July 11, 2026 • 27 mins
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Speaker 1 (00:04):
The Michael berry Is.
Speaker 2 (00:05):
Show, Doctor Mohit Kara, Welcome to the program. Good sir,
Good morning, Michael. Thank you, 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 3 (00:20):
Yeah, you know. So what happens is July first is
we're 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 if you get sick, don't get sick on July first.
That's all I'm telling you.
Speaker 2 (00:39):
Because it's a it's a madhouse. How are they different?
Speaker 3 (00:43):
Everyone's new wells.
Speaker 2 (00:46):
Different today than when you were coming up.
Speaker 3 (00:50):
I think they're smarter. 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 so well accomplished.
They've published a lot, they've done a lot. 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 actually,
(01:11):
even the surgical skills of these residents coming in or
are far greater than we've seen in the past.
Speaker 2 (01:17):
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 3 (01:29):
It is? 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 happened 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
(01:50):
a big component in the interview.
Speaker 2 (01:54):
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. 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 3 (02:11):
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
(02:32):
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 skill, it's it's such a great feeling.
Speaker 2 (02:44):
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 om or I don't know what it was that
was playing, and you had the most beautiful music going.
(03:07):
And I said, did it bother you? And he goes, no,
he kept me calm. So was that music for him
or for you?
Speaker 3 (03:13):
And it's really for him. So you know, people come
in if they're having procedures, they're nervous, especially if you
get a guy who's going to get a visess 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 feugure 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
(03:36):
thinking about the procedure. So music talking to them make
a big difference.
Speaker 2 (03:41):
There's a movie Willem Dafoe is in. I can't remember
if it's our Town or 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 3 (03:52):
Ramon?
Speaker 2 (03:54):
Yeah, they are Boondock Saints, but Boondock Saints. Have you
seen that?
Speaker 3 (03:59):
I've seen that.
Speaker 2 (04:01):
So Williem 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 coming in here like this? But what
he does is he turns on his music, in his
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
(04:23):
anyway more 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.
(04:43):
And I'm laying down, and I'm the guy that when
I get a shot, looks away. And I don't know
if you remember this. Maybe you do this for everybody,
but there's a.
Speaker 3 (04:50):
Thing I do remember.
Speaker 2 (04:51):
It. It's way up in me. I mean, it feels
like it's up in my throat.
Speaker 3 (04:55):
Yea.
Speaker 2 (04:55):
And you said, Michael, this looks great. Look at the
screen and try 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.
Speaker 3 (05:04):
I don't.
Speaker 2 (05:05):
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 this 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
(05:26):
folks should do about that.
Speaker 3 (05:29):
Right, great points. 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
(05:49):
two to two point five liters a day. Well, if
you're going 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. If you do that, that's the
number one way not only to keep kidney stones from
happening in the first place, but it reduces your chance
of recurrent kidney stones by fifty percent. So you know,
(06:12):
it's hard. 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.
Think about why this happens. 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
(06:35):
start making stones. So the best way to stop making
those stones is don't make the crystals in the first place.
You've got to drink the fluid.
Speaker 2 (06:44):
Since we live in America and neither I nor anyone
else knows what a leader is. How much is that
in terms of gallons?
Speaker 3 (06:52):
Well, you think of three lids as three thousand millileters,
and that's typically going to have at least lost eighty
one hundred ounce Let's think of this eighty to one
hundred ounces, eighty to one hundred ounces a day, eighty
two one hundred ounces a day. That's eight to ten
cups of water a day, right, So that's that's quite
a bit. I means you got to remember that eight
(07:13):
to ten cups. But you gotta do it, It will
really make a difference.
Speaker 2 (07:17):
And do you recommend putting anything in there? A lot
of folks say you don't want to wash out all
of your your minerals and gatorade or some other pack.
We'll talk about that coming up with my eurologists. Can hear,
friend Mohit Kara stayed.
Speaker 3 (07:33):
Two yellow pudding pops prosen putting on a stag the.
Speaker 2 (07:38):
Michael Fairy Show, Yellow brand pudding pops made with the
goodness of real jello pudding. Doctor Mohic Kara, my urologist
and dear friend, is our guest. How many patients do
you see on average? Just office visits, not surgeries or
meta or actual procedures.
Speaker 3 (07:55):
It's pretty busy. We're about one hundred and fifty. I'm
about one hundred fifty patients a week.
Speaker 2 (08:00):
And how many days is that? Seeing patients.
Speaker 3 (08:04):
Four days a week? Okay?
Speaker 2 (08:05):
And then and if you're doing.
Speaker 3 (08:08):
A surgery Wednesdays, all day Wednesday is surgery of the surgery? Ye?
Speaker 2 (08:16):
How many surgery? How many surgeries will you do.
Speaker 3 (08:18):
In a day? About six to seven every Wednesday?
Speaker 1 (08:23):
I know.
Speaker 2 (08:24):
One of the surgeries that you're kind of renowned for
is when the UH vascular 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 the procedure you do?
Speaker 3 (08:47):
So you call it a sectomy?
Speaker 2 (08:49):
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 they can't get price. It's fertility procedure.
What's that called?
Speaker 3 (09:05):
You got it? It's called a vericaceal repair. It's actually
a very interesting concept. Vi Caceals 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. Those
are called varicose veins. Will men get varicose veins in
the scrotum, And in fact, fifteen percent of men in
(09:26):
the world walk around with dilated veins in their scrote
And that's a lot of men. Think about it. 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
(09:47):
stop or really reduce the sperm production. So what we
go in and we do is we go 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 men start having a significant
improvement in their semen parameters. So it is the number
one procedure for fertility. But other reasons why you can
(10:08):
fix it are some people just have pain. Is hey,
doctor Carre, I don't have any I don't have any
fertility issues, but I'm having pain. 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 diald of veins,
that testicle doesn't grow as well as the other side,
(10:28):
so it looks like you have different sized testicles. So
you really want to fix it. In a kid. So
the three reasons to 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 stains, you actually can raise natural testosterol levels,
(10:51):
which is interesting. So when you take the heat off,
when you take the pressure off, the testicle starts producing
more natural testoster as well. So a very interesting concept,
but many people don't realize it's a very common phenomenon.
Speaker 2 (11:04):
Fifteen percent, you said one in seven do you can
you see that with the naked eye? If you do,
if you.
Speaker 3 (11:09):
Check them, yes, So this is really important. There's we
call it three grades of Verica 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 needed. He's a grade three.
If he's a grade two, typically what you'll do is
(11:31):
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 (11:44):
And what percentage or grade three of one hundred percent
of people who have them? What percent or grade three?
Speaker 3 (11:49):
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 gonna see a
little bit more grade threes because as I mentioned earlier,
I specialize in fertility. So forty percent of men who
come to a fertility clinic will have a varicacile forty percent.
That's the cause. So most of those men will have
(12:12):
either a 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 verical sveins in his legs. We fix them in
the scrotum and the sperm count starts to go up.
Speaker 2 (12:35):
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 3 (12:53):
It depends on what the problem is. And fertility is
so easy. It's either he's not making sperm or he's blocked.
That's it. Either he's not making sperm or he's blocked.
So all I have to do is figure out which
side of the fence he's on. If he's blocked, I
can unblock them. There are numerous surgeries I can to
unblock them. If he's not making sperm, then I have
(13:15):
to do things to help make the tesco start purchasing,
fixing the varicas, heels, using some medications. And remember this
lifestyle modification is so critical. Healthier people are more fertile. Period.
Healthier people are more fertile. So I tell patients diet
four pillars are diet, exercise, sleep, and stress reduction. I
(13:38):
don't have a pill on the planet stronger than diet, exercise, sleep,
and reduction. And that's for anything. It's for ed TESTAWSTERM fertility.
So if you want to help me, I help yourself.
You've got to really help focus on the lifestyle modification.
And if you do those, each one of those have
been shown to help improve fertility, not only in men
but also in women. Now remember fifteen, some of those
(14:00):
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, there
are new techniques that we now can do to go
find the sperm. 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
(14:21):
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.
So I'll give you an example. I had a patient the
other day that had a surgery called the microtesty, and
(14:41):
that's a pretty in depth surgery. Were taken the 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. I said, fine, This time we were
able to use that ultrasound device and we are to
pinpoint exact location of where the sperm was went back in,
(15:03):
and we found it right away. It was a it's
a game changer. So we're really using this technology to
help us. It's a 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 (15:18):
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 were talking about start
talking about this, I don't know, ten twelve years ago.
Speaker 3 (15:35):
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 libido,
rectile dysfunction, increase, fat decrease, muscle depression, poor sleep. Okay,
(15:55):
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
testostional levels are much more likely to have a heart
attack period. Men with low test dostrial levels are much
more likely to break a bone ostiopeniostriprosis. Men with low
(16:16):
testosteral levels are more like a diabetes.
Speaker 2 (16:19):
Hold on, just a moment. Doctor Mohic Kara is r gas.
It's spelled k h E r a.
Speaker 1 (16:29):
G. The Michael Berry Show is simple man.
Speaker 2 (16:35):
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 lot of folks are very concerned about an increased
risk of prostate cancer if they take hormone replacement, particularly testosterone.
(16:59):
Your thoughts.
Speaker 3 (17:01):
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 to go look at that paper, Michael.
It's based on one patient. In twenty eighteen, my society
called the American Brologic Association put out guidelines staying that
(17:22):
patients should be informed that testosterone does not 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 thousand, 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
(17:43):
do it. We published it last year, our last publication,
and we showed that there was absolutely no increased risk
in those men taking testosterone forbo 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 (18:01):
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 3 (18:18):
Yeah, But if your PSA marker struts 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 testosterone is very low below the fifty,
I expect your PSA to go up a little bit.
(18:40):
And if 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 you got a five, 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 start into a biopty. Just get an MRI
and see if we need to go any further. So
(19:00):
it's been really, really good if you look at the
past five ten years, the technology and the tests we
have to diagnose prostate cancer.
Speaker 2 (19:08):
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
(19:31):
it up because you can do harm with the And
why has the word escaped me? What is the word
that guys dread?
Speaker 3 (19:37):
There's two things. I think you're thinking about. Colonoscopy, yeah,
but we're talking about yeah, but that's different. Remember, colonoscopy
is looking for colon cancer, right, and so we know
that the guidelines state starting at fifty Some would even
say now earlier you start getting a klnoscopy, But that's
screening for colon cancer. I'm screening for something different. I'm
screening for prostate cancer. And every man in the ages
(20:00):
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 history
like you mentioned, you should be screened earlier. 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 risks for prostate cancer.
So typically we do a rectal exam with the finger
(20:21):
and we check a PSA and so that's important to
do that, but for prostate cancer. Your colonoscopy is for
your colon cancer.
Speaker 2 (20:30):
Why do Blacks have a higher rate. Is that a
behavioral cultural food stress or is that something like sickle
cell an amia is that is specific to the race?
Speaker 3 (20:44):
Yeah, it could be so. One theory and we've seen
this before, something called the sensitivity of the androgen receptor.
So we all have testosal receptors and we know that
if there is increased sensitivity the receptor, it's called the
CG you repeat. And we know that African Americans have
a different sage Europeae than others. It could increase their
risk for prostate cancer. That's one theory. But we do
(21:06):
know that certain races like Asians are less likely that
prostate cancer. Right, so there is the different propensity amongst
races to get prostate cancer.
Speaker 2 (21:16):
Interesting, biggest development in urology in the last ten to
twenty years that makes you very excited.
Speaker 3 (21:25):
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. I think it's a big deal.
I think our knowledge of testoster now as a marker
of overall health every man over the age of forty
should have a testosteron level checked every man every year.
And what I get shocked about is when you go
(21:45):
in for your physical, they check your thyroid, they check
your humoglin A ONEC. That is the best marker of
your overall health, Michael. Is your testosterol level. Not only
is it a marker of how you are going to
be your medical condition today, but what's going to happen
to you in the future. I said earlier. At risk
for heart attack, bone fracture, diabetes, obesity, it's associated with
(22:07):
prostate cancer, low testosterone levels, it's associated with depression. And
I'll tell you this. I've been working at the VA
Hospital now for twenty five years with veterans, and these
veterans typically will have a lot of them will come
with depression, and I can't tell you how few of
them ever had a testosterone level check. Low testosterone increases
your risk for depression, and testosterone can't help with depression.
(22:30):
And most of these patients are not getting their testosteron
level checked. I had a big honor. I was invited
to go to a special operations command in Florida and
present to the military on something called operator syndrome. What
is operator syndrome. Operator syndrome is when our military when
they go train really hard, and when they're training really hard,
doing hell week, they feel lousy for several weeks afterwards.
(22:52):
And what we found is that their testosteron 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 called it operators in them. But the
reality is that their t levels go down. And my
bias is that you know, these men and women should
have the ability to get their testosteral level back just
(23:13):
to be in the normal range. Because I'll 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
(23:36):
before they went to combat because 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 (23:51):
And what would you like yours to be ideally your
testosterone level.
Speaker 3 (23:57):
I would the guidelines say you should be between war
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 fill in the normal range, but at
least four fifty to six hundred. But you look at
all these military perconel, they're at three point thirty three forty.
(24:19):
Even if you look at people I take care a
lot of professional athletes, they come in and their levels
are at three fifty. Well, they're not allowed to take
testos from because it's banned, right, but they're at a
huge disadvantage when they're on the field compared to others.
Speaker 2 (24:31):
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 do it that's
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. Yeah,
(24:51):
you're using botox to treat that? Is that true?
Speaker 3 (24:55):
Yes? Yes, it's phenomenal. It's FDA approved. It you inject
into the bladder floor and it makes a huge difference
in quieting the bladder down. It works so well to
cover by most insurances as well. But it only lasts
six months, so you got to do it every six months.
Speaker 1 (25:10):
You the Magic Man. I love it.
Speaker 2 (25:13):
Mo it the Magicman. Kara Kae r A as always
my friend. Thank you.
Speaker 1 (25:20):
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(25:41):
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Podcast is produced by Ramon Roeblis, The King of Ding.
Executive producer is Chad Knakanishi. Jim Mudd is the creative director.
(26:05):
Voices jingles, Tomfoolery and Shenanigans are provided by chance McLean.
Director of Research is Sandy Peterson. Emily Bull is our
assistant listener and superfan. Contributions are appreciated and often incorporated
into our production. Where possible, we give credit, where not,
(26:28):
we take all the credit for ourselves. God bless the
memory of Rush Limbaugh. Long live Elvis, be a simple
man like Leonard Skinnard told you, and God bless America. Finally,
if you know a veteran suffering from PTSD, call Camp
Hope at eight seven seven seven one seven PTSD and
(26:53):
a combat veteran will answer the phone to provide free counseling.
Speaker 2 (27:00):
Three
The Michael berry Is.
Speaker 2 (00:05):
Show, Doctor Mohit Kara, Welcome to the program. Good sir,
Good morning, Michael. Thank you, 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 3 (00:20):
Yeah, you know. So what happens is July first is
we're 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 if you get sick, don't get sick on July first.
That's all I'm telling you.
Speaker 2 (00:39):
Because it's a it's a madhouse. How are they different?
Speaker 3 (00:43):
Everyone's new wells.
Speaker 2 (00:46):
Different today than when you were coming up.
Speaker 3 (00:50):
I think they're smarter. 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 so well accomplished.
They've published a lot, they've done a lot. 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 actually,
(01:11):
even the surgical skills of these residents coming in or
are far greater than we've seen in the past.
Speaker 2 (01:17):
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 3 (01:29):
It is? 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 happened 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
(01:50):
a big component in the interview.
Speaker 2 (01:54):
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. 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 3 (02:11):
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
(02:32):
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 skill, it's it's such a great feeling.
Speaker 2 (02:44):
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 om or I don't know what it was that
was playing, and you had the most beautiful music going.
(03:07):
And I said, did it bother you? And he goes, no,
he kept me calm. So was that music for him
or for you?
Speaker 3 (03:13):
And it's really for him. So you know, people come
in if they're having procedures, they're nervous, especially if you
get a guy who's going to get a visess 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 feugure 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
(03:36):
thinking about the procedure. So music talking to them make
a big difference.
Speaker 2 (03:41):
There's a movie Willem Dafoe is in. I can't remember
if it's our Town or 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 3 (03:52):
Ramon?
Speaker 2 (03:54):
Yeah, they are Boondock Saints, but Boondock Saints. Have you
seen that?
Speaker 3 (03:59):
I've seen that.
Speaker 2 (04:01):
So Williem 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 coming in here like this? But what
he does is he turns on his music, in his
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
(04:23):
anyway more 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.
(04:43):
And I'm laying down, and I'm the guy that when
I get a shot, looks away. And I don't know
if you remember this. Maybe you do this for everybody,
but there's a.
Speaker 3 (04:50):
Thing I do remember.
Speaker 2 (04:51):
It. It's way up in me. I mean, it feels
like it's up in my throat.
Speaker 3 (04:55):
Yea.
Speaker 2 (04:55):
And you said, Michael, this looks great. Look at the
screen and try 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.
Speaker 3 (05:04):
I don't.
Speaker 2 (05:05):
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 this 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
(05:26):
folks should do about that.
Speaker 3 (05:29):
Right, great points. 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
(05:49):
two to two point five liters a day. Well, if
you're going 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. If you do that, that's the
number one way not only to keep kidney stones from
happening in the first place, but it reduces your chance
of recurrent kidney stones by fifty percent. So you know,
(06:12):
it's hard. 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.
Think about why this happens. 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
(06:35):
start making stones. So the best way to stop making
those stones is don't make the crystals in the first place.
You've got to drink the fluid.
Speaker 2 (06:44):
Since we live in America and neither I nor anyone
else knows what a leader is. How much is that
in terms of gallons?
Speaker 3 (06:52):
Well, you think of three lids as three thousand millileters,
and that's typically going to have at least lost eighty
one hundred ounce Let's think of this eighty to one
hundred ounces, eighty to one hundred ounces a day, eighty
two one hundred ounces a day. That's eight to ten
cups of water a day, right, So that's that's quite
a bit. I means you got to remember that eight
(07:13):
to ten cups. But you gotta do it, It will
really make a difference.
Speaker 2 (07:17):
And do you recommend putting anything in there? A lot
of folks say you don't want to wash out all
of your your minerals and gatorade or some other pack.
We'll talk about that coming up with my eurologists. Can hear,
friend Mohit Kara stayed.
Speaker 3 (07:33):
Two yellow pudding pops prosen putting on a stag the.
Speaker 2 (07:38):
Michael Fairy Show, Yellow brand pudding pops made with the
goodness of real jello pudding. Doctor Mohic Kara, my urologist
and dear friend, is our guest. How many patients do
you see on average? Just office visits, not surgeries or
meta or actual procedures.
Speaker 3 (07:55):
It's pretty busy. We're about one hundred and fifty. I'm
about one hundred fifty patients a week.
Speaker 2 (08:00):
And how many days is that? Seeing patients.
Speaker 3 (08:04):
Four days a week? Okay?
Speaker 2 (08:05):
And then and if you're doing.
Speaker 3 (08:08):
A surgery Wednesdays, all day Wednesday is surgery of the surgery? Ye?
Speaker 2 (08:16):
How many surgery? How many surgeries will you do.
Speaker 3 (08:18):
In a day? About six to seven every Wednesday?
Speaker 1 (08:23):
I know.
Speaker 2 (08:24):
One of the surgeries that you're kind of renowned for
is when the UH vascular 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 the procedure you do?
Speaker 3 (08:47):
So you call it a sectomy?
Speaker 2 (08:49):
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 they can't get price. It's fertility procedure.
What's that called?
Speaker 3 (09:05):
You got it? It's called a vericaceal repair. It's actually
a very interesting concept. Vi Caceals 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. Those
are called varicose veins. Will men get varicose veins in
the scrotum, And in fact, fifteen percent of men in
(09:26):
the world walk around with dilated veins in their scrote
And that's a lot of men. Think about it. 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
(09:47):
stop or really reduce the sperm production. So what we
go in and we do is we go 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 men start having a significant
improvement in their semen parameters. So it is the number
one procedure for fertility. But other reasons why you can
(10:08):
fix it are some people just have pain. Is hey,
doctor Carre, I don't have any I don't have any
fertility issues, but I'm having pain. 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 diald of veins,
that testicle doesn't grow as well as the other side,
(10:28):
so it looks like you have different sized testicles. So
you really want to fix it. In a kid. So
the three reasons to 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 stains, you actually can raise natural testosterol levels,
(10:51):
which is interesting. So when you take the heat off,
when you take the pressure off, the testicle starts producing
more natural testoster as well. So a very interesting concept,
but many people don't realize it's a very common phenomenon.
Speaker 2 (11:04):
Fifteen percent, you said one in seven do you can
you see that with the naked eye? If you do,
if you.
Speaker 3 (11:09):
Check them, yes, So this is really important. There's we
call it three grades of Verica 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 needed. He's a grade three.
If he's a grade two, typically what you'll do is
(11:31):
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 (11:44):
And what percentage or grade three of one hundred percent
of people who have them? What percent or grade three?
Speaker 3 (11:49):
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 gonna see a
little bit more grade threes because as I mentioned earlier,
I specialize in fertility. So forty percent of men who
come to a fertility clinic will have a varicacile forty percent.
That's the cause. So most of those men will have
(12:12):
either a 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 verical sveins in his legs. We fix them in
the scrotum and the sperm count starts to go up.
Speaker 2 (12:35):
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 3 (12:53):
It depends on what the problem is. And fertility is
so easy. It's either he's not making sperm or he's blocked.
That's it. Either he's not making sperm or he's blocked.
So all I have to do is figure out which
side of the fence he's on. If he's blocked, I
can unblock them. There are numerous surgeries I can to
unblock them. If he's not making sperm, then I have
(13:15):
to do things to help make the tesco start purchasing,
fixing the varicas, heels, using some medications. And remember this
lifestyle modification is so critical. Healthier people are more fertile. Period.
Healthier people are more fertile. So I tell patients diet
four pillars are diet, exercise, sleep, and stress reduction. I
(13:38):
don't have a pill on the planet stronger than diet, exercise, sleep,
and reduction. And that's for anything. It's for ed TESTAWSTERM fertility.
So if you want to help me, I help yourself.
You've got to really help focus on the lifestyle modification.
And if you do those, each one of those have
been shown to help improve fertility, not only in men
but also in women. Now remember fifteen, some of those
(14:00):
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, there
are new techniques that we now can do to go
find the sperm. 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
(14:21):
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.
So I'll give you an example. I had a patient the
other day that had a surgery called the microtesty, and
(14:41):
that's a pretty in depth surgery. Were taken the 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. I said, fine, This time we were
able to use that ultrasound device and we are to
pinpoint exact location of where the sperm was went back in,
(15:03):
and we found it right away. It was a it's
a game changer. So we're really using this technology to
help us. It's a 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 (15:18):
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 were talking about start
talking about this, I don't know, ten twelve years ago.
Speaker 3 (15:35):
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 libido,
rectile dysfunction, increase, fat decrease, muscle depression, poor sleep. Okay,
(15:55):
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
testostional levels are much more likely to have a heart
attack period. Men with low test dostrial levels are much
more likely to break a bone ostiopeniostriprosis. Men with low
(16:16):
testosteral levels are more like a diabetes.
Speaker 2 (16:19):
Hold on, just a moment. Doctor Mohic Kara is r gas.
It's spelled k h E r a.
Speaker 1 (16:29):
G. The Michael Berry Show is simple man.
Speaker 2 (16:35):
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 lot of folks are very concerned about an increased
risk of prostate cancer if they take hormone replacement, particularly testosterone.
(16:59):
Your thoughts.
Speaker 3 (17:01):
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 to go look at that paper, Michael.
It's based on one patient. In twenty eighteen, my society
called the American Brologic Association put out guidelines staying that
(17:22):
patients should be informed that testosterone does not 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 thousand, 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
(17:43):
do it. We published it last year, our last publication,
and we showed that there was absolutely no increased risk
in those men taking testosterone forbo 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 (18:01):
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 3 (18:18):
Yeah, But if your PSA marker struts 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 testosterone is very low below the fifty,
I expect your PSA to go up a little bit.
(18:40):
And if 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 you got a five, 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 start into a biopty. Just get an MRI
and see if we need to go any further. So
(19:00):
it's been really, really good if you look at the
past five ten years, the technology and the tests we
have to diagnose prostate cancer.
Speaker 2 (19:08):
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
(19:31):
it up because you can do harm with the And
why has the word escaped me? What is the word
that guys dread?
Speaker 3 (19:37):
There's two things. I think you're thinking about. Colonoscopy, yeah,
but we're talking about yeah, but that's different. Remember, colonoscopy
is looking for colon cancer, right, and so we know
that the guidelines state starting at fifty Some would even
say now earlier you start getting a klnoscopy, But that's
screening for colon cancer. I'm screening for something different. I'm
screening for prostate cancer. And every man in the ages
(20:00):
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 history
like you mentioned, you should be screened earlier. 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 risks for prostate cancer.
So typically we do a rectal exam with the finger
(20:21):
and we check a PSA and so that's important to
do that, but for prostate cancer. Your colonoscopy is for
your colon cancer.
Speaker 2 (20:30):
Why do Blacks have a higher rate. Is that a
behavioral cultural food stress or is that something like sickle
cell an amia is that is specific to the race?
Speaker 3 (20:44):
Yeah, it could be so. One theory and we've seen
this before, something called the sensitivity of the androgen receptor.
So we all have testosal receptors and we know that
if there is increased sensitivity the receptor, it's called the
CG you repeat. And we know that African Americans have
a different sage Europeae than others. It could increase their
risk for prostate cancer. That's one theory. But we do
(21:06):
know that certain races like Asians are less likely that
prostate cancer. Right, so there is the different propensity amongst
races to get prostate cancer.
Speaker 2 (21:16):
Interesting, biggest development in urology in the last ten to
twenty years that makes you very excited.
Speaker 3 (21:25):
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. I think it's a big deal.
I think our knowledge of testoster now as a marker
of overall health every man over the age of forty
should have a testosteron level checked every man every year.
And what I get shocked about is when you go
(21:45):
in for your physical, they check your thyroid, they check
your humoglin A ONEC. That is the best marker of
your overall health, Michael. Is your testosterol level. Not only
is it a marker of how you are going to
be your medical condition today, but what's going to happen
to you in the future. I said earlier. At risk
for heart attack, bone fracture, diabetes, obesity, it's associated with
(22:07):
prostate cancer, low testosterone levels, it's associated with depression. And
I'll tell you this. I've been working at the VA
Hospital now for twenty five years with veterans, and these
veterans typically will have a lot of them will come
with depression, and I can't tell you how few of
them ever had a testosterone level check. Low testosterone increases
your risk for depression, and testosterone can't help with depression.
(22:30):
And most of these patients are not getting their testosteron
level checked. I had a big honor. I was invited
to go to a special operations command in Florida and
present to the military on something called operator syndrome. What
is operator syndrome. Operator syndrome is when our military when
they go train really hard, and when they're training really hard,
doing hell week, they feel lousy for several weeks afterwards.
(22:52):
And what we found is that their testosteron 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 called it operators in them. But the
reality is that their t levels go down. And my
bias is that you know, these men and women should
have the ability to get their testosteral level back just
(23:13):
to be in the normal range. Because I'll 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
(23:36):
before they went to combat because 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 (23:51):
And what would you like yours to be ideally your
testosterone level.
Speaker 3 (23:57):
I would the guidelines say you should be between war
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 fill in the normal range, but at
least four fifty to six hundred. But you look at
all these military perconel, they're at three point thirty three forty.
(24:19):
Even if you look at people I take care a
lot of professional athletes, they come in and their levels
are at three fifty. Well, they're not allowed to take
testos from because it's banned, right, but they're at a
huge disadvantage when they're on the field compared to others.
Speaker 2 (24:31):
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 do it that's
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. Yeah,
(24:51):
you're using botox to treat that? Is that true?
Speaker 3 (24:55):
Yes? Yes, it's phenomenal. It's FDA approved. It you inject
into the bladder floor and it makes a huge difference
in quieting the bladder down. It works so well to
cover by most insurances as well. But it only lasts
six months, so you got to do it every six months.
Speaker 1 (25:10):
You the Magic Man. I love it.
Speaker 2 (25:13):
Mo it the Magicman. Kara Kae r A as always
my friend. Thank you.
Speaker 1 (25:20):
If you like The Michael Berry Show and Podcast, please
tell one friend, and if you're so inclined, write a
nice review of our podcast. Comments, suggestions, questions, and interest
in being a corporate sponsor and partner can be communicated
directly to the show at our email address, Michael at
(25:41):
Michael Berryshow dot com, or simply by clicking on our
website Michael Berryshow dot com. The Michael Berry Show and
Podcast is produced by Ramon Roeblis, The King of Ding.
Executive producer is Chad Knakanishi. Jim Mudd is the creative director.
(26:05):
Voices jingles, Tomfoolery and Shenanigans are provided by chance McLean.
Director of Research is Sandy Peterson. Emily Bull is our
assistant listener and superfan. Contributions are appreciated and often incorporated
into our production. Where possible, we give credit, where not,
(26:28):
we take all the credit for ourselves. God bless the
memory of Rush Limbaugh. Long live Elvis, be a simple
man like Leonard Skinnard told you, and God bless America. Finally,
if you know a veteran suffering from PTSD, call Camp
Hope at eight seven seven seven one seven PTSD and
(26:53):
a combat veteran will answer the phone to provide free counseling.
Speaker 2 (27:00):
Three
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