Sep 15, 2020

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Scot: Nobody's got any questions? Good.

Dr. Smith: I thought you brought the questions.

Scot: I do. I've got the questions.

Troy: That's Scot's job.

Scot: That's right. I have two jobs. One is to provide everybody with microphones, although you bought your own, so I feel pretty . . .

Dr. Smith: I did. I brought the heat today.

Scot: Yeah, Troy, Dr. Smith bought his own mic.

Troy: Exactly. Why buy it when you're getting it for free? You gave me mine, so I'm like, "I'm not spending money on this thing."

Dr. Smith: Well played.

Scot: It's "Who Cares About Men's Health." That's the name of the podcast. What do we do here? We provide information, inspiration, and motivation to understand and engage in your health so you can feel better today and in the future. My name is Scot Singpiel. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Smith: And I'm John Smith. I'm a non-surgical urologist at the University of Utah and I care about men's health.

Scot: All right. Dr. Smith, Dr. John . . . can I call you John, Dr. Smith? Is that okay?

Dr. Smith: You can surely call me John.

Scot: It's John's first time on the show. Welcome. This is exciting.

Dr. Smith: Thank you.

Troy: Welcome, John. Thanks for joining us.

Scot: I noticed Troy is not clapping. He's not nearly as excited as I am, but that's okay.

Troy: I'm very excited.

Scot: He's tough to win over sometimes, so . . .

Troy: Thanks, Scot.

Scot: We'll see how you do.

Troy: We'll see how you do. I'm still warming up to you, so . . .

Dr. Smith: We'll see if I can get him to clap by the end of the show.

Troy: We'll try.

Scot: Dr. Smith, thank you for being on the show. We're going to do some listener questions today. We're going to get to those in just a couple of seconds. But first, Troy, I'm curious, as an emergency room physician, what is the general take in the medical field on urologists? Like, when I said, "We're going to have a urologist on," what goes through your mind?

Troy: What goes through my mind? Well, we very regularly talk to our urologist. We see all sorts of urologic emergencies in the emergency department, whether it's trauma related or other issues we're seeing. They're people we talk to frequently. So, it's someone we rely on in the emergency department and we're very grateful always to have their assistance.

Scot: All right. So, it's great to have their assistance. But, I mean, what do you really think about urologists in general?

Troy: Scot, what are you getting at here?

Scot: I mean, in all fields of medicine, isn't there a little friendly competition between you all and there's some . . .

Troy: I'm jealous of urologists. It's a great field. It's a really great field. It's a very competitive specialty. It's a great field. It's one of those things where the people I knew who went into urology in med school were great people, like good friends of mine. I think it's a very well-respected specialty.

Scot: Dr. Smith, are there some urology stereotypes out there?

Dr. Smith: Oh, of course.

Scot: Yeah? What are some of these urologist stereotypes? Because I think I've noticed some patterns when I've met a few urologists.

Dr. Smith: I guess, on the other side, I . . .

Troy: Are you just trying to get him to cracks and dirty jokes? Is that where we're going, Scot?

Scot: Anything for ratings.

Dr. Smith: There are a few urologist jokes out there that are semi-family-friendly.

Scot: Well, hold on that because, actually, at the end of the show, I'm going to ask you to end with a urologist joke. So, hold on to that, okay?

Dr. Smith: Well, I'll save my favorite for then.

Scot: All right. But are there kind of some stereotypes in the medical field when it comes to urologists? It seems like urologists tend to have a better sense of humor than some of the other specialties. They're cracking jokes a lot. Is that fair or . . .

Dr. Smith: I would agree with that, I think. Most of them are good-natured, fun-loving guys and gals that they like to have a good time, but they also are very intelligent, like to work hard, and take care of folks.

Scot: All right. Sounds good. I can't wait for the joke at the end though. I'm really looking forward to that. That's going to be great, a good urologist joke.

Troy: Yeah. Stick around for the joke. For no other reason. We've got a good joke on the way.

Scot: These questions for our urologist, Dr. John Smith, came from a few different sources. First of all, we have a listener line. You can call and leave a message, and that is 601-557-2673, or easy way to remember it, 601-55SCOPE. You could also email hello@thescoperadio.com, and we also got a few Facebook direct messages. So, if you have a question for a urologist, those are the channels that you can get those to us.

But we figured we'd start with a urologist because a lot of times, when it comes to the medical field, it seems like urological questions are the ones a lot of us guys are hesitant or embarrassed to ask. Why is it that guys are embarrassed to talk about this stuff, do you think? I mean, it's just our bodies, right?

Troy: Sure, it's our bodies, but it's something that's obviously very personal and people crack jokes about their genitalia, and so I think it's one of those things where, yeah, it's something that . . . And it really gets at the essence of our manhood. If you're talking about erectile dysfunction, sure, it's a medical issue, but it really gets at the essence of your virility and your manliness. So, I think it's tough to bring up and it's tough to really be willing to address it, for sure.

Dr. Smith: I think that's true. And then you also have the society stereotypes. It does get to the heart of manliness. A lot of people feel like, "Well, if I can't perform, I'm not a certain one way or another." I mean, I've heard it all from different guys who have different perceptions of things.

But again, it is. It's a body part that can break down just like anything else. You see an athlete tear their ACL. I mean, it happens. People get injured. Not necessarily with the erectile dysfunction, but sometimes it's related to other medical problems where it's very difficult to avoid.

Scot: If you want to ask a question and you are a little embarrassed or hesitant, we're going to make this as simple as possible. So, you can say that you're asking for a friend if that makes you feel better. We'll totally believe that. You don't have to use your real name. You can make up a name. You can even use a fake name that's obviously fake, like John Smith, for example. We're just trying to make it super safe. And as a matter of fact, we're making it so safe that we have a urologist who's obviously also using a fake name. So, this is about as anonymous as it gets.

Dr. Smith: Witness protection has been good to me through the years.

Troy: There you go. Nice.

Scot: All right. Here we go. Question number one.

John: Hi. My name is John Smith and I'm calling in the urology line to ask the question "Can guys really get urinary tract infections?" I thought that was more of a woman thing. Anyway, just asking for a friend. Thank you.

Scot: Okay. So, yeah, great question. I guess I am in the same camp. I guess I figured that urinary tract infections, mainly women get them. Can men get them?

Dr. Smith: So, a couple of different reasons why a man would get a urinary tract infection. As men age, their prostates continue to grow. Your nose, your ears, and your prostate continue to grow, but they only told you the first two in school growing up. But when your prostate gets larger, it can obstruct your urinary flow and predispose you to urinary tract infections. That's one of the most common things that we'll see. A gentleman has urinary tract infection and he's older, prostate is generally the cause.

Another common thing we'll see where men will have a urinary tract infection is if they have a stricture of their urethra. Sometimes you can have a narrowing of the urethra for whatever reason. Sometimes it's trauma-related. Sometimes we can never pinpoint why it happens.

Anything that obstructs the flow of urine. So, another way a man could get a urinary tract infection, sometimes kidney stones that are infected can cause a urinary tract infection or even a kidney infection.

So, those would be a couple of the ways that a man could get a urinary tract infection.

Men are less likely to get a urinary tract infection because their urethra is about 20 centimeters long and a female's is about 3 centimeters long. So, the distance travelled is much further, but it definitely can happen.

Scot: What if you have to pee and oftentimes find yourself in a situation where you have to pee but you don't have the ability to do so? Can that cause urinary tract infections? If you're a long-haul truck driver or something like that and you're not going to the bathroom as often as you should . . .

Dr. Smith: You can predispose yourself to that. It's less likely. If there's not an obstruction . . . so I tell my patients, "You're either a pond or you're a river." And what that means is if you've ever been around a pond of stagnant water, you know what happens to it. A river generally doesn't look like that.

So, someone without an obstruction is more like a river and things are just kind of cleared out with the urine flowing. And then when you become a pond and have urinary retention where you don't empty your bladder the way that you should, you predispose yourself to an infection and looking like that stagnant pond water.

Scot: All right. And what does that urinary tract infection feel like? I mean, I've heard about it a lot from men and women in my life, but . . .

Dr. Smith: So, it depends on . . .

Scot: And rightly so, it's painful.

Dr. Smith: It sounds awful, yeah. It's miserable.

Scot: I can get myself in trouble here.

Troy: You are going to get yourself in trouble, Scot.

Dr. Smith: Asking for a friend, right, Scot?

Scot: Yes. Friends have told me they've heard this.

Troy: Yeah. Women in your life have said things . . .

Dr. Smith: "I've heard . . ." So, generally, folks will end up with dysuria or burning with urination. Some people go to the bathroom more frequently. Some guys will get kind of groin pain, flank pain. Testicular pain can also occur. Those are signs that you could have that. Fever and chills can also be a sign.

Some people complain of a change in their urine color or cloudiness, or a smell to the urine. Those ones aren't as well kind of . . . they don't necessarily mean you have an infection as much as some of the others do. But you should definitely come and have your urine evaluated to make sure that there's not something that we need to get treated and taken care of.

Scot: Yeah. The good news about all those symptoms you mentioned, if any of that stuff start happening on a regular basis, I think I'm going to go visit a doctor.

Troy: Yeah.

Dr. Smith: You probably should.

Troy: Those aren't subtle things. Once you start seeing blood in your urine and burning, you're going to get checked out.

Scot: Question number two, this one is one that came in through Facebook Messenger. No shock here. It's from John Smith and asking for a friend. "Is there any legitimacy to exercises that promise more size, girth, stamina, those sorts of things?" You know those emails you get that say, "Do these exercises and all these good things will happen."

Troy: Now, you're referring to bicep girth, or what's the gist here, Scot?

Scot: These emails are generally in your junk folder and they're promising . . .

Troy: And referring to your junk. Okay, right. Got it.

Scot: Yes, exactly

Dr. Smith: That's why it's a junk mailbox.

Troy: That's right. Got it.

Scot: Yes, because that's all that's in there. Dr. Smith, is there any legitimacy to any of those exercises?

Dr. Smith: I can't confirm that there's any legitimacy there to any of that stuff. The one thing we do know is that diet and exercise can help the quality of your erection for men with kind of mild erectile dysfunction. But there are no exercises or stretches or anything that has been shown to be super effective in that category.

There are different devices to help different conditions, like a condition where there's curvature of the penis. There are some devices that can help to straighten things back out, so to speak. Those have been shown to be effective, but there's not anything that's been shown to give increased length, girth, or quality of the male member, so to speak.

Scot: All right. And even those ones that are for medical use, I'd imagine, if you were experiencing something like that, probably best to visit a physician first and use those under the guidance of a physician, not just kind of a do-it-yourself thing. Or is that okay?

Dr. Smith: Absolutely. You want to be evaluated to make sure that you're a candidate for a lot of those devices. It's always smart to go see a doctor. When in doubt, you should probably go and see a physician about things. It just makes sense and it's safer that way to kind of be under the guidance of someone who's done this before.

Troy: Any downside to using those devices? Have you ever seen things go wrong with those sorts of things?

Dr. Smith: So, I've seen some folks come in with certain cultural injections that they've had put into the penis and things that have promised to give increased size or girth, where they've had an infection from that, and had to have some things taken care of that way. I've also seen people who have tried to inject caulk or silicone.

Scot: What?

Dr. Smith: Oh, yeah.

Scot: What? How? Where?

Troy: Just like something from Home Depot, like some silicone caulk or something?

Dr. Smith: Exactly.

Scot: The way I'm imagining that they would inject it, I mean, there's like one way that I'm thinking that gets in there.

Dr. Smith: And you're probably thinking of it the right way.

Scot: Okay. Wow.

Dr. Smith: I've also had people who've come in with urinary retention who've placed things like that inside their urethra to try to help with rigidity of their erection, so . . .

Troy: Wow.

Scot: Wow. There's a do-it-yourselfer right there.

Troy: So, when you say inject, you're not talking . . . they don't have a needle. They're just going in the urethra, right in the hole there, with the silicone.

Dr. Smith: Oh, no, both ways.

Troy: Both ways? Wow.

Dr. Smith: Oh, yeah. A lot of them will get an infection under the skin because they've injected some of those things at times.

Troy: So, they've injected with a needle under the skin and then just shot it directly in the urethra? Wow. That sounds like a recipe for disaster.

Scot: You haven't had any of those come through the emergency room ever, huh, Troy?

Troy: I have never seen that. After 15 years of doing this, you think you've seen just about everything, but that is one thing . . . I mean, I've seen some crazy things and some crazy things people have put in their urethra, but I've never seen silicone shot in the urethra. That sounds awful.

Dr. Smith: You must not work nights, Troy.

Troy: I worked plenty of nights, yeah. That's just one thing I haven't seen. It's crazy. I haven't seen it, so . . .

Scot: Wow. All right.

Troy: Interesting.

Scot: So, question number two, is there any legitimacy to exercise to promote more size, girth, or stamina? According to what Dr. Smith says, there's no real good research that says that there is. So, don't spend your money on that stuff, I suppose, and don't be injecting either.

Troy: But he did say, though, and it's worth noting, it sounds like . . . John, you did mention that exercise and diet can improve the quality of erections. Maybe not necessarily just the size of a man's penis, but it sounds like there is potentially benefit from diet and exercise.

Scot: And it comes back to that core four that we talk about here. To stay healthy now and feel good now and in the future, you want to work on your nutrition, your activity, your sleep, your stress management, and, of course, know your genetics as well and manage those addictive behaviors and those nagging health issues. So, diet and exercise, it seems like it always comes back to that.

All right. Question number three, our final question for our urologist, Dr. John Smith. Of course, you can use an alias if you'd like to, like an obviously made-up name, like John Smith. Let's see who this is.

John: Hi. This is John Smith here and I'm calling about the "Who Cares About Men's Health" podcast. I was just wondering if I found a lump on my testicle, is it cancer? Just curious.

Troy: So, Scot, were these guys all planted? Did you tell them just to make up the name and call themselves John Smith?

Scot: On the Facebook page . . .

Troy: What are the odds?

Scot: Here's the thing. On the Facebook page, I said, "If you don't want to use your real name, use an alias like John Smith. You could also say you're asking for a friend." I'm trying to . . .

Dr. Smith: So, you set all these guys up then. Okay.

Scot: Dr. Smith, lump on testicle, does that mean cancer?

Dr. Smith: It does not mean cancer. It can mean cancer, but it quite often does not mean cancer. The other thing is a lot of men like to say, "I have a lump on my testicle," and then I'll do an examination and it's not even on the testicle. There's something that's very common called an epididymal head cyst or an epididymal cyst. Sometimes people will call it a spermatocele. It's kind of a cystic little area of the epididymis, which they can continue to grow, get larger. And a lot of times, men will notice those and they think that there's something going on. I see quite a bit of those, especially younger and middle-aged men.

Something that can actually be on the testicle itself that wouldn't be cancer would be a tunica albuginea cyst, or albuginea, depending on who you ask and where they went to school. But it kind of feels like a BB right under the testicle. They're generally benign. There's nothing really to them. It's just kind of a fibrous little ball underneath the layer of the testicle there and you can kind of feel it. It feels like a little BB.

But the best thing to do is if you're worried at all, come in, and we can order an ultrasound to make sure that there's nothing sinister going on. But it doesn't always mean that it's cancer. Oftentimes, it's benign. However, it's definitely worth getting checked out if there's any concern whatsoever.

Troy: So, John, I guess that raises the question as well, as a young man going through sex education in fifth grade, I was taught I should be examining myself every month in the shower to feel for lumps and bumps, get it checked out, and then from my understanding, it's kind of gone out of vogue. Is that something we should be continuing to do, that men should do?

Dr. Smith: So, I think self-examination is important. The biggest thing is just knowing your body, knowing yourself. I don't know that marking the calendar for the 24th of every month to check your scrotum is the way to go. But, you know . . .

Troy: So, you're saying I've been doing it wrong?

Dr. Smith: No, I'm saying you're probably doing it just fine.

Scot: That's so weird. I was over at Troy's house and saw the calendar on his kitchen refrigerator. I'm like, "Well, that's weird, but okay." But now I understand.

Troy: Scot's like, "What's TSE?" "Scot . . ."

Dr. Smith: But yeah, I think to know yourself . . . I mean, most guys, if you have the opportunity to just check things every once in a while and make sure that things are normal. And if anything feels abnormal, it's worth coming in and having someone take a peek at it.

Scot: Yeah, and . . .

Troy: It sounds like . . . oh, sorry, Scot.

Scot: Go ahead.

Troy: It sounds like from what you're saying, though, you don't have to feel like you've got cancer. It's worth checking out. What percentage of these cases that you see actually end up being cancer, people that come in for lumps and bumps they're concerned about?

Dr. Smith: So, for me, it's a lower percentage that I would see that are cancer. Most of them are these very small little lumps that end up being epididymal head cysts or things like that. Testicle cancer, or testis cancer, you tend to have your testicle . . . it feels like a rock. It changes its consistency more so than just a teeny little lump or bump. Those teeny little lumps and bumps are often benign. However, you will find some of those that are cancer, and so it's good to just get it checked out.

But when you have testis cancer, oftentimes, you'll see growth of the testis itself, and it changes in consistency. Now, that's not an everyday, all the time, but it's always worth getting checked out regardless.

Scot: You know what? This is a podcast about understanding your health, and here I am, not going to be as educated as I'd like to be, I discovered a lump about 10 years ago, went in, and it was . . . help me out here. It was benign. They did an ultrasound on it and it was on the spermicidal cord. That's not right, because spermicidal is some . . .

Dr. Smith: Yeah, the spermatic cord.

Scot: Spermatic cord, yeah. It was just something on the spermatic cord and they just said, "Watch it." And if it ever starts hurting, that's when I need to come back. Otherwise, don't worry about it too much. Did I get good information?

Dr. Smith: You did. That's in a similar family to those epididymal cysts. It's in a different location. But those cystic structures, they just end up . . . it just turns into a little sac of fluid, a little sac of water.

One other thing that guys will come in sometimes, they'll say, "Oh, my testicle has gotten larger." There's something called a hydrocele where you can have a fluid build-up around the testicle itself that can make the testicle appear large or fill up the scrotum. They can be quite large. And again, you can come in and we can take a look at it, get imaging if we need to. But that's, again, something that's not cancer. It's just a bag of fluid that develops around the testicle. Those things are all benign and we just watch them.

Troy: John, getting to your point here, this is kind of what I see too in the ER. We do occasionally see people who come in for this and they find a lump. They're concerned. They don't want to wait to try and get in to see a urologist. But it's a small percentage of the time it's cancer. But like you said, it's worth getting checked out, get an ultrasound just to make sure everything's okay.

Dr. Smith: And ultrasounds are relatively inexpensive, too. There's no reason not to get one, really.

Scot: And probably not go to the ER for it.

Troy: Yeah, not necessarily.

Scot: Unless Troy's on at night.

Troy: Yeah, unless it's 3:00 a.m. on a Friday night, because I have nothing better to do then. Please come in.

Dr. Smith: Well, a lot of times, a good primary care doctor will order an ultrasound for you and get you a referral to the urologist's office where you can get some peace of mind. Because specialists can be difficult to get into at times, but . . .

Scot: All right. Well, that was a good session. How are we feeling about that? Dr. Smith, how do you feel about your first experience on the "Who Cares about Men's Health" podcast?

Dr. Smith: I like it. It's a lot of fun. I think I feel a little ill-prepared at times because there's always more. I mean, in medicine, it's never just as simple as the wham-bam, as Troy will tell you. But I think this is great. I appreciate you guys having me on. It's a lot of fun.

Scot: It's been a lot of fun having you on. And now, the moment you've all been waiting for. Oh, boy. I tell you what. I'm sure that everybody woke up this morning thinking . . .

Troy: I thought it was this, Scot. I thought it was me clapping.

Dr. Smith: Is that Troy clapping?

Troy: I'm clapping.

Dr. Smith: Wow.

Troy: I'm clapping for John. He did a great job. I've warmed up to him now. I'm going to give him some applause. So, it's great having you on here, John.

Dr. Smith: Hey, I appreciate you guys having me. This has been a lot of fun.

Scot: All right. Time to end with a good urologist joke. Dr. Smith, go ahead.

Dr. Smith: All right. What does the urologist say before he starts the procedure?

Scot: What does a urologist say before he starts the procedure? Troy?

Troy: I don't know.

Scot: I know what a urologist says if he or she has a breakthrough. They say, "Urethra!" But I don't know what the urologist says when they start the procedure.

Dr. Smith: "It won't be long now." That's my dad joke/urologist joke. It works for both.

Troy: Yeah. That's good.

Scot: Fine work. Thank you so much for being on the podcast, Dr. Smith, and thank you for caring about men's health.

Time for "Just Going To Leave This Here." It could be something completely random or it might have something to do with health. I guess we'll find out now. Troy, kick it off.

Troy: So, Scot, I'm just going to leave this here. The silver lining in the pandemic, I think, for a lot of us . . . I know you've talked about some different things you've done. But one thing for us is I've gained a greater appreciation of getting takeout. We have now done where we're regularly getting takeout at least once a week from a local place. We like to try different places out. We really had some pleasant surprises in trying out new places where we'd never eaten before.

But I think it's more just fun, the whole process, because we're taking our dogs with us. If we went to a restaurant to sit down and eat, we would never take the dogs. We're taking the dogs. They love going for a ride with us. They think it's the coolest thing to get in the car and go somewhere. Now, we are not eating the takeout in the car because, usually, our dogs are not the most well-behaved animals.

Scot: So the takeout always goes home.

Troy: The takeout always goes home because, otherwise, the dogs are leaning over the takeout and drooling in it. That never goes well.

Scot: Maybe you could take the takeout to a park sometime, though.

Troy: We could.

Scot: They could watch squirrels and . . .

Troy: They could watch squirrels and then try and jump up on the picnic table and eat our takeout.

Scot: Just going to leave this here. So, last week, we had "windmaggedon." I don't know what people are calling it. They called it the inland hurricane here in Utah, in the Salt Lake area, in the valley where we had these category two hurricane winds. Now, the difference being that we didn't have water, and the other difference being that category two hurricane winds are constant and these were just the gusts would be up to category two.

But it was windy enough to knock down a lot of trees. Took our power out for about 36 hours, and it just really shocked me how dependent I am on power. Just one thing in our world, if it was to be disrupted, would just bring the entire country to a screeching halt. Thirty-six hours later . . .

I tried to work. We were still supposed to work. But around 11:00 that morning, my laptop ran out of juice. My cellphone, because I was tethering it for Wi-Fi, ran out of juice. And I couldn't do anything else. I was done. My work was done, which just really kind of shocked me.

There are so many people that have it so much more worse. And the other weird thing was that was just limited to our area, so in other parts of the United States, it was just life is normal. But here, life was just so disrupted without electricity.

Troy: But talk about that feeling of the haves and the have-nots. It was 7:00, 8:00 at night. The sun is going down. I look across the street, and all the houses on the other side of the street, their lights are on.

Scot: That was us, too.

Troy: Like, "Wait a second. This is not fair. I'm over here . . ."

Scot: I know.

Troy: Yeah. "I have nothing here." I am here in my 50-degree house with no heat and my neighbors all are just enjoying it and their heat is on, and their lights are . . . I'm like, "Wait, this isn't right."

Scot: That's when you find an outdoor outlet at your neighbor's and run an extension cord across the street.

Troy: Exactly. That's a good thought. I did not do that. I should have.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. As always, thanks for listening. Please subscribe if you like the podcast so we can be sure to be in your podcast player of choice every single week, and we're on all of them. And if you want to reach out, Troy's got the details on that.

Troy: Yeah. You can reach out to us. Drop us an email at hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Website is whocaresmenshealth.com. We actually have a listener line as well. You can call in and ask questions, and I'm hoping Scot has the number for that line.

Scot: 601-55SCOPE. Go ahead and write that down, Troy, and write that down, everybody else. 601-55SCOPE. If you have any questions, comments, you just leave your message right there. Thanks for listening and thanks for caring about men's health.

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