theAmerican Heart Association,
they recommend like six weeksdoing a sub maximal stress
(13:00):
test. You know, I currentlystate if a patient's able to do
cardiac rehab or participateand walk one mile, you're good
enough in cardiovascularcondition to have sex. But then
they come back and say, welldoc, I can't get it up. Mm-hmm.
conversation, so I'm gonnathrow it back to you, Dr. Yang,
what is your algorithm fortreating erectile dysfunction?
Speaker 4 (13:19):
I wanted to comment first on what you just said.
From what I'm hearing, if theyattempt to have intercourse,
that's a pretty good stresstest right there. Right. Okay.
you order. Right. But , butmore fun. Yeah. But having
other courses is a , is astress test.
Speaker 5 (13:34):
It's not one that I can prescribe. Okay . Which
many men probably would want meto. Yeah . But , uh,
Speaker 4 (13:38):
A note from their doctor, no , that would be be
good to prove to their wifethat it's okay. Alright . For
men who come in with erectiledysfunction, I think we've
talked about it before on thisshow, there's kind of a lot of
different potential causes. Youknow, one, one thing, we look
at hormones, you know,including testosterone and
estrogen, some others, we lookat the vascular disease to
basically look at if there'sany diabetes, any high blood
(14:00):
pressure, high cholesterol thatcan be, you know, contributing
to erectile dysfunction. Wealso look at structural issues
of the penis and then we lookat kind of psychological social
issues as well treatment wise .
You know, typically I look atmedications like Viagra,
Cialis, things like that.
Speaker 5 (14:16):
How do you decide, like, so let's say , what would
be a typical starting dose andhow do you decide between
Viagra and Cialis now that bothare generic, right ? Sure.
Speaker 4 (14:23):
Yeah. Yeah. You know, and kind of depends on
the patient's preference. Somethey work a little bit
differently in that Cialis isin your bloodstream for a
little bit longer. So patientswho are younger who might want
to have multiple, you know,multiple episodes of
intercourse over the course ofa weekend. Sometimes Cialis
works better. People who don'treally wanna think about it too
much, you know, we canprescribe a low dose Cialis
(14:46):
that you take every day , butyou know, some people, since
Viagra is the one that's beenaround the longest, some people
prefer that. Mm-hmm .
as patient preference mm-hmm.
Speaker 3 (14:57):
Right.
Speaker 5 (14:58):
Yeah. And from a cardiology standpoint, I , I
typically go with Viagra onlybecause , uh, a lot of my
patients are on multiplemedications that may drop their
blood pressure mm-hmm.
effects of , uh, this class ofdrugs is that this in
conjunction with other smoothmuscle relaxers can really drop
someone's blood pressure.
Mm-hmm.
and use a shorter acting agent, um, as my , most of my
(15:22):
patients are, you know ,elderly and on other
combinations of therapies thatmay affect their blood
pressure. So you , you know, Iget the question all the time
where, you know, is it safe forme to take these drugs? And I
tell them, these are safe,well-studied drugs, it just
matters the pharmacology of ,uh, of , of all your
medications put together andthis is why you come see
specialists like Dr. Yang andmyself. Yeah. Now,
Speaker 4 (15:41):
One of the other things that we had talked about
before is one of the othertests that we do here in the
office is a penile duplexultrasound where we're looking
at the actual blood flow intothe penis. There's an artery on
each side called the cavernosalartery that actually fills out
the penis with blood when youget an erection. So one of the
tests that we do is called apenile duplex ultrasound.
Basically we're looking at theblood flow in, and that ties in
(16:04):
with Dr. Krishna here 'cause hedoes a procedure , uh, where he
actually can put a stent inthere. Is that
Speaker 5 (16:09):
Correct? That's correct. Yeah. Pudendal artery
stenting topic that has beenhot for the last seven, eight
years. And , uh, the, the howit works is you have iliac
arteries and you have aninternal iliac artery that
gives off the arteries to thepenis. And so, like we were
talking about before, theytypically range anywhere from
two to four millimeters andthey get, they can get disease
(16:31):
depending on the risk factorsthat you have, there's
approaches that you can engagethe internal iliac artery and
then put a wire and able to puta stent that is metallic and
tell the
Speaker 3 (16:40):
Listeners what a stent is. Yeah . Because
Speaker 5 (16:42):
You don't know, most of the stents that we use
currently for this would be acobalt chromium metal stent.
And they typically soundsfancy. Yeah . It's painful.
Speaker 3 (16:50):
It sounds fast.
Speaker 5 (16:50):
Uh , it is very fast. It's mounted on a , it's
crimped on a balloon mm-hmm .
goes onto the wall and becomespart of the artery within 45
days. Wow. And the DR and thenit has a drug coating on it so
that it prevents new tissuefrom regrowing inside the
stent.
Speaker 4 (17:06):
Now , uh, after they get a stent like that, do they
set off the x-ray detectorswhen they go to the , the Air
Force
Speaker 5 (17:12):
you know, they have a metalrod, I have a giant stent .
Right . Exactly.
will not, or fortunately theywill not be , uh, setting off
any metal detectors. Mm-hmm .
Speaker 4 (17:25):
Okay. Now, you know, from, fromwhat I've seen as far as, you
know, the times to do thisstent, it seems like it works
better with younger patients.
It works better with patientswho had this issue because of
trauma. Right. Not the olderpatients who's had a heart
attack and things
Speaker 5 (17:43):
Like that.
Absolutely. So the, the premiseof this is that typically if
you wait later in life, youdon't generally have more
diffuse disease. And so whenyou have diffuse disease, you
can't put stents throughout theentire penis artery. And so
that becomes a, that's too bad
it becomes a problem. Right. Soyour point is, when you have
trauma, you're typically havinga focal spot where there is ,
(18:05):
uh, there's a change in flowand that's typically where
stents work best anywhere inthe body. And when you're
dealing with diffused diabetesor elderly age and the arteries
really become narrowed,stenting is not the optimal
option. And again, this isstill not something that's, you
know, I would say everydaypractice. It's, this is one
where, you know , you'd wannasee , uh, specialists who are
(18:26):
endovascularly trained and ,and partner with a urologist on
this topic, not one that , uh,is just performed on an
everyday basis.
Speaker 3 (18:32):
Um , I wanted to take a minute too to
reintroduce Dr. Krishna and letyou guys know where he's at.
He's accepting new patients.
Yes. Uh, seton.net is thewebsite where you can find ,
um, Dr. Vasey Krishna . Mm-hmm.
website there. Mm-hmm .
4 0 8 6 0. Uh, he again, is atWestlake, Kyle and Luling at
(18:55):
the Seton locations. Thank youso much for coming in today.
Thank
Speaker 5 (18:57):
You guys for having me. That
Speaker 3 (18:58):
Was awesome. Thanks Dr. Yang for popping in and
saving the day. 'cause Dr. Mr.
Disappeared. Yeah. Yeah.
Speaker 4 (19:03):
I'll , I'll gladly take over the co-host roll from
him .
Speaker 3 (19:06):
Awesome. You can send us your questions at Armor
men's health@gmail.com. Um ,armor men's health.com is our
website. We're located inAustin, north Austin, round
Rock, south Austin, and inDripping Springs. Um , but we
wanna hear your questions, soif you have a question for Dr.
Krisna , um, send it over tome. Is it okay if I reach out
to you and say, Hey, thispatient had a question?
Speaker 5 (19:26):
Absolutely. Awesome.
Speaker 3 (19:27):
Well, we appreciate your time and thank you guys so
much again, and we'll be rightback after this commercial.
Speaker 2 (19:32):
The Armor Men's Health Show is brought to you
by N a U Urology specialist.
For questions or to schedule anappointment, please call 5 1 2
2 3 8 0 7 6 2 or online atarmor men's health.com.
Popular Podcasts
Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.