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July 26, 2023 10 mins

In this segment,  Dr. Mistry and Donna Lee are joined by friend of the practice, Dr. Nathan Pekar of Victory Medical Center in South Austin, Westlake, and Cedar Park. Today, Dr. Pekar and Dr. Mistry discuss the importance of advanced cardiac health screening for middle age men. Victory Medical is proud to offer the Heartwise Physical--an intensive cardiac workup that offers patients a full and detailed picture of their heart health and is covered by most commercial insurances. If you or a loved one is concerned about cardiac health or are experiencing symptoms of erectile dysfunction (which may be an early indicator of vascular disease elsewhere in your body), please call Victory Medical today at (512) 462-3627 or online at victorymed.com.
 
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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Transcript

Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:09):
Welcome back to the Armor Men's Health Show with
Dr. Mystery and Donna Lee.

Speaker 2 (00:17):
Hello

Speaker 3 (00:17):
And welcome to Men's Health Hour. I'm Dr. Mr , your
host here as always, with myincredibly computer savvy and
competent co cohost

Speaker 4 (00:26):
. Uh , for those of you who don't know
when I make a boo boo before westart talking, that's why he
makes that reference.

Speaker 3 (00:31):
If you have, if you have an opening for an
information technology expert, , send us your, send us
your job listing. We'll sendyou John ,

Speaker 4 (00:39):
Me . It should , I can barely touch the record
button, but I do produce itsometimes.

Speaker 3 (00:43):
That's right. I'm a board certified urologist. This
is a men's health show. Um, andthis show is brought to you by
the urology practice that Istarted in 2007. Mm-hmm .
, n a u , urologyspecialist.

Speaker 4 (00:55):
That's right. And your name is Dr . Mystery . M i
s t r y. Not like mysterynovel.

Speaker 3 (00:59):
It has been mis thought of called Gimmicky .

Speaker 4 (01:01):
Yes. Somebody thought it was fake.

Speaker 3 (01:04):
Oh , if you thought I was gonna come up with a
name, you think that that wasthe one I was gonna come up

Speaker 4 (01:07):
With. misspell the word Mystery
.

Speaker 3 (01:09):
That's right. Let me tell you what name I would've
come up with. Oh, oh , Dr .
Pecker .

Speaker 5 (01:14):
Oh no. Oh no.

Speaker 4 (01:17):
Speaking of, we have a special guest today,

Speaker 3 (01:20):
But before we enter to that special guest, Donna,
why don't you tell people aboutour practice and how to go to
ahold ?

Speaker 4 (01:24):
That's right. Our practice is lovely and it's all
over Austin and Round Rock.
North Austin. South Austin,dripping Springs. Uh, we have
four MD surgeons. We have fivemid-level , uh, sex therapy,
sleep coordinator, what am Iforgetting?

Speaker 3 (01:36):
Two p pelvic floor

Speaker 4 (01:37):
Physical , two pelvic floors . You

Speaker 3 (01:38):
Better not forget them .

Speaker 4 (01:38):
I know they lovely .
Stabbing in the heart . Twopelvic floor physical
therapists. You can reach us at5 1 2 3 8 0 7 6 2 during the
week. You can ask for me. Italked to a lot of our radio
listeners now .

Speaker 3 (01:47):
Absolutely. And we wanna see you . That's right .
So if you , if you have a , aproblem, come on , don't delay
your care. Come on in. We'dlove to take care of you.

Speaker 4 (01:53):
That's right. We're here for you. Um , and then our
website's, arm men'shealth.com. Send us your
questions to arm mens healthgmail.com.

Speaker 3 (01:59):
And today we have a guest that , uh, we've had on
the show before, and I reallythank you for coming back to
us. Uh, you Dr . Nathan Pekar .

Speaker 4 (02:06):
That's right. Not Pcca . P

Speaker 3 (02:07):
P K A R

Speaker 4 (02:08):
P E K A R . That's right.

Speaker 3 (02:10):
And he's a , uh, physician at Victory Medical.
How long you been with thegroup?

Speaker 5 (02:14):
Got to Austin in 2009 with Victory, was a
physician for 10 years with theAir Force before that, hope to
, uh, be in Austin for at leastanother 20, 30 years practicing

Speaker 4 (02:23):
forever.
Well, good . You

Speaker 5 (02:24):
For you. Well , uh, you know , someday I might die.

Speaker 4 (02:26):
. No , no, no, no, no.

Speaker 3 (02:29):
So when I started at my medical practice, I did
general urology and I starteddoing a lot of hormonal
therapy. And then I startednoticing that the way that men
were getting testosterone outthere was really not fully
thought out. And , uh, one ofthe big reasons I thought that
is because the cardiacimplications of having low
testosterone and just beingoverweight and lethargic and
things like that in generalwere not, a lot of people were
doing it then. I had a verygood friend in his early

(02:51):
fifties, and he had a heartattack when he was supposedly
under good care by a competent, uh, cardiologist, and then a
very well known infectiousdisease doctor up north. He
dropped dead at 48 from a heartattack. Mm . And you start
wondering yourself and what areyou supposed to do? I already
went to the doctor, I got mycholesterol done. Is there
anything more else I can do tomake sure that I don't get hit

(03:13):
by a cardiac event? And so Ithought that you could give us
some insight into that.

Speaker 5 (03:17):
I'm so glad you brought that up. What a good ,

Speaker 3 (03:19):
Uh , segue .

Speaker 5 (03:20):
A great segue . Uh , so Victory has
had this program for about fouryears now called the HeartWise
Physical. It's basically anexecutive style physical that
any patient can do. Uh, youdon't have to be an executive
covered by insurance. It'scovered by most insurances.
Some mm-hmm . ,most commercial insurances.
Mm-hmm. . Um, sowhat we're able to do with the
HeartWise that you're gonna getbeyond a normal physical is a

(03:41):
much more advanced cardiacworkup. The, obviously it's
everything starts with theheart on the HeartWise, where
you start with the heart echo.
We look at the heart before andafter doing a treadmill test,
and , uh, we're able to pick upvalve issues, major heart
related issues that wouldn't bepicked up on a normal physical.
And

Speaker 3 (03:59):
You're looking to see if the heartbeat, the look
of it changes with exercise,which could be a sign that some
parts aren't getting blood whenyou're exercising, which you
would start seeing even beforechest pain.

Speaker 5 (04:10):
That's correct.
Yeah. So a lot of the earlysigns of heart disease aren't
gonna show up on a bloodpressure or even an

Speaker 3 (04:16):
Symptoms

Speaker 5 (04:16):
Or anek or an ekg .
Yeah . So let's say the heartecho itself looks fine. Then we
also look at the arteriesthemselves too, on the , uh,
physical. And that's much moreadvanced than what you're gonna
get on a normal physicalbetween the big arteries and
also the small arteries of thebody. So the heart pumps the
blood, it goes to the bigarteries first, and then that
blood will then go to the smallarteries. What a lot of people
don't realize is that a lot oftimes it's the small arteries

(04:39):
that will show the disease wellbefore the large arteries do.
And the small arteries willoften show disease before the
blood pressure gets elevated.
You

Speaker 3 (04:47):
Know, who knows that the small arteries cause
problems before the big ones.
All those guys out there witherectile dysfunction.

Speaker 5 (04:52):
That is exactly right.

Speaker 3 (04:53):
Because the smallest artery that has importance for
us is the one that go to ourpenis. Then , then the neck
size is the one that goes toour heart. Oh . So when your ,
when your penis goes out, yougotta be a little worried that
your heart may go out. That is

Speaker 5 (05:05):
Exactly right. So , uh, we have something called
the cardiovascular profiler,and , uh, it's actually, it's
actually used on the wrist, butit basically, computers are
able to analyze the waveform ofthe , uh, without getting a
bunch of computer jargon, but ,uh, the wave forms of the
arteries to interpret how, howwell the arteries are able to
expand or how elastic they are.

(05:25):
That's really the best way wehave for detecting small artery
disease. First. There is apretty high correlation with
small artery disease anderectile dysfunction like you
mentioned. So I see that a lotin my young males , uh, let's
say 30 to 40 range wherethey're having ed issues. And
we'll see , uh, that on the ,uh, HeartWise physical, what

Speaker 3 (05:42):
An important thing.
Right. So, I mean, it's onething to fail on a date
, but it's something elseentirely to drop dead from a
heart attack, you know, 10years later when the erectile
dysfunction could have beenvery important telltale sign of
something to come. So for us ,um, when we find somebody like
this and we put 'em through acardiac evaluation, oftentimes

(06:03):
even with a cardiologist, we'llbe disappointed that they
didn't do more than just kindof like talk to 'em. Because,
because I sent them there toget like an advanced, you know,
invasive executive style,physical is literally what I
want. And you have to go to aspecial program and know what
you're missing out or you won'tknow what what's even available
to you.

Speaker 5 (06:20):
That's exactly right. So let's say they do
have early small vesseldisease, that's definitely
gonna get missed even on acarotid ultrasound. You , you
might see plaque on a carotidultrasound, but you're not
gonna see that loss ofelasticity of the arteries like
you will with the profiler. Soprofiler is probably the best
way to pick up early erectileissues , uh, or potential
erectile issues in a young malethat

Speaker 3 (06:41):
They are vascular in origin. And that could be the
sign of something going on.
And, and why I tell people it'simportant is that let's say you
have a borderline cholesteroland somebody has decided not to
put you on drugs, but now itends up that you're either your
CT scan of your heart isabnormal, or this type of
profile is abnormal. We mighthave lower thresholds for what
our target cholesterol is foryou. Is that right?

Speaker 5 (07:02):
That's exactly right. And also blood pressure.
Let's say their bloodpressure's one 30 s over
eighties , consistently, maybeI would've just done lifestyle
changes, but now I'm seeingthat profiler showing obvious
small vessel damage or loss ofthat , uh, elasticity of the
arteries. I'm probably gonnamore aggressively treat that.
Maybe still try lifestyle, butmy, my threshold for going to

(07:23):
perhaps even medicine, it'sgonna be a little faster in
that mill . It,

Speaker 3 (07:26):
It's so important, and I'm gonna just reiterate
this, there's normal and thenthere's normal for you as an
individual patient. Just likewhen it comes to testosterone
levels or thyroid levels orexercise levels or whatever
levels, you can publish normalblood pressure levels. There
are levels that as a physicianyou tolerate for people who are
diabetic and people who arenon-diabetic, because, you
know, the diabetic is more atrisk for heart disease. So by

(07:48):
doing a more advanced invasivecardiac evaluation, you're able
to establish a new normal forthat person and make sure that
you're not kind of skirting theimportance of cholesterol and
blood pressure.

Speaker 5 (07:59):
That's, that's correct.

Speaker 4 (08:00):
It's almost like you know what you're talking

Speaker 3 (08:01):
About. I'm telling you it makes me angry. How does
that sound? , you know,because I think that these
kinds of things are exactlywhat you should do. Mm-hmm .
. And so whenpeople, people call me up all
the time, they say, I'm 40,what should I get done? I tell
'em this. I tell 'em, youshould, you should figure out
if your heart's gonna poop outat 48. Mm-hmm. .

Speaker 4 (08:17):
Well now they can go to Dr. Piar . That's right .
For a HeartWise physical . That's

Speaker 3 (08:20):
Right. And so as part of the HeartWise physical
, uh, you mentioned thescreener, you mentioned an
exercise , uh, echocardiogram.
Correct. What else do youinclude even including lab work
for

Speaker 5 (08:31):
The , uh, big arteries? We, we do the carotid
arteries to look for plaquethere. That's an , obviously,
it's one of the easier arteriesto see in the neck. And then
also the aorta and the a , uh,in the abdomens. So

Speaker 3 (08:40):
You do an abdominal ultrasound or carotid
ultrasound, carotid ultrasound.
And when you do labs, do you doadvanced lipids? Do you look
for the different size littlecholesterol levels?

Speaker 5 (08:48):
Unfortunately, a lot of the commercial insurances
aren't covering that yet,although , uh, we can
definitely do it as an add-on.
It's not standard yet. Althoughin the near future, we're
hoping that's a standard labthat insurances will cover.
There's a lot of labsunfortunately, that , uh,
insurance coverage can be anissue. But we definitely do a
very thorough liver, kidneyelectrolytes. We look at all

(09:10):
the hormones, all the vitamins, uh, of course prostate
screening and things like that.
Anything that we can getthrough insurance, we , we can
make it as advanced aspossible. And

Speaker 4 (09:19):
The patients can pay for a specific test. If you
recommend the test and it's notcovered by insurance, they can
pay a nominal fee Yeah . Tohave that test done.

Speaker 5 (09:26):
Absolutely. We don't like to surprise patients with
any right fees, obviously, butat , at the , uh, visit, we can
discuss other advanced optionsas well .

Speaker 3 (09:33):
But I would encourage those patients, there
are some things that are wortha few bucks, right? Mm-hmm .
It's never as expensive as youthink it's gonna be. Right. You
know, it might be

Speaker 4 (09:41):
20, 30 bucks for

Speaker 3 (09:42):
All you know, it may , maybe a cup . You can
probably get all these testsout of pocket for less than a
thousand dollars and giveyourself a great piece of mind
mm-hmm. thatthings are gonna be fine for
you. So Absolutely . Right . Ifthey want a HeartWise test, how
do they get ahold of you? They

Speaker 5 (09:53):
Would , uh, just call our main line . It's five
one two four six two docs. D OC s . Mm-hmm . 3
6 27 . Right. So , uh, or theycan go online. Uh , we're
available through zoc doc , uh,victory medical.com as well.

Speaker 3 (10:07):
Well, thank you so much, Nathan . Thank you . That
was great . Dr . Piar .

Speaker 5 (10:10):
Thank you for having me . Dr .

Speaker 3 (10:12):
Bakar . My name Syn

Speaker 5 (10:13):
,

Speaker 4 (10:15):
You two should go into business together. We
should, Dr . Mystery , mysteryPiar and Dr . Piar . Um , you
can read us of us 5 1 2 2 3 8 07 6 2 our website's, arm men's
health.com . Thank you so much.
Listen to our podcast. ThanksDr . Piar .

Speaker 5 (10:27):
Thank you very much.

Speaker 1 (10:28):
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 oronline@armormenshealth.com.
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