July 3, 2025 • 34 mins
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
It's that time time, time, time, luck and load. So
Michael Verie Show is on the air, and this.
Speaker 2 (00:14):
Morning you woke up dead. Kind the hell you wake
up bed because you're alive when you go to sleep.
Speaker 3 (00:19):
Just tell me?
Speaker 2 (00:20):
Can you telling me that you can go to bed
dead and wake up alive. You can't go to bed dead, man,
would just yell know what?
Speaker 4 (00:26):
Because you can go to bed and not be dead,
and you can die but not be in a bed.
Speaker 2 (00:30):
But you are in a bed.
Speaker 3 (00:31):
Man, that's how you wake up dead in the first place.
Speaker 4 (00:33):
Food die man talking ticket class.
Speaker 3 (00:38):
Three hundred thousand people have already died from just this
cut off, this hard cut of USAID. So this food
rotting in boats and warehouses, there is this. This, this
will whip you off. This will not You will not
be happy, No American will. But there is I think
it's fifty thousand tons of food that are stored in Chiboosi,
(01:04):
South Africa, Dubai.
Speaker 2 (01:07):
And wait for it.
Speaker 5 (01:08):
Houston, Texas Secretary of State Marco Rubio is hailing the
end of us AID, the nation's largest foreign aid agency,
even as a new analysis finds that its closure could
contribute to some fourteen million deaths in the next five years.
Speaker 4 (01:51):
The estimate, and I believe these are very considered estimates,
that HR one would lead to seventy thousand kids dying.
Of that, seventy thousand and thirty thousand would come from
malaria control programs that would have to be scaled back. Specifically,
The other forty thousand is broken out as twenty four
thousand would die because of a lack of support for
(02:14):
immunizations and other investments, and sixteen thousand would be because
of a lack of skilled attendance at birth.
Speaker 6 (02:20):
I am exceptionally upset about USA. I lived in the
refugee camp for four years as a child surviving civil war.
It is the essential programs that USA provided that kept
my family and.
Speaker 2 (02:34):
I fit and safe.
Speaker 7 (02:36):
The consequences are that people die, Babies die. I mean
right now we are involved in Gaza and in Sudan
in providing food to malnourished babies. Literally, there will be
dead children, one hundreds thousands of them.
Speaker 1 (02:53):
Long.
Speaker 8 (03:31):
The people who work at USA did not come to
work at USA for the money. The civil servants, the
foreign servants, the contractors. They came to usaid because they
wanted to make a difference in the world because they
saw America's interests as tied up with the interests of
people vulnerable people around the world. And so even as
(03:51):
they're struggling to figure out how to make rent, all
of a sudden, they're most struggling with the fear that
many millions of people who allied on US as a country,
on US eight as an agency, but on them as individuals,
that those individuals out in the world have no place
(04:11):
to turn. And indeed they're showing up and finding health
clinics shuttered and soup kitchens closed.
Speaker 4 (04:17):
Doock knock knocking on Heaven's down wall.
Speaker 2 (04:23):
Yeah. One of the great joys of owning a live
music venue and having no shame is that you can
get up on stage with the bands, and you can
(04:43):
get your friends up on stage with the bands, even
if it's inadvisable, and my brother's favorite thing to do.
Josh Fuller would always invite my brother on stage because
he got a kick out of my brother getting so
excited to get to sing, and he loved to do
the hall all haul. He loved that song, so Josh
would always have to do the song so that he
(05:05):
could do it. Just a brag on our team. When
our folks travel, they still work. So Chad Nakanishi, who
was from Hawaii, is flew back yesterday to visit his
family in Hawaii in Hilo. I got an email this
(05:28):
morning that was a He had set it on a
timer so that it came to me at the normal
time I would get my show prep. But I said, Chad,
how in the world did you send me show prep?
You've been flying and you just landed. And he said, well,
I got here, and I got in bed, and I
got up at one am, five hours behind, and I'll
(05:50):
send production a little later as well. See Ramon. That's
commitment right there. Then I sent back and he said, well,
I like, I want to be able to hear the
show live in case there's anything I need to add,
and then I'll nap after that and then I'll try
to get on my Hawaiian sleep schedule from there.
Speaker 8 (06:07):
Now.
Speaker 2 (06:07):
How awesome is that? In other news, not as impressive.
My friend Jonathan Kim, the president of Gringo's Text Mex,
apparently took his girlfriend Emma Salazar fishing and cast a
hook into her nose and hung her nose. I'll post
the picture here in a minute. But you know how
(06:29):
Indian women will do the nose ring where they punched
the hole through the nose and then they hook it
on a chain to the ear. Well, she's gonna have
a big hole. She won't need to get her nose
pierced now because Jonathan was kind enough to hook her
nose with his dealer. Well, how much time we have left?
I want to talk about AL two A Okay, it happened.
(06:50):
Josel Tuve passed Jeff Bagwell last night to become number
two all time on the Astros hit list. Any of
the Estros need another bits Right here, there's a ball
in the center field bar, a base hit. Two runs
are gonna score. Jake Meyer's coach pers the third Jose
out too. Bag gives the Astros.
Speaker 9 (07:09):
A qre too, leads Also, would we like to see
how two bay coming through in the clutch, not wasting
any time. Took a breaking ball on the outside corner,
hit it up the middle, and he passes Jeff Bagwell.
The Astros want that baseball.
Speaker 2 (07:25):
He's uh a little over six hundred hits behind video
now for a six year period, he got two hundred
or more hits and led the AL every year in hits,
but he'd have to do that for just over. He'd
have to have a good second half in another three years.
Ramon asked me if he's the greatest astro of all time,
(07:47):
and I am. I'm struggling with the answer to that
because I hold to the Nolan Ryans of my of
my youth. But wow, I mean, just wow, what this
guy has delivered. How much fun it has been to
have this guy in our town playing ball for the
teams our jersey. My urologists will be our guest coming
(08:10):
up next. The subject was how to deal in the
heat and whether that leads to kidney stones, But we'll
probably end up talking about directions and crooked wieners and
also to other stuff we always go with. Kara's my guest,
dude the Michael Berry Show, Silver.
Speaker 4 (08:26):
Bells hanging on our stream.
Speaker 10 (08:28):
She told me.
Speaker 2 (08:29):
It was, yes, it indeed it is doctor Mohit Kara,
the most interviewed doctor in our radio program for the
most number of times in the most number of minutes.
The line of the day this morning, I asked, I
asked Mohit Kara to call in at eight point fifteen
and Ramon will turn on his mic so that I
(08:52):
can hear him talking to the caller, so I know, okay,
the caller's calling in and he put him on hold
and he said, we've got doctor Kara, and I said, good,
he's I like when the doctors come to us and
we make them wait. That was pretty good, Doctor Mohit Kara.
Welcome to the program. Good sir, Good morning, Michael, Thank you,
(09:13):
Thank you're so serious. Thank you for making time for us. Now,
what was the issue I wanted you on Tuesday? You
were teaching residents or something.
Speaker 10 (09:21):
Yeah, you know.
Speaker 11 (09:22):
So what happens is July first is where all the
new residents and the medical students and the fellows start,
and so it's it's crazy because you know, everyone's trying
to figure out what to do, where to go, and uh,
if you get sick, don't get sick on July first.
Speaker 10 (09:37):
That's all I'm telling you.
Speaker 2 (09:38):
Because it's a it's a madhouse. How are they different?
Everyone's new, Well, the residents different today than when you
were coming up.
Speaker 10 (09:49):
I think they're smarter.
Speaker 11 (09:50):
I think it's much harder to get into medical school
and residency today than it was in the past. I
think that you know, if you look at the caliber
these people have been well accomplished and published a lot.
Speaker 10 (10:01):
They've done a lot.
Speaker 11 (10:02):
Back when I was getting in you it wasn't it
was hard, but it wasn't like this. I mean, they
really have stepped up their game. Really, and I'll tell
you to actually, even the surgical skills of these residents.
Speaker 10 (10:11):
Coming in or are far greater than we've seen in
the past.
Speaker 2 (10:15):
I've heard that much more focus is given to bedside
manners now than it ever was because that was something
that was complained about for a long time. Is that true?
Speaker 10 (10:26):
It is?
Speaker 11 (10:26):
And it's also on ethics, So you know, the interview
is really important, and we will sometimes give mock questions
during the interview. Hey, we have a patient that had
this happen to them, how would you handle it? And
you want to make sure that they are ethical, that
they would do the right thing, and that plays a
(10:47):
big component in the interview.
Speaker 2 (10:50):
We've all seen the TV shows, you know, and the
resident comes in there and here's the big fancy doctor
and that's you, and I'm the little resident and I
want to be the big fancy doctor, and I got
to go through all that. It's kind of got to
be a charge to know that they're you know, they're
all excited like a teacher on the first day of school.
Speaker 11 (11:06):
It's amazing. And I'll tell you, it's amazing to teach.
One of my passions obviously is teaching. And just to
see them grow over the year and how they progress
is incredible. But they're hungry, you know, when they come in,
they're hungry to learn. They're eager to learn, and it's
just fun. I'll tell you what's really fun operating with
the residents and the fellows. And you operate with them
(11:26):
and watch them over the year, it's amazing. At the beginning,
you're a little nervous, don't get me wrong, and you're
just trying to make sure everything's fine. But as you
go on and watch them get better and better in
their skills, it's such a great feeling.
Speaker 2 (11:37):
A friend of mine who do to Hippa your requirement,
I'm not under that restriction, but I won't say his name,
had a vasectomy with you, and he came highly recommended
from me to you, and he commented on the fact
that you came waltzing in and you had an opera
love on him or I don't know what it was.
That was playing and you had the most beautiful music going.
(11:58):
And I said, did it Badia? And he goes, no,
he kept me calm. So is that music for him
or for you?
Speaker 10 (12:05):
And it's really for him.
Speaker 11 (12:06):
So you know, people come in if they're having procedures,
they're nervous, especially if you get a guy who's gonna
get as to me, they're gonna be a little nervous.
And so what you got to do is just keep
them calm. And I found that music really keeps them calm.
The teacher doesn't take that long. And if you talk
to them while they're doing the procedure, you know, when
they're done, they're just you know, they don't even I
don't want them thinking about the procedure. So music talking
(12:28):
to them make a big difference.
Speaker 2 (12:31):
There's a movie Willem Dafoe is in I can't remember
if it's our town, Ramon, do you remember what it
was where he's brought in as the FBI specialist to
recreate the scene and he plays the opera? Do you
remember that?
Speaker 10 (12:41):
Romon?
Speaker 2 (12:44):
Yeah, they are Boondock Saints, but Boondock Saints. Have you
seen that? Well?
Speaker 10 (12:48):
I've seen that.
Speaker 2 (12:49):
I have not Willem Dafoe comes in and he's this
very flamboyant gay guy, but he's brilliant. And the other cops,
you know, they're old fashioned, you know, Irish cops. You know,
who is this guy come in here like this? But
what he does is he turns on his music in
his headsets, and in front of them he recreates the
scene as if it's an opera, and then he tells them,
all right, he stood here, he shot here anyway more
(13:11):
than you wanted to know. Speaking of talking to I've
told the story Ramon. I don't know if I told
you this. I don't remember what you were checking for.
But I had something that I was worried about with
my kidney or my liver or my urological tract or something.
And you put some tube up my willie and it
goes all the way up in there, and I'm laying down,
and I'm the guy that when I get a shot,
(13:33):
looks away. And I don't know if you remember this.
Maybe you do this for everybody, but there's a.
Speaker 10 (13:36):
Thing I do remember.
Speaker 2 (13:38):
It It's way up in me. I mean, it feels
like it's up in my throat. And you said Michael
this looks great. Look at the screen and tried to
get me to turn and look at it, and I said,
I'm sure you recall tell me when that thing is
out of me. I don't. You're going the wrong way
on a one way street. I asked you the other
day because we were talking about this heat and his
(13:58):
searing heat and how tough it is and dehydration and
all that, and someone suggested to me that people should
be careful because this is when you get kidney stones.
And you said, that's absolutely true. So explain if you would,
why that is and what folks should do about that.
Speaker 10 (14:14):
Right, great points.
Speaker 11 (14:14):
So look at the summer's coming now, and it's getting hot,
and you got to realize that you're much more dehydrated
than you think you are. The number one risk factor
for kidney stones number one is dehydration. So if you're
going to do anything, you're going to hydrate. The number
you want to remember, Michael, is you want to urinate
about two point five liders a day, between two to
two point five liters a day. Well, if you're going
(14:35):
to urinate two to two point five liters a day,
you have to drink more than that anywhere from two
point five to three liters per day, which is quite
a bit. But if you if you do that, that's.
Speaker 10 (14:45):
The number one way not only.
Speaker 11 (14:47):
To keep kidney stones from happening in the first place,
but it reduces your chance of recurrent kidney stones by
fifty percent.
Speaker 10 (14:55):
So you know, it's hard.
Speaker 11 (14:56):
It's hard to think about getting all those all that
water in a day, but you have to do it,
particularly in the summer. And I tell my patients, you're
much more dehydrated than you really think you are.
Speaker 10 (15:06):
Think about why this happens.
Speaker 11 (15:07):
When you're dehydrated and your urine is concentrated, your urine
makes crystals. They make calcium oxalate uric acid crystals. Those
crystals will adjoin and then start making stones. So the
best way to stop making those stones is don't make
the crystals in the first place.
Speaker 10 (15:24):
You've got to drink the fluid.
Speaker 2 (15:27):
Since we live in America, and neither I know or
anyone else knows what a leader is. How much is
that in terms of gallons?
Speaker 11 (15:35):
Well, you think of three liters as three thousand milli liters,
and that's typically going to have at least lost eighty
to one hundred ounces. Okay, eight look at there's eighty
to one hundred ounces. Eighty to one hundred ounces a day.
Eighty tow one hundred ounces a day. That's eight to
ten cups of water a day. Wow, right, so that's
quite a bit. It means you've got to remember that
(15:56):
eight to ten cups, but you got to do it.
Speaker 10 (15:58):
It will really make it difference.
Speaker 2 (16:00):
And do you recommend putting anything in there? A lot
of folks say, you know, you don't want to wash
out all of your your minerals and gatorade or some
other package. We'll talk about that coming up with my
eurologists and dear friend Mohit Kara, Stay check yellow pudding,
Bobs Prosen, putting on a.
Speaker 8 (16:21):
Stake the Michael Barry Show, Jello brand pudding pops maybe
with the goodness of real Jello pudding.
Speaker 2 (16:27):
I got a message from Shirley Guidry that says Larry
Guidry is going to see him at nine o'clock, so
hurry please or he will be stuck in the waiting room.
Doctor Mohick Kara, my urologist and dear friend, is our guest.
How many patients do you see on average? Just office visits,
not surgeries? Or medical or actual procedures.
Speaker 11 (16:48):
It's pretty busy. We're about one hundred and fifty. I'm
about one hundred fifty patients a week a week.
Speaker 2 (16:53):
And how many days is that? Seeing patients.
Speaker 10 (16:57):
Four days a week?
Speaker 2 (16:59):
Okay? And then and and.
Speaker 10 (17:00):
If you're doing a surgery Wednesdays, all.
Speaker 2 (17:02):
Day Wednesday is surgery all the surgery, yep? And how
many surgery? How many surgeries will you do in a day?
Speaker 10 (17:13):
About six to seven every Wednesday.
Speaker 2 (17:17):
I know. One of the surgeries that you're kind of
renowned for is when the uh vascular I said, the
vast I guess, the vast deference. What do you call that?
When when the when the vessel wraps around and prevents
UH and burns the sperm off? What is that called?
(17:39):
The procedure you do?
Speaker 10 (17:41):
So you call it a sectomy?
Speaker 2 (17:43):
No, no, you told me about a procedure that you
do a lot of where the vein wraps around. I
don't know if it's the vast deference or what. And
it and it it basically the heat of that vein
burns the sperm and then you can't get price. It's
fertility procedure. What's that called?
Speaker 11 (17:59):
You got it? It's called the vericceal repair. It's actually
a very interesting concept. Casals mean dilated blood vessels around
the testicle. You know how you look at a woman
and you look at her legs, sometimes you can see
those big veins coming out those dilated veins.
Speaker 10 (18:12):
Those are called varicose veins.
Speaker 11 (18:14):
Will men get varicose veins in the scrotum, and in fact,
fifteen percent of men in the world walk around with
dilated veins in those scrode and that's a lot of men.
Speaker 10 (18:24):
Think about it.
Speaker 11 (18:24):
One out of seven men in the world have very
large dilated veins in the scrotum. The problem is when
you get those dilated veins in the scrotum, they carry
heat and they carry pressure, and the testicle does not
like it. So that heat and that pressure causes that
testicle to stop or really reduce the sperm production. So
what we go in and we do is we go
(18:45):
in and we tie off all those bad veins with
the high powered microscope and take off that heat, take
off that pressure, and guess what, Seventy percent of men
start having a significant improvement in their semen parameters. So
it is the number one procedure for utility. But other
reasons why you could fix it are some people just
have pain. Is hey, doctor care, I don't have any
I don't have any fertility issues, but I'm having pain.
(19:08):
So that's another reason to fix it. And the third
reason to fix it is in pediatrics because if you
have a kid, let's say he's twelve or thirteen years old,
and he has a air caceial, the side that has
the dial in veins, that testicle doesn't grow as well
as the other side, so it looks like you have,
you know, different sized testicles. So you really want to
fix it in a kid. So the three reasons to
(19:29):
fix it are if you're a kid, if you will
have pain, or you're trying to have a child. Recently,
a very interesting story, a position out of New York,
Mark Goldstein showed that if you fix those Verico s veins,
you actually can raise natural testosterol levels, which is interesting.
So when you take the heat off, when you take
the pressure off, the testicle starts producing more natural testosterone
(19:51):
as well. So a very interesting concept, but many people
don't realize it's a very common phenomenon.
Speaker 2 (19:58):
Fifteen percent, you said one in seven. Do you can
you see that with the naked eye. If you do,
if you.
Speaker 11 (20:03):
Check them, yes, so this is really important. There's we
call it three grades of Erica seals Grade one, Grade two,
Grade three, Grade three. You can see it through the
scroll to wall. You don't have to even examine them.
It means if I can see those veins bulging out
through the skin, there's no exam need that he's a
grade three. If he's a grade two, typically what you'll
(20:24):
do is you can feel it on exam. Grade one
typically they have to bear downs called the valsalva, and
you can feel some pressure. So those are the different grades.
But yes, you can see them on a grade three,
no question.
Speaker 2 (20:38):
And what percentage of grade three of of one hundred
percent of people who have them, what percent or grade three?
Speaker 11 (20:43):
Yeah, I would say that it's a bell curve. It's
that most of them are typically grade two. Now it
depends what they're coming in for. I'm going to see
a little bit more Grade three because as I mentioned earlier,
I specialize in fertility. So forty percent of men who
come to a fertility clinic will have a veraricacisl forty
that's the cause.
Speaker 10 (21:03):
So most of those.
Speaker 11 (21:04):
Men will have you know, either grade two or a
grade three. But you know the good news is Michael,
it's reversible. So yeah, you can do with procedure. It
doesn't take very long. You know, they go home the
same day and you can fix those veins just like
you would if a woman had vericos veins in her
legs or a man had verico spains in his legs.
We fix them in the scrotum and the sperm count
(21:26):
starts to go up.
Speaker 2 (21:29):
There's takes two to tango, so either one of the
partners could be the reason they're not getting pregnant. But
if a man comes in and he is the reason
for the infertility in the relationship, in what percentage of
cases are you able to get him to the point
where they're able to get pregnant.
Speaker 11 (21:47):
It depends on what the problem is. And fertility is
so easy. It's either he's not making sperm or he's blocked.
Speaker 10 (21:55):
That's it.
Speaker 11 (21:55):
Either he's not making sperm or he's blocked. So all
I have to do figure out which side of the
fence he's on. If he's blocked, I can unblock them.
There are numerous surgeries I can unblock them. If he's
not making sperm, then I have to do things to
help make the testicle start purducing, fixing the varicas heels,
using some medications. And remember this lifestyle modification is so critical.
(22:20):
Healthier people are more fertile.
Speaker 10 (22:23):
Period. Helpier people are more fertile.
Speaker 11 (22:25):
So I tell patients diet four pillars are diet, exercise, sleep,
and stress reduction. I don't have a pill on the
planet stronger than diet, exercise, sleep and such reduction. And
that's for anything. It's for ed testawsterm fertility. So if
you want to help me help yourself, you've got to
really help focus on the lifestyle modification. And if you
(22:47):
do those, each one of those have been shown to
help improve fertility, not only in men but also in women. Now,
I remember fifteen percent of those men that come in
can have a genetic cause. So we got to look
for the genetic reasons why they may have infertility. But
if they're not producing it, then I got to go
find it. In other words, are there are new techniques
that we now can do to go find the sperm?
(23:09):
At Baylor, we have something that's say to the art.
We have a new ultrasound that could actually look into
the testicle and show me where the sperm may be.
And so that's really a game changer because in the
old days, I'd have to take the operating room, open
them up, look everywhere, try to find it. With this
new technology, we can now identify where the patch of
sperm may be before I even go in there.
Speaker 10 (23:31):
So I'll give you an example.
Speaker 11 (23:31):
I had a patient the other day that had a
surgery called the MICROTESTI, and that's a pretty in depth surgery.
Speaker 10 (23:37):
We've taken the.
Speaker 11 (23:37):
Surgery, we look everywhere, and we take maybe twenty samples,
thirty samples, and we could not find the sperm. So
a year later he comes back and says, look, I
really want to try again.
Speaker 10 (23:49):
I said, fine.
Speaker 11 (23:50):
This time we were able to use that ultrasound device
and we were to pinpoint exact location where the sperm was,
went back in and we found it right away. It's
a game changer. So we're really using this technology to
help us. It also has a heat map, so it
can actually show you where there could be life inside
the testicle. So actually it's pretty cool, and I think
that's going to be a game changer.
Speaker 2 (24:12):
You know, Well, I'm going to move past that for
a second because I want to ask you about testosterone
and where we are in testosterone delivery, testosterone replacement, Your
thoughts on that you and I first start talking about this,
I don't know, ten twelve years ago.
Speaker 11 (24:29):
Yeah, so let's start very at the basic There is
not a better barometer of a man's overall health than
his testosterone level. I want to be very clear. Low
testosterone can have signs and symptoms, low energy, low lebido,
rectile dysfunction, increase, fat decrease, muscle depression, poor sleep. Okay,
(24:49):
so that's those are symptoms. Okay, but let's take a
little bit deeper. Did you know that low testosterone is
a significant risk factor or patients having an increased risk
for a heart attack. In other words, men with low
test austrial levels are much more likely to have a
heart attack period. Men with low test ostinal levels are
much more likely to break a bone offha peniostriprosis. Men
(25:10):
with low test ascal levels more like a diabetes.
Speaker 2 (25:13):
Hold on, just a moment, Doctor Mohip Kara is hard.
Guess it's spelled k h E r Asi.
Speaker 10 (25:26):
The Michael Barry Show, Simple Man.
Speaker 2 (25:32):
At the end of the game, our guest is doctor
Mohith Kara. My urologist and dear friend, we're talking about
urological issues because that's his area of expertise. The clock
cut you off, but you were talking about the importance
of testosterone. Let me ask you a question first, and
then I want you to go back to that. A
(25:53):
lot of folks are very concerned about an increased risk
of prostate cancer if they take hormone replacement for two
picularly testosterone. Your thoughts.
Speaker 11 (26:04):
So it was a myth that started in nineteen forty
one by a doctor named Huggins. Huggins in nineteen forty
one said if you take testoser increases your risk for
prostate cancer, and we found if you go look at
that paper, Michael, it's based on one patient. In twenty eighteen,
my society called the American Logic Association put out guidelines
saying that patients should be informed that testosterone does not
(26:27):
increase the risk of prostate cancer. And that was a
strong recommendation. And more importantly, there was a large study
that came out. Everyone needs to know about this. It
was called the Traverse Trial. This was five thousan two
hundred and forty six patients. I was one of the
ones running this trial. I designed this trial. It took
us six years to do it. We published it last year,
our last publication, and we show that there was absolutely
(26:48):
no increased risk in those men taking testosterone global placebo
for prostate cancer or any cardiovascar risk. No cardiovascar risk either,
So I think we've kind of put that one to rest.
Speaker 2 (27:00):
Interesting if in fact that is true, even if it
wasn't true. Isn't it the case that if your PSA
markers started increasing, you could just dial back the testosterone anyway.
Speaker 11 (27:16):
Yeah, but if your PSA marker starts increasing, then I
suspect that you have something underlying going on, like prostate cancer,
and I'm going to want to work it up. So
I think it's actually a good thing that your PSA
went up now as opposed to later, because you could
have an underlying prostate cancer. So just remember, if your
test starting testosphone is very low below fifty, I expect
your PSA to go up a little bit. And if
(27:37):
it does go up too much, let's go find out
what's going on. And in the old days, I'd have
to biops you. But now we have the MRI. The
MRI is really good. It gives you a score from
one to five. If it's not good, I got to
biopsy you. If you got a one, I'll leave you alone.
So we now don't have to run into a biopsy,
just get an MRI and see if we need to
go any further.
Speaker 10 (27:56):
So it's been really, really good if you.
Speaker 11 (27:58):
Get the past five ten years technology and the tests
we have to diagnose prostate cancer.
Speaker 2 (28:04):
I forget what the term is for the finger up
the booty when a guy reaches a certain age. But
my theory is that unless someone has a based on
my readings, unless someone has a propensity for prostate cancer
in their family, that you should just do the Pooh
test and unless that comes back positive and then follow
(28:25):
it up because you can do harm with the And
why has the word escaped me? What is the word
that guy's dread?
Speaker 10 (28:31):
The two things?
Speaker 11 (28:32):
I think you're thinking about a colonoscopy or we're talking
about yeah, but that's different. Remember, colonoscopy is looking for
colon cancer, right, and so we know that the guidelines
states starting at fifty.
Speaker 10 (28:43):
Some would even say.
Speaker 11 (28:44):
Now earlier you start getting that kolnoscopy, But that's screening
for colon cancer. I'm screening for something different. I'm screening
for prostate cancer. And every man between the ages of
fifty five and seventy should be screened every year for
prostate cancer. And if you have a high risk, if
you're African American, if you have a family.
Speaker 10 (28:59):
History like you mentioned, and you should be screened earlier.
Speaker 11 (29:01):
And a family history could be your father had prostate cancer,
or even a mother or a woman on having a
history of breast cancer puts you to increased risk for
prostate cancer. So typically we do a rectal exam with
the finger and we check a PSA and so that's
that's important to do that. But for prostate cancer. Your
colonoscopy is for your colon cancer.
Speaker 2 (29:21):
Why do Blacks have a higher rate? Is that a
behavioral cultural food stress or is that something like sickle
cell anemia? Is that is specific to the race?
Speaker 10 (29:34):
Yeah, it could be. So.
Speaker 11 (29:35):
One theory we've seen this before something called the sensitivity
of the androgen receptor. So we all have testosand receptors,
and we know that if there is increased sensitivity the receptor,
it's called the c AG repeat, and we know the
African Americans have a different SAG repeat than others. It
could increase their risk for prostate cancer. That's one theory.
But we do know that certain races like Asians are
(29:57):
less likely to have prostate cancer, right, So there, what
is the different propency amongst races to get prostate cancer?
Speaker 2 (30:04):
Interesting? Biggest development in urology in the last ten to
twenty years that makes you very excited.
Speaker 11 (30:12):
Well, there's so many So I talked about the Traverse trial.
This was a huge trial, five thousand patients just showing
the safety of testosterone.
Speaker 10 (30:20):
I think it's a big deal.
Speaker 11 (30:21):
I think our knowledge of testosterone now as a marker
of overall health.
Speaker 10 (30:25):
Every man over the.
Speaker 11 (30:26):
Age of forty should have a testosteron level checked every
man every year. And what I get shocked about is
when you go in for your physical, they check your thyroid,
they check your humogin aec that is the best marker
of your overall health, Michael, is your TESTOSTERL level. Not
only is it a marker of how you are going
to be your kind medical condition today, but what's going
to happen to.
Speaker 10 (30:44):
You in the future.
Speaker 11 (30:46):
I said earlier it was for heart attack, bone fracture, diabetes, obesity,
it's associated with prostate cancer. Lower testosteron levels it's associated
with depression.
Speaker 10 (30:56):
And I'll tell you this.
Speaker 11 (30:57):
I've been working at the VA Hospital for twenty five
years with veterans, and these veterans typically will have a
lot of them become under depression. And I can't tell
you how few of them ever had a testosteronal level check.
Low testosterone increases your risk for depression, and testosterone can't
help with depression, and most of these patients are not
getting their testotional level check.
Speaker 10 (31:16):
I had a big honor.
Speaker 11 (31:17):
I was invited to go to a special operations command
in Florida and present to the military on something called
operator syndrome.
Speaker 10 (31:24):
What is operator syndrome.
Speaker 11 (31:25):
Operator syndrome is when our military when they go train really.
Speaker 10 (31:30):
Hard, and when they're training really hard.
Speaker 11 (31:31):
Doing Hell Week, they feel lousy for several weeks afterwards.
Speaker 10 (31:35):
And what we found is that their.
Speaker 11 (31:36):
Testosterol levels go down significantly and they stay down for
quite a bit of time. And that's men and women
in the military, and so they call the operator syndom,
But the reality is that their te levels go down.
In my bias is that you know, these men and
women should have the ability to get their testosteral level
back just to be in the normal range, because I'll
(31:57):
give you an example. The normal range is three hundred
to one thousand, okay, And let's say you have a
US military at a level of three ten and you
look at someone who they're fighting against and their level
is at nine hundred. Who do you think is going
to have the advantage the nine hundred. And if you
look at history, the Germans used to give their military
high doses of testosterone before they went to combat because
(32:18):
it would increase their mental acuity, it would help them
with the fighting. And our military if they're at three
ten or three twenty, they are not allowed to take testosterone,
which is a big disadvantage to them when they're in combat.
Speaker 2 (32:32):
And what would you like yours to be ideally your
testosterone level.
Speaker 11 (32:37):
I would the guidelines say you should be between four
point fifty and six hundred, and I think that's an
appropriate level. If the levels between three hundred and one
thousand is a normal range, putting someone at least in
the middle makes sense. Some patients do better when they're
a bit high high, but still in the normal range,
but at least four to fifty to six hundred. But
you look at all these military personnel there at three
(32:58):
point thirty three forty eight. And if you look at
people I take care a lot of professional athletes. They
come in and their levels are at three point fifty.
Well they're not allowed to take testos from because band, right,
but they're at a huge disadvantage when they're on the
field compared to others.
Speaker 2 (33:12):
You know, Yeah, what your body is producing is giving
you an advantage or not producing is giving you a disadvantage.
You know, I would probably have to touch that the
right time. But a friend of mine went to you,
his wife went to you with urinary incontinence. He sent
me a message to talk to you about this, but
I think we're going to run out of time, and
(33:32):
that you're using botox to treat that. Is that true?
Speaker 11 (33:36):
Yes, yes, it's phenomenal. It's FDA approved. You be injected
into the bladder floor and it makes a huge difference
in quieting the bladder down. It so works so well
as covered by most insurances as well. But it only
lasts six months, so you got to do it every
six months.
Speaker 2 (33:51):
You're the magic man. I love it. If the magic
man Caric Kae r A as always my friend.
Speaker 10 (33:59):
Thank you, Thank you so much, Michael, really I.
Speaker 2 (34:03):
Wish you could stay two more hours. I got a
hundred questions from listeners, but I know you've got to
treat patients.
It's that time time, time, time, luck and load. So
Michael Verie Show is on the air, and this.
Speaker 2 (00:14):
Morning you woke up dead. Kind the hell you wake
up bed because you're alive when you go to sleep.
Speaker 3 (00:19):
Just tell me?
Speaker 2 (00:20):
Can you telling me that you can go to bed
dead and wake up alive. You can't go to bed dead, man,
would just yell know what?
Speaker 4 (00:26):
Because you can go to bed and not be dead,
and you can die but not be in a bed.
Speaker 2 (00:30):
But you are in a bed.
Speaker 3 (00:31):
Man, that's how you wake up dead in the first place.
Speaker 4 (00:33):
Food die man talking ticket class.
Speaker 3 (00:38):
Three hundred thousand people have already died from just this
cut off, this hard cut of USAID. So this food
rotting in boats and warehouses, there is this. This, this
will whip you off. This will not You will not
be happy, No American will. But there is I think
it's fifty thousand tons of food that are stored in Chiboosi,
(01:04):
South Africa, Dubai.
Speaker 2 (01:07):
And wait for it.
Speaker 5 (01:08):
Houston, Texas Secretary of State Marco Rubio is hailing the
end of us AID, the nation's largest foreign aid agency,
even as a new analysis finds that its closure could
contribute to some fourteen million deaths in the next five years.
Speaker 4 (01:51):
The estimate, and I believe these are very considered estimates,
that HR one would lead to seventy thousand kids dying.
Of that, seventy thousand and thirty thousand would come from
malaria control programs that would have to be scaled back. Specifically,
The other forty thousand is broken out as twenty four
thousand would die because of a lack of support for
(02:14):
immunizations and other investments, and sixteen thousand would be because
of a lack of skilled attendance at birth.
Speaker 6 (02:20):
I am exceptionally upset about USA. I lived in the
refugee camp for four years as a child surviving civil war.
It is the essential programs that USA provided that kept
my family and.
Speaker 2 (02:34):
I fit and safe.
Speaker 7 (02:36):
The consequences are that people die, Babies die. I mean
right now we are involved in Gaza and in Sudan
in providing food to malnourished babies. Literally, there will be
dead children, one hundreds thousands of them.
Speaker 1 (02:53):
Long.
Speaker 8 (03:31):
The people who work at USA did not come to
work at USA for the money. The civil servants, the
foreign servants, the contractors. They came to usaid because they
wanted to make a difference in the world because they
saw America's interests as tied up with the interests of
people vulnerable people around the world. And so even as
(03:51):
they're struggling to figure out how to make rent, all
of a sudden, they're most struggling with the fear that
many millions of people who allied on US as a country,
on US eight as an agency, but on them as individuals,
that those individuals out in the world have no place
(04:11):
to turn. And indeed they're showing up and finding health
clinics shuttered and soup kitchens closed.
Speaker 4 (04:17):
Doock knock knocking on Heaven's down wall.
Speaker 2 (04:23):
Yeah. One of the great joys of owning a live
music venue and having no shame is that you can
get up on stage with the bands, and you can
(04:43):
get your friends up on stage with the bands, even
if it's inadvisable, and my brother's favorite thing to do.
Josh Fuller would always invite my brother on stage because
he got a kick out of my brother getting so
excited to get to sing, and he loved to do
the hall all haul. He loved that song, so Josh
would always have to do the song so that he
(05:05):
could do it. Just a brag on our team. When
our folks travel, they still work. So Chad Nakanishi, who
was from Hawaii, is flew back yesterday to visit his
family in Hawaii in Hilo. I got an email this
(05:28):
morning that was a He had set it on a
timer so that it came to me at the normal
time I would get my show prep. But I said, Chad,
how in the world did you send me show prep?
You've been flying and you just landed. And he said, well,
I got here, and I got in bed, and I
got up at one am, five hours behind, and I'll
(05:50):
send production a little later as well. See Ramon. That's
commitment right there. Then I sent back and he said, well,
I like, I want to be able to hear the
show live in case there's anything I need to add,
and then I'll nap after that and then I'll try
to get on my Hawaiian sleep schedule from there.
Speaker 8 (06:07):
Now.
Speaker 2 (06:07):
How awesome is that? In other news, not as impressive.
My friend Jonathan Kim, the president of Gringo's Text Mex,
apparently took his girlfriend Emma Salazar fishing and cast a
hook into her nose and hung her nose. I'll post
the picture here in a minute. But you know how
(06:29):
Indian women will do the nose ring where they punched
the hole through the nose and then they hook it
on a chain to the ear. Well, she's gonna have
a big hole. She won't need to get her nose
pierced now because Jonathan was kind enough to hook her
nose with his dealer. Well, how much time we have left?
I want to talk about AL two A Okay, it happened.
(06:50):
Josel Tuve passed Jeff Bagwell last night to become number
two all time on the Astros hit list. Any of
the Estros need another bits Right here, there's a ball
in the center field bar, a base hit. Two runs
are gonna score. Jake Meyer's coach pers the third Jose
out too. Bag gives the Astros.
Speaker 9 (07:09):
A qre too, leads Also, would we like to see
how two bay coming through in the clutch, not wasting
any time. Took a breaking ball on the outside corner,
hit it up the middle, and he passes Jeff Bagwell.
The Astros want that baseball.
Speaker 2 (07:25):
He's uh a little over six hundred hits behind video
now for a six year period, he got two hundred
or more hits and led the AL every year in hits,
but he'd have to do that for just over. He'd
have to have a good second half in another three years.
Ramon asked me if he's the greatest astro of all time,
(07:47):
and I am. I'm struggling with the answer to that
because I hold to the Nolan Ryans of my of
my youth. But wow, I mean, just wow, what this
guy has delivered. How much fun it has been to
have this guy in our town playing ball for the
teams our jersey. My urologists will be our guest coming
(08:10):
up next. The subject was how to deal in the
heat and whether that leads to kidney stones, But we'll
probably end up talking about directions and crooked wieners and
also to other stuff we always go with. Kara's my guest,
dude the Michael Berry Show, Silver.
Speaker 4 (08:26):
Bells hanging on our stream.
Speaker 10 (08:28):
She told me.
Speaker 2 (08:29):
It was, yes, it indeed it is doctor Mohit Kara,
the most interviewed doctor in our radio program for the
most number of times in the most number of minutes.
The line of the day this morning, I asked, I
asked Mohit Kara to call in at eight point fifteen
and Ramon will turn on his mic so that I
(08:52):
can hear him talking to the caller, so I know, okay,
the caller's calling in and he put him on hold
and he said, we've got doctor Kara, and I said, good,
he's I like when the doctors come to us and
we make them wait. That was pretty good, Doctor Mohit Kara.
Welcome to the program. Good sir, Good morning, Michael, Thank you,
(09:13):
Thank you're so serious. Thank you for making time for us. Now,
what was the issue I wanted you on Tuesday? You
were teaching residents or something.
Speaker 10 (09:21):
Yeah, you know.
Speaker 11 (09:22):
So what happens is July first is where all the
new residents and the medical students and the fellows start,
and so it's it's crazy because you know, everyone's trying
to figure out what to do, where to go, and uh,
if you get sick, don't get sick on July first.
Speaker 10 (09:37):
That's all I'm telling you.
Speaker 2 (09:38):
Because it's a it's a madhouse. How are they different?
Everyone's new, Well, the residents different today than when you
were coming up.
Speaker 10 (09:49):
I think they're smarter.
Speaker 11 (09:50):
I think it's much harder to get into medical school
and residency today than it was in the past. I
think that you know, if you look at the caliber
these people have been well accomplished and published a lot.
Speaker 10 (10:01):
They've done a lot.
Speaker 11 (10:02):
Back when I was getting in you it wasn't it
was hard, but it wasn't like this. I mean, they
really have stepped up their game. Really, and I'll tell
you to actually, even the surgical skills of these residents.
Speaker 10 (10:11):
Coming in or are far greater than we've seen in
the past.
Speaker 2 (10:15):
I've heard that much more focus is given to bedside
manners now than it ever was because that was something
that was complained about for a long time. Is that true?
Speaker 10 (10:26):
It is?
Speaker 11 (10:26):
And it's also on ethics, So you know, the interview
is really important, and we will sometimes give mock questions
during the interview. Hey, we have a patient that had
this happen to them, how would you handle it? And
you want to make sure that they are ethical, that
they would do the right thing, and that plays a
(10:47):
big component in the interview.
Speaker 2 (10:50):
We've all seen the TV shows, you know, and the
resident comes in there and here's the big fancy doctor
and that's you, and I'm the little resident and I
want to be the big fancy doctor, and I got
to go through all that. It's kind of got to
be a charge to know that they're you know, they're
all excited like a teacher on the first day of school.
Speaker 11 (11:06):
It's amazing. And I'll tell you, it's amazing to teach.
One of my passions obviously is teaching. And just to
see them grow over the year and how they progress
is incredible. But they're hungry, you know, when they come in,
they're hungry to learn. They're eager to learn, and it's
just fun. I'll tell you what's really fun operating with
the residents and the fellows. And you operate with them
(11:26):
and watch them over the year, it's amazing. At the beginning,
you're a little nervous, don't get me wrong, and you're
just trying to make sure everything's fine. But as you
go on and watch them get better and better in
their skills, it's such a great feeling.
Speaker 2 (11:37):
A friend of mine who do to Hippa your requirement,
I'm not under that restriction, but I won't say his name,
had a vasectomy with you, and he came highly recommended
from me to you, and he commented on the fact
that you came waltzing in and you had an opera
love on him or I don't know what it was.
That was playing and you had the most beautiful music going.
(11:58):
And I said, did it Badia? And he goes, no,
he kept me calm. So is that music for him
or for you?
Speaker 10 (12:05):
And it's really for him.
Speaker 11 (12:06):
So you know, people come in if they're having procedures,
they're nervous, especially if you get a guy who's gonna
get as to me, they're gonna be a little nervous.
And so what you got to do is just keep
them calm. And I found that music really keeps them calm.
The teacher doesn't take that long. And if you talk
to them while they're doing the procedure, you know, when
they're done, they're just you know, they don't even I
don't want them thinking about the procedure. So music talking
(12:28):
to them make a big difference.
Speaker 2 (12:31):
There's a movie Willem Dafoe is in I can't remember
if it's our town, Ramon, do you remember what it
was where he's brought in as the FBI specialist to
recreate the scene and he plays the opera? Do you
remember that?
Speaker 10 (12:41):
Romon?
Speaker 2 (12:44):
Yeah, they are Boondock Saints, but Boondock Saints. Have you
seen that? Well?
Speaker 10 (12:48):
I've seen that.
Speaker 2 (12:49):
I have not Willem Dafoe comes in and he's this
very flamboyant gay guy, but he's brilliant. And the other cops,
you know, they're old fashioned, you know, Irish cops. You know,
who is this guy come in here like this? But
what he does is he turns on his music in
his headsets, and in front of them he recreates the
scene as if it's an opera, and then he tells them,
all right, he stood here, he shot here anyway more
(13:11):
than you wanted to know. Speaking of talking to I've
told the story Ramon. I don't know if I told
you this. I don't remember what you were checking for.
But I had something that I was worried about with
my kidney or my liver or my urological tract or something.
And you put some tube up my willie and it
goes all the way up in there, and I'm laying down,
and I'm the guy that when I get a shot,
(13:33):
looks away. And I don't know if you remember this.
Maybe you do this for everybody, but there's a.
Speaker 10 (13:36):
Thing I do remember.
Speaker 2 (13:38):
It It's way up in me. I mean, it feels
like it's up in my throat. And you said Michael
this looks great. Look at the screen and tried to
get me to turn and look at it, and I said,
I'm sure you recall tell me when that thing is
out of me. I don't. You're going the wrong way
on a one way street. I asked you the other
day because we were talking about this heat and his
(13:58):
searing heat and how tough it is and dehydration and
all that, and someone suggested to me that people should
be careful because this is when you get kidney stones.
And you said, that's absolutely true. So explain if you would,
why that is and what folks should do about that.
Speaker 10 (14:14):
Right, great points.
Speaker 11 (14:14):
So look at the summer's coming now, and it's getting hot,
and you got to realize that you're much more dehydrated
than you think you are. The number one risk factor
for kidney stones number one is dehydration. So if you're
going to do anything, you're going to hydrate. The number
you want to remember, Michael, is you want to urinate
about two point five liders a day, between two to
two point five liters a day. Well, if you're going
(14:35):
to urinate two to two point five liters a day,
you have to drink more than that anywhere from two
point five to three liters per day, which is quite
a bit. But if you if you do that, that's.
Speaker 10 (14:45):
The number one way not only.
Speaker 11 (14:47):
To keep kidney stones from happening in the first place,
but it reduces your chance of recurrent kidney stones by
fifty percent.
Speaker 10 (14:55):
So you know, it's hard.
Speaker 11 (14:56):
It's hard to think about getting all those all that
water in a day, but you have to do it,
particularly in the summer. And I tell my patients, you're
much more dehydrated than you really think you are.
Speaker 10 (15:06):
Think about why this happens.
Speaker 11 (15:07):
When you're dehydrated and your urine is concentrated, your urine
makes crystals. They make calcium oxalate uric acid crystals. Those
crystals will adjoin and then start making stones. So the
best way to stop making those stones is don't make
the crystals in the first place.
Speaker 10 (15:24):
You've got to drink the fluid.
Speaker 2 (15:27):
Since we live in America, and neither I know or
anyone else knows what a leader is. How much is
that in terms of gallons?
Speaker 11 (15:35):
Well, you think of three liters as three thousand milli liters,
and that's typically going to have at least lost eighty
to one hundred ounces. Okay, eight look at there's eighty
to one hundred ounces. Eighty to one hundred ounces a day.
Eighty tow one hundred ounces a day. That's eight to
ten cups of water a day. Wow, right, so that's
quite a bit. It means you've got to remember that
(15:56):
eight to ten cups, but you got to do it.
Speaker 10 (15:58):
It will really make it difference.
Speaker 2 (16:00):
And do you recommend putting anything in there? A lot
of folks say, you know, you don't want to wash
out all of your your minerals and gatorade or some
other package. We'll talk about that coming up with my
eurologists and dear friend Mohit Kara, Stay check yellow pudding,
Bobs Prosen, putting on a.
Speaker 8 (16:21):
Stake the Michael Barry Show, Jello brand pudding pops maybe
with the goodness of real Jello pudding.
Speaker 2 (16:27):
I got a message from Shirley Guidry that says Larry
Guidry is going to see him at nine o'clock, so
hurry please or he will be stuck in the waiting room.
Doctor Mohick Kara, my urologist and dear friend, is our guest.
How many patients do you see on average? Just office visits,
not surgeries? Or medical or actual procedures.
Speaker 11 (16:48):
It's pretty busy. We're about one hundred and fifty. I'm
about one hundred fifty patients a week a week.
Speaker 2 (16:53):
And how many days is that? Seeing patients.
Speaker 10 (16:57):
Four days a week?
Speaker 2 (16:59):
Okay? And then and and.
Speaker 10 (17:00):
If you're doing a surgery Wednesdays, all.
Speaker 2 (17:02):
Day Wednesday is surgery all the surgery, yep? And how
many surgery? How many surgeries will you do in a day?
Speaker 10 (17:13):
About six to seven every Wednesday.
Speaker 2 (17:17):
I know. One of the surgeries that you're kind of
renowned for is when the uh vascular I said, the
vast I guess, the vast deference. What do you call that?
When when the when the vessel wraps around and prevents
UH and burns the sperm off? What is that called?
(17:39):
The procedure you do?
Speaker 10 (17:41):
So you call it a sectomy?
Speaker 2 (17:43):
No, no, you told me about a procedure that you
do a lot of where the vein wraps around. I
don't know if it's the vast deference or what. And
it and it it basically the heat of that vein
burns the sperm and then you can't get price. It's
fertility procedure. What's that called?
Speaker 11 (17:59):
You got it? It's called the vericceal repair. It's actually
a very interesting concept. Casals mean dilated blood vessels around
the testicle. You know how you look at a woman
and you look at her legs, sometimes you can see
those big veins coming out those dilated veins.
Speaker 10 (18:12):
Those are called varicose veins.
Speaker 11 (18:14):
Will men get varicose veins in the scrotum, and in fact,
fifteen percent of men in the world walk around with
dilated veins in those scrode and that's a lot of men.
Speaker 10 (18:24):
Think about it.
Speaker 11 (18:24):
One out of seven men in the world have very
large dilated veins in the scrotum. The problem is when
you get those dilated veins in the scrotum, they carry
heat and they carry pressure, and the testicle does not
like it. So that heat and that pressure causes that
testicle to stop or really reduce the sperm production. So
what we go in and we do is we go
(18:45):
in and we tie off all those bad veins with
the high powered microscope and take off that heat, take
off that pressure, and guess what, Seventy percent of men
start having a significant improvement in their semen parameters. So
it is the number one procedure for utility. But other
reasons why you could fix it are some people just
have pain. Is hey, doctor care, I don't have any
I don't have any fertility issues, but I'm having pain.
(19:08):
So that's another reason to fix it. And the third
reason to fix it is in pediatrics because if you
have a kid, let's say he's twelve or thirteen years old,
and he has a air caceial, the side that has
the dial in veins, that testicle doesn't grow as well
as the other side, so it looks like you have,
you know, different sized testicles. So you really want to
fix it in a kid. So the three reasons to
(19:29):
fix it are if you're a kid, if you will
have pain, or you're trying to have a child. Recently,
a very interesting story, a position out of New York,
Mark Goldstein showed that if you fix those Verico s veins,
you actually can raise natural testosterol levels, which is interesting.
So when you take the heat off, when you take
the pressure off, the testicle starts producing more natural testosterone
(19:51):
as well. So a very interesting concept, but many people
don't realize it's a very common phenomenon.
Speaker 2 (19:58):
Fifteen percent, you said one in seven. Do you can
you see that with the naked eye. If you do,
if you.
Speaker 11 (20:03):
Check them, yes, so this is really important. There's we
call it three grades of Erica seals Grade one, Grade two,
Grade three, Grade three. You can see it through the
scroll to wall. You don't have to even examine them.
It means if I can see those veins bulging out
through the skin, there's no exam need that he's a
grade three. If he's a grade two, typically what you'll
(20:24):
do is you can feel it on exam. Grade one
typically they have to bear downs called the valsalva, and
you can feel some pressure. So those are the different grades.
But yes, you can see them on a grade three,
no question.
Speaker 2 (20:38):
And what percentage of grade three of of one hundred
percent of people who have them, what percent or grade three?
Speaker 11 (20:43):
Yeah, I would say that it's a bell curve. It's
that most of them are typically grade two. Now it
depends what they're coming in for. I'm going to see
a little bit more Grade three because as I mentioned earlier,
I specialize in fertility. So forty percent of men who
come to a fertility clinic will have a veraricacisl forty
that's the cause.
Speaker 10 (21:03):
So most of those.
Speaker 11 (21:04):
Men will have you know, either grade two or a
grade three. But you know the good news is Michael,
it's reversible. So yeah, you can do with procedure. It
doesn't take very long. You know, they go home the
same day and you can fix those veins just like
you would if a woman had vericos veins in her
legs or a man had verico spains in his legs.
We fix them in the scrotum and the sperm count
(21:26):
starts to go up.
Speaker 2 (21:29):
There's takes two to tango, so either one of the
partners could be the reason they're not getting pregnant. But
if a man comes in and he is the reason
for the infertility in the relationship, in what percentage of
cases are you able to get him to the point
where they're able to get pregnant.
Speaker 11 (21:47):
It depends on what the problem is. And fertility is
so easy. It's either he's not making sperm or he's blocked.
Speaker 10 (21:55):
That's it.
Speaker 11 (21:55):
Either he's not making sperm or he's blocked. So all
I have to do figure out which side of the
fence he's on. If he's blocked, I can unblock them.
There are numerous surgeries I can unblock them. If he's
not making sperm, then I have to do things to
help make the testicle start purducing, fixing the varicas heels,
using some medications. And remember this lifestyle modification is so critical.
(22:20):
Healthier people are more fertile.
Speaker 10 (22:23):
Period. Helpier people are more fertile.
Speaker 11 (22:25):
So I tell patients diet four pillars are diet, exercise, sleep,
and stress reduction. I don't have a pill on the
planet stronger than diet, exercise, sleep and such reduction. And
that's for anything. It's for ed testawsterm fertility. So if
you want to help me help yourself, you've got to
really help focus on the lifestyle modification. And if you
(22:47):
do those, each one of those have been shown to
help improve fertility, not only in men but also in women. Now,
I remember fifteen percent of those men that come in
can have a genetic cause. So we got to look
for the genetic reasons why they may have infertility. But
if they're not producing it, then I got to go
find it. In other words, are there are new techniques
that we now can do to go find the sperm?
(23:09):
At Baylor, we have something that's say to the art.
We have a new ultrasound that could actually look into
the testicle and show me where the sperm may be.
And so that's really a game changer because in the
old days, I'd have to take the operating room, open
them up, look everywhere, try to find it. With this
new technology, we can now identify where the patch of
sperm may be before I even go in there.
Speaker 10 (23:31):
So I'll give you an example.
Speaker 11 (23:31):
I had a patient the other day that had a
surgery called the MICROTESTI, and that's a pretty in depth surgery.
Speaker 10 (23:37):
We've taken the.
Speaker 11 (23:37):
Surgery, we look everywhere, and we take maybe twenty samples,
thirty samples, and we could not find the sperm. So
a year later he comes back and says, look, I
really want to try again.
Speaker 10 (23:49):
I said, fine.
Speaker 11 (23:50):
This time we were able to use that ultrasound device
and we were to pinpoint exact location where the sperm was,
went back in and we found it right away. It's
a game changer. So we're really using this technology to
help us. It also has a heat map, so it
can actually show you where there could be life inside
the testicle. So actually it's pretty cool, and I think
that's going to be a game changer.
Speaker 2 (24:12):
You know, Well, I'm going to move past that for
a second because I want to ask you about testosterone
and where we are in testosterone delivery, testosterone replacement, Your
thoughts on that you and I first start talking about this,
I don't know, ten twelve years ago.
Speaker 11 (24:29):
Yeah, so let's start very at the basic There is
not a better barometer of a man's overall health than
his testosterone level. I want to be very clear. Low
testosterone can have signs and symptoms, low energy, low lebido,
rectile dysfunction, increase, fat decrease, muscle depression, poor sleep. Okay,
(24:49):
so that's those are symptoms. Okay, but let's take a
little bit deeper. Did you know that low testosterone is
a significant risk factor or patients having an increased risk
for a heart attack. In other words, men with low
test austrial levels are much more likely to have a
heart attack period. Men with low test ostinal levels are
much more likely to break a bone offha peniostriprosis. Men
(25:10):
with low test ascal levels more like a diabetes.
Speaker 2 (25:13):
Hold on, just a moment, Doctor Mohip Kara is hard.
Guess it's spelled k h E r Asi.
Speaker 10 (25:26):
The Michael Barry Show, Simple Man.
Speaker 2 (25:32):
At the end of the game, our guest is doctor
Mohith Kara. My urologist and dear friend, we're talking about
urological issues because that's his area of expertise. The clock
cut you off, but you were talking about the importance
of testosterone. Let me ask you a question first, and
then I want you to go back to that. A
(25:53):
lot of folks are very concerned about an increased risk
of prostate cancer if they take hormone replacement for two
picularly testosterone. Your thoughts.
Speaker 11 (26:04):
So it was a myth that started in nineteen forty
one by a doctor named Huggins. Huggins in nineteen forty
one said if you take testoser increases your risk for
prostate cancer, and we found if you go look at
that paper, Michael, it's based on one patient. In twenty eighteen,
my society called the American Logic Association put out guidelines
saying that patients should be informed that testosterone does not
(26:27):
increase the risk of prostate cancer. And that was a
strong recommendation. And more importantly, there was a large study
that came out. Everyone needs to know about this. It
was called the Traverse Trial. This was five thousan two
hundred and forty six patients. I was one of the
ones running this trial. I designed this trial. It took
us six years to do it. We published it last year,
our last publication, and we show that there was absolutely
(26:48):
no increased risk in those men taking testosterone global placebo
for prostate cancer or any cardiovascar risk. No cardiovascar risk either,
So I think we've kind of put that one to rest.
Speaker 2 (27:00):
Interesting if in fact that is true, even if it
wasn't true. Isn't it the case that if your PSA
markers started increasing, you could just dial back the testosterone anyway.
Speaker 11 (27:16):
Yeah, but if your PSA marker starts increasing, then I
suspect that you have something underlying going on, like prostate cancer,
and I'm going to want to work it up. So
I think it's actually a good thing that your PSA
went up now as opposed to later, because you could
have an underlying prostate cancer. So just remember, if your
test starting testosphone is very low below fifty, I expect
your PSA to go up a little bit. And if
(27:37):
it does go up too much, let's go find out
what's going on. And in the old days, I'd have
to biops you. But now we have the MRI. The
MRI is really good. It gives you a score from
one to five. If it's not good, I got to
biopsy you. If you got a one, I'll leave you alone.
So we now don't have to run into a biopsy,
just get an MRI and see if we need to
go any further.
Speaker 10 (27:56):
So it's been really, really good if you.
Speaker 11 (27:58):
Get the past five ten years technology and the tests
we have to diagnose prostate cancer.
Speaker 2 (28:04):
I forget what the term is for the finger up
the booty when a guy reaches a certain age. But
my theory is that unless someone has a based on
my readings, unless someone has a propensity for prostate cancer
in their family, that you should just do the Pooh
test and unless that comes back positive and then follow
(28:25):
it up because you can do harm with the And
why has the word escaped me? What is the word
that guy's dread?
Speaker 10 (28:31):
The two things?
Speaker 11 (28:32):
I think you're thinking about a colonoscopy or we're talking
about yeah, but that's different. Remember, colonoscopy is looking for
colon cancer, right, and so we know that the guidelines
states starting at fifty.
Speaker 10 (28:43):
Some would even say.
Speaker 11 (28:44):
Now earlier you start getting that kolnoscopy, But that's screening
for colon cancer. I'm screening for something different. I'm screening
for prostate cancer. And every man between the ages of
fifty five and seventy should be screened every year for
prostate cancer. And if you have a high risk, if
you're African American, if you have a family.
Speaker 10 (28:59):
History like you mentioned, and you should be screened earlier.
Speaker 11 (29:01):
And a family history could be your father had prostate cancer,
or even a mother or a woman on having a
history of breast cancer puts you to increased risk for
prostate cancer. So typically we do a rectal exam with
the finger and we check a PSA and so that's
that's important to do that. But for prostate cancer. Your
colonoscopy is for your colon cancer.
Speaker 2 (29:21):
Why do Blacks have a higher rate? Is that a
behavioral cultural food stress or is that something like sickle
cell anemia? Is that is specific to the race?
Speaker 10 (29:34):
Yeah, it could be. So.
Speaker 11 (29:35):
One theory we've seen this before something called the sensitivity
of the androgen receptor. So we all have testosand receptors,
and we know that if there is increased sensitivity the receptor,
it's called the c AG repeat, and we know the
African Americans have a different SAG repeat than others. It
could increase their risk for prostate cancer. That's one theory.
But we do know that certain races like Asians are
(29:57):
less likely to have prostate cancer, right, So there, what
is the different propency amongst races to get prostate cancer?
Speaker 2 (30:04):
Interesting? Biggest development in urology in the last ten to
twenty years that makes you very excited.
Speaker 11 (30:12):
Well, there's so many So I talked about the Traverse trial.
This was a huge trial, five thousand patients just showing
the safety of testosterone.
Speaker 10 (30:20):
I think it's a big deal.
Speaker 11 (30:21):
I think our knowledge of testosterone now as a marker
of overall health.
Speaker 10 (30:25):
Every man over the.
Speaker 11 (30:26):
Age of forty should have a testosteron level checked every
man every year. And what I get shocked about is
when you go in for your physical, they check your thyroid,
they check your humogin aec that is the best marker
of your overall health, Michael, is your TESTOSTERL level. Not
only is it a marker of how you are going
to be your kind medical condition today, but what's going
to happen to.
Speaker 10 (30:44):
You in the future.
Speaker 11 (30:46):
I said earlier it was for heart attack, bone fracture, diabetes, obesity,
it's associated with prostate cancer. Lower testosteron levels it's associated
with depression.
Speaker 10 (30:56):
And I'll tell you this.
Speaker 11 (30:57):
I've been working at the VA Hospital for twenty five
years with veterans, and these veterans typically will have a
lot of them become under depression. And I can't tell
you how few of them ever had a testosteronal level check.
Low testosterone increases your risk for depression, and testosterone can't
help with depression, and most of these patients are not
getting their testotional level check.
Speaker 10 (31:16):
I had a big honor.
Speaker 11 (31:17):
I was invited to go to a special operations command
in Florida and present to the military on something called
operator syndrome.
Speaker 10 (31:24):
What is operator syndrome.
Speaker 11 (31:25):
Operator syndrome is when our military when they go train really.
Speaker 10 (31:30):
Hard, and when they're training really hard.
Speaker 11 (31:31):
Doing Hell Week, they feel lousy for several weeks afterwards.
Speaker 10 (31:35):
And what we found is that their.
Speaker 11 (31:36):
Testosterol levels go down significantly and they stay down for
quite a bit of time. And that's men and women
in the military, and so they call the operator syndom,
But the reality is that their te levels go down.
In my bias is that you know, these men and
women should have the ability to get their testosteral level
back just to be in the normal range, because I'll
(31:57):
give you an example. The normal range is three hundred
to one thousand, okay, And let's say you have a
US military at a level of three ten and you
look at someone who they're fighting against and their level
is at nine hundred. Who do you think is going
to have the advantage the nine hundred. And if you
look at history, the Germans used to give their military
high doses of testosterone before they went to combat because
(32:18):
it would increase their mental acuity, it would help them
with the fighting. And our military if they're at three
ten or three twenty, they are not allowed to take testosterone,
which is a big disadvantage to them when they're in combat.
Speaker 2 (32:32):
And what would you like yours to be ideally your
testosterone level.
Speaker 11 (32:37):
I would the guidelines say you should be between four
point fifty and six hundred, and I think that's an
appropriate level. If the levels between three hundred and one
thousand is a normal range, putting someone at least in
the middle makes sense. Some patients do better when they're
a bit high high, but still in the normal range,
but at least four to fifty to six hundred. But
you look at all these military personnel there at three
(32:58):
point thirty three forty eight. And if you look at
people I take care a lot of professional athletes. They
come in and their levels are at three point fifty.
Well they're not allowed to take testos from because band, right,
but they're at a huge disadvantage when they're on the
field compared to others.
Speaker 2 (33:12):
You know, Yeah, what your body is producing is giving
you an advantage or not producing is giving you a disadvantage.
You know, I would probably have to touch that the
right time. But a friend of mine went to you,
his wife went to you with urinary incontinence. He sent
me a message to talk to you about this, but
I think we're going to run out of time, and
(33:32):
that you're using botox to treat that. Is that true?
Speaker 11 (33:36):
Yes, yes, it's phenomenal. It's FDA approved. You be injected
into the bladder floor and it makes a huge difference
in quieting the bladder down. It so works so well
as covered by most insurances as well. But it only
lasts six months, so you got to do it every
six months.
Speaker 2 (33:51):
You're the magic man. I love it. If the magic
man Caric Kae r A as always my friend.
Speaker 10 (33:59):
Thank you, Thank you so much, Michael, really I.
Speaker 2 (34:03):
Wish you could stay two more hours. I got a
hundred questions from listeners, but I know you've got to
treat patients.
Popular Podcasts
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
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.