← The Neuro Experience
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- [00:00]
A
When males come to us, you know, and they actually tell us that they're having problems with their erections, one out of three of them will have low testosterone, you know, and ED affects, you know, 30 million Americans, just Americans alone. And so when you look at someone with low testosterone and yes, we talk about the 300 nanograms per deciliter, but back in the day, anything, anybody that had, you know, a level of 50 or less were basically considered castrate. Right. Have like no testosterone and anything actually sometimes less than 250. And so we always look at testosterone as kind of an age specific testosterone level. So someone in their 80s should have a different age range. Sorry, a different testosterone range for normalcy versus someone that's like in their 20s. Right. And so we've looked at the studies and we looked at, you know, thousands of men and basically the older you get, so each decade of life that you get, the range of testosterone actually decreases.
- [00:56]
B
I'm very excited to announce that the Neuro Experience podcast is now proudly partnered with Hone Health. When was the last time you had your testosterone levels checked? HONE is the modern men's health platform that offers personalized care with data driven insights along with licensed physician consultations and medications, all from home. The best part is HONE men typically see their hormone levels double and report low energy and mood improvement by 33% over six months. Guys, hone is doing everything they can to not only thoroughly test hormone levels in men, but optimize from there in the best way possible. So if you want to get your testosterone levels checked, you can save $15 on your test when you click the link below or you can go to honehealth.com neuro to save $15 off on your at home hormonal testing kit. Dr. Lana. Chuck, welcome to the newer Experience podcast.
- [02:04]
A
Thank you so much. I'm so excited to be here.
- [02:06]
B
I we've been going back and forth. I'm so happy that you're here and you're located in New York City, which actually makes my life so much easier.
- [02:14]
A
Yes, yes, we met not too long ago through mutual friends and just love all your content and I actually work like 15 minutes away from here, so just Uber down here was so easy, so simple.
- [02:23]
B
Well, actually let's get into that. So you, let's talk about your background. First and foremost, you're a board certified urologist, correct?
- [02:30]
A
Yes. I know not a lot of there are not a lot of women in urology. I'm actually like the 1% of minority female urologists that actually do robotic urology. I'm actually board certified in urology, but I did a fellowship in robotics advanced lap endo. So really, you know, anything prostate health related, kidney stones, and then really kind of moving into the whole sexual health realm, which is so important. So kind of do that and then also do aesthetics as well.
- [02:58]
B
Yeah, and so that's amazing. Like you've got the aesthetics over one side and then you've also got the urology and you're doing both still.
- [03:06]
A
Yes, it's interesting. You know, I was a urologist for 10 years and I say was because I left academia. I, you know, left an academic urology position as an associate professor and then as an assistant professor and then I did esthetics because I just, you know, loved how making people look and feel more confident really helped their self esteem. And there was just something in the way of like looking good and feeling good from the inside out that you just look in the mirror and you're happy with what you see and then you can go out there and crush it in the world. You know, so and so, yeah, I switched and I pivoted about seven years ago. And so I feel like, you know, my passion obviously has been urology all these years and taking care of men, women, children, you know, the elderly, like septuagenarians, octogenarians. But also now taking care of the aesthetics as well and not really focusing on the vanity part of aesthetics. Because, you know, a lot of people think that aesthetics is just vanity, but it's really not. It's just, you know, looking in the mirror and remembering who you are. There's an emotional component that's tied to looking at yourself or seeing yourself in a certain way. And then when you see yourself stressed out, lack of sleep, you know, aging, and just who is that person in the mirror or on the video that you're seeing and just, you know, feeling a certain type of way. And we're able to kind of help reverse and anti, you know, do a lot of anti aging. So not only for sexual health, but also with aesthetics as well. So powerful to have both.
- [04:32]
B
Oh my gosh, I concur with that. When I haven't had a good night's sleep, oh, I look, I can see it. And funnily, funny enough, you said that I was actually looking at photos and I was talking with my brother, he's 10 years older than me, and I was like, oh my gosh, Leo. I was like, I was looking at photos of you and I when we were, when I was in my early 20s. And he's like, oh, you haven't reached 40 yet. He goes, that's when things like start to really look different.
- [04:54]
A
Yeah, I will say 40 is kind of like, you know, we lose collagen at the age of 18. We just stop making new collagen. And every year we lose 1% of collagen. By the time you're 40, it's like, what is collagen? Your body just doesn't even know. So we actually have to trick our bodies into making more collagen. So there's like a whole new field of like, you know, anti aging and regenerative medicine, which I'm sure you know a lot about regenerative medicine, but really just kind of tricking your body into start making back all that collagen and elastin.
- [05:23]
B
Oh, we're going to do a part two with you and talk all about that because that's incredible. Today we're going to focus on urology, hormones, sexual health, diagnostic approaches and many other things. And I'm actually very interested in, and I mentioned to you earlier, we haven't had a urologist yet. My only experience in this field has been I've. During a rotation I was on a vasectomy case and I got to like see that and shadow. I was like, okay, this is, I don't think this is going to be for me, this field.
- [05:54]
A
Yeah, it's not for everybody. But you know, we, we love the vasectomies and reversals.
- [05:59]
B
Yeah. So I want to off with just understanding what, you know, this whole region from the hips down and, and start with pelvic floor because that's something that includes both women and men.
- [06:13]
A
Absolutely.
- [06:14]
B
I didn't think that, you know, when I was doing research, I didn't even think about men in this case. I just thought about women and the whole pelvic floor region. And the reason why I'm asking you this question is because when I put a statement out on Instagram saying that you're coming on, a lot of people actually asked me about Kegels. So I want to know, are they real? Do they work? And what is the pelvic floor?
- [06:36]
A
That's such a good question. And like you said, when people talk about pelvic floor, all you think about are women. Right. But men also have issues with their pelvic floor and incontinence will increase, you know, as you get older. And for women, you know, the statistics are pretty staggering when it comes to things like urinary leakage or incontinence of urine and Stress induced, meaning that when you're coughing, sneezing, jumping on trampoline, sprinting, running a marathon, you know, every time you do that, you leak urine. And that is such a common thing in women. I mean, I would say one out of three or one out of four women at some point will experience some sort of urinary incontinence. And their pelvic floor is something that really needs to be addressed. You know, pelvic floor as, you know, just like any other muscle in our body. And you, you know, you're like muscle and neuro expert. So you understand that really, from a standpoint of really making sure your pelvic floor muscles are contracting the way that they're supposed to not, you know, laxed because of having childbirth or radiation or even pelvic surgery. You know, a lot of things that women face, right. And just hormone changes and aging in general, that really affects our pelvic floor muscles. And so after having children and even those that don't have children but are aging and have decreased estrogen hormone imbalances, what tends to happen is you get pelvic floor laxity, and things start to droop and they start to, you know, descend. So it's like a hammock effect where your pelvic floor, when you're. When you're bearing down and that hammock just moves so much, and you have that, what we call that urethral instability or hyperactivity, you leak urine. And so Kegel exercises is one of the few methods that we as women, I'm not even going to say urologist, but we as women can do on our own to help contract our pelvic floor in order to strengthen the pelvic floor muscles so that you don't leak urine. The problem is not everyone knows how to do Kegel.
- [08:26]
B
Correct me if I'm wrong, my friend actually bought me these weighted little things.
- [08:31]
A
The vaginal cones.
- [08:32]
B
Yeah.
- [08:32]
A
Or balls.
- [08:33]
B
Yeah. That was quite fun. It was a fun night. Yeah. Me and my girlfriends, for the men listening, this is what girls do when they get together.
- [08:39]
A
Absolutely. I mean, vaginal weights have been, you know, really, really used in the last, I would say, decade for strengthening your pelvic floor muscles. But there's so many things that are out there now. So if you don't have the vaginal weights, the balls, the cones, or devices that help stimulate with the ems, which is electric muscle stimulation, you can do your own Kegel exercise. The problem is, if you're sitting and you're watching t and you're you know, and your doctor urologists saying, okay, now do your Kegel exercises. Every time a commercial comes on, right? You forget. And then it's also like, it's onerous. It's like you don't, you know, you're like, am I even contracting and isolating the right muscles? So when I teach someone Kegel exercise, I actually do a vaginal exam. I squeeze my finger, and half the time they're not squeezing my finger. It's like they're squeezing the abdominal muscles. Maybe they're, you know, their rectal sphincter, but they're not squeezing my fingers. Or sometimes I'll say to them, when you're urinating, just pretend you're gonna stop for a moment and stop in midstream. And just remember those muscles that you use. Then the problem is. And they go home and they said, doc, you know, I pee and then I stop like you told me to. I'm like, no, no, no, don't stop peeing. Just remember those muscles that you're isolating to stop you from peeing. So those are two ways where you can, at home, kind of learn how to do keto's. But nowadays we have things like the V tone, where it's, you know, we actually place it in your vagina, and it's like a. It's two metal plates, and it causes electric muscle stimulation. So basically you're doing. They're doing the Kegel exercises for you. So there's. There's devices like that. There's a chair that, you know, you sit on that, you know, helps you contract your pelvic floor.
- [10:14]
B
Wow.
- [10:14]
A
So it's a. It's a big thing. But, you know, men are not really doing Kegels. But it could benefit certain men, especially if they've had prostate surgery. Right. We always tell them to do Kegel exercise even before. And prevention, I think it's so important for. To understand that women, before they get pregnant, or men, before any radiation or prostate surgery or instrumentation meditation, to do your Kegel exercise beforehand. So you really strengthen that pelvic floor muscle.
- [10:37]
B
I think it's interesting to highlight the importance of pelvic floor not just for, you know, jumping on a trampoline and accidentally urinating. It's more for. Is there other benefits to having a healthy and strong pelvic floor?
- [10:53]
A
Absolutely. So we all know of stressed incontinence. We just talked about stress, urine incontinence. But there's also urgency, urge incontinence. You know, I always talk about it like you put the key in through the door, and before you even know it, like, your brain is telling you, like, I have to go pee. So if you don't get there on time, it's like the key in the door phenomenon. Then you leak all over yourself. Right? So that's urgency, urge, incontinence, nocturia, getting up at night multiple times to go urinate, the urgency, the frequency. So really, pelvic floor exercises can really benefit, you know, a whole host of urinary symptoms. Not only urinary, but we could talk about sexual, you know, issues and improvement of that as well. We all know, and I think you asked the question earlier to me privately, you know, about doing, you know, exercises. Can you acute versus chronic exercise? Can you fatigue your muscles? Is it a good thing, is it ever a bad thing to exercise your pelvic floor? I mean, the answer that I would say is normally the more exercise you do, the more blood flow, the healthier, the stronger the tissues are. Right? And so those are all things that could help not only with climax and sensation and blood flow and decreased pelvic pain and etc. And strengthening the pelvic floor muscles. But. But one of the things that I do want to say is that there's no one size fits all for patients. And if you have certain issues, then doing a lot of. Let's just say weight training may not always be the answer to your pelvic floor issue. Patients that come to me with endometriosis or have an endometrioma or a tumor from the endometriosis, anytime you increase blood flow in those patients, it's a little bit tougher for them, maybe a little bit more painful. Those with vaginismus, those with pelvic floor muscles that are so tight that you really want to relax them. And we can relax them in many ways. Botox is one of the ways that we actually relax them along with physical therapy. So there are times where, you know, doing too much of an exercise for specific muscles that are already hyper contractile may not be the best idea.
- [12:55]
B
I love that. You know, I know that they're even doing certain Pilates classes that are really focused on that now. I haven't taken one, but maybe I will because you've just highlighted how important it is. All right, so you and I were actually connected. You know, we're both advisors to hone health and that that's a really great company. What they're doing for everybody listening is they're really helping males optimize hormones. And I focus a lot in educating People on the current epidemic, if you will, of low testosterone amongst males, which I think it's classified as 300 nanograms per deciliter and below, and I forget the statistic, but maybe a percentage of men, maybe what, 30, 40, 50% of men having low testosterone. And we know testosterone is the hormone that is, yes, it can be involved in libido and a lot of male dominant things, but we know that it's also involved in focus, attention, concentration, energy. So I think it's a hormone that needs a bit more education around. But I would actually love to understand what, what low testosterone levels have on sexual function in men, because that's what a topic I haven't dealt.
- [14:11]
A
Yeah, no, that's a great topic. And you mentioned, I would say most of the time when males come to us, you know, and they actually tell us that they're having problems with their erections, one out of three of them will have low testosterone, you know, and ED affects, you know, 30 million Americans, just Americans alone. And so when you look at someone with low testosterone and yes, we talk about the 300 nanograms per a liter, but back in the day, anything, anybody that had, you know, a level of 50 or less were basically considered castrate, right? Have like no testosterone and anything actually sometimes less than 250. And so we always look at testosterone as kind of an age specific testosterone level. So someone in their 80s should have a different age range, sorry, a different testosterone range for normalcy versus someone that's like in their 20s. Right. And so we've looked at the studies and we looked at, you know, thousands of men and basically the older you get, so each decade of life that you get, the range of testosterone actually decreases, which makes sense, right? So if you're 80 years old or if you're 30 years old and you have a range of Testosterone like you're 80 year old and that's a big problem, right? And also looking at your function, your muscular function and your exercise tolerance and things like that, someone who's like a big bodybuilder, right, Their testosterone level, their needs for testosterone may be different from someone who doesn't do any type of exercise or weight training or weightlifting. So I think it's important, important for us to understand that it is a number, but it can affect your libido. And that's really one of the biggest things that we've seen, low testosterone affecting your libido and doesn't mean that if you have a low testosterone, you don't have a high desire for sex. Because we know that sexual desire and libido and erectile function really is a very complex thing that doesn't just involve, you know, a diagnostic laboratory test. Right. There's psychological things that can happen. There's medication, there's surgery, you know, so there's really, if you look at, like, sexual health, it's really just a component of your overall holistic health, but it's a really major component.
- [16:22]
B
You mentioned that it's like one out of. Was it one out of three men.
- [16:26]
A
That actually come to the doctor saying they have erectile issues? Yeah, we check their testosterone as one of the tests.
- [16:32]
B
What else would be going on in erectile dysfunction?
- [16:35]
A
Yeah, so with erectile dysfunction, when somebody comes to me, I'll just kind of bring you like. Yeah, one of our consultations. Yeah. Because a lot of men, you know, if you don't mention it, we're not going to know how to treat it. Right. And so like you said earlier, someone with, like, mental fatigue, fogginess, lack of sleep, irritability, mood changes, difficulty with weight gain and central obesity and just distribution of fat versus muscle, you know, all those things. And stress, of course, tie into your hormone levels, whether it's testosterone. And women estrogen and progesterone with men also have estrogen as well, but also like your thyroid function, your adrenal function, et cetera. So it's like a whole complex thing. And so, you know, really, just to. Just to come back to the simplicity, I would say, you know, the most important thing when you are discussing with somebody the erectile function is to really do a full history and to do not only like a regular history of their medical problems, but also a mental history as well, I think psychological history as well. But also like their medications, what surgeries have they had, you know, what is their diet like, are they exercising, are they drinking, are they smoking? So all these lifestyle things also come into play. So it's really a whole host of things. And if you look at erectile dysfunction in general and you put it in like a pie chart, and you're saying, okay, what is the number one reason for men with ed and what is that reason? Okay, yes, you look at diabetes, you look at vasculogenic, which is like blood vessels, Right. It's an endothelial disease. Right. And, you know, one of the things I always say to my patients is if you have issues with erections that are vasculogenic in nature, then that's a harbinger for disease, for your cardiovascular function. So then this, you Know, we do studies all the time looking at ed. When patients say. Cause they may not come to you. And they may say, you know, I feel like my heart's not healthy. Right. But they'll come to you and say, you know, my erections aren't as durable, aren't as firm as they used to be. And so that really is a harbinger for disease, for cardiovascular disease. So we actually look at endothelial function as well as, you know, as medications. And so. And then we do a whole slew of tests, you know, once we evaluate, examine, and we can go into that, if you want to. Exactly what we're looking for.
- [18:50]
B
I would love that, because I find it. I don't know what the statistics are, but are you seeing a larger proportion of men coming to you with this. This distinct issue?
- [18:59]
A
Yes, we are seeing, I would say, younger patients now with issues with ed. Some of it. I'm gonna. I'm gonna talk about this a little bit, but some of this could be contributed to porn. The porn industry. Yeah. Porn induced ed, you know, and it's controversial, but some of it' that also a lot of psychological things, too, as we know, mental health is so important. Oh, yeah, yeah. Let's get back to. Let's get back to the board. Yeah.
- [19:26]
B
Because I have read that ongoing usage of pornography can lead to somebody to not, you know, feel like they can have normal sex in real life. Is that what you're referring to?
- [19:39]
A
Absolutely. Yeah. So, you know, the idea and the theory behind porn induced ED is that that when someone. And they looked at studies to show the length of time that patients would watch porn, that would decrease their sensitivity. It's usually about 30 minutes or more. So if you're someone that watches porn every day for 30 minutes or more, that's going to decrease your erectile function. And the reason is because, number one, you may be hyperstimulated, but really, it's hyperstimulated in all senses of the word. Right. It's like hyperstimulated that they could only have orgasm with masturbation and watching porn. And those that, you know, are just so used to such visual stimuli and, you know, auditory and everything else that even with their partner, they're unable to get to that level. And so they, you know, they have issues. And so the treatment for that. Can you imagine what the treatment is?
- [20:34]
B
Stop watching porn. Stop watching porn?
- [20:36]
A
Yes, exactly. Just stop watching porn. And that's what we tell our younger patients, you know, with these issues. But we are seeing a lot of younger patients. I Used to work at the va and, you know, you know, a lot of ptsd. So a lot of, you know, the mental health, you know, screening questions that we need to ask as well. So we are seeing a lot more younger patients with ED or patients that are slightly older. And, you know, they. They're saying that they're, you know, that their erections aren't as strong enough, but when you look at their history, you know, they have obesity, they have high blood pressure, you know, they have risk factors for coronary artery disease and stroke and things like that. And. And they. They're just not really putting all the emphasis and understanding that. That, you know, whatever you put in your body, whatever kind of lifestyle choices you make and however healthy you are, really has a huge impact on your erectile function. So we talk a lot about maximizing your erections and maximizing your sexual health for women and for men. And a lot of it is just, you know, doing those things that you always talk about, three things, which is.
- [21:38]
B
Exercise, sleep well, stress less.
- [21:40]
A
Correct? Yeah.
- [21:41]
B
But I wanted to see if there was a correlation between, you know, we're seeing that endocrine disruptors, plastics, and, you know, things like this are getting into our system and dampening. The dampening, how much testosterone we have. So I wanted to see if that was correlated somehow with these issues.
- [21:59]
A
You know, I. I will say I've not seen a lot of studies looking at the direct correlation, but certainly, like, I know, you know, Saad from Hone talks about EDCs and how it directly increases the infertility rates. Definitely we're seeing things in our diet, you know, whether it's organic or whether it's like, gmo. We're definitely seeing a lot more hormonal disruptors and imbalances nowadays that could lead to erectile issues, but also just sexual health issues in women as well.
- [22:33]
B
I came to your office, your beautiful office, and you gave me a tour. And I. I remember you. You know, you were going through, you know, the. The menu of things that you do there. And I remember you said to me that you do a lot of. Of girth injections as well. And I wanted to actually ask you this because I was thinking about. I'm like, that's interesting. Has that got to do with, you know, males just wanting a. Is it a larger penis or is it just.
- [22:59]
A
Is it.
- [22:59]
B
Is it medical as well?
- [23:01]
A
I would say mostly enhancement. It's. There's very few real instances of.
- [23:07]
B
I thought maybe that's an ED problem.
- [23:09]
A
As well for ed. I will say not so much for ed. But for something like Peyronie's, which is abnormal curvature due to micro trauma and formation of plaque that causes a bent penis, with those patients, yeah, they're definitely looking for a cosmetic improvement because it's not just cosmetic. Right. If they're unable to have vaginal penetration because of pain, let's just say because, you know, the degree of curvature is like 90 degrees or above, and there's pain involved, then that's a real issue, too. And urination as well. Right. I mean, you have to be able to urinate kind of know, so you're not spraying all over the place. But, you know, I would say most people that come to us asking for girth enhancement, they themselves actually don't have what we consider like a small penis. You know, the standard. You know, that the penis size is. You know, of course, it differs from race and ethnicities and. But it's really, you know, anywhere between four and a half inches. Now, you look at flaccid versus. Versus, you know, stretch, penile length, which is what we use to kind of. To put the ruler and we stretch that. We put the penis in the back.
- [24:16]
B
You really put it on a ruler?
- [24:18]
A
We do, absolutely. We put on a ruler. Yeah, we do a stretch, you know, flaccid. Okay, right. Because you can get a lot of penile shrinkage with just, you know, being in the cold and whatnot. And there's a lot of spongy tissue. And so we. So we should put it on stretch, and then we. We go ahead and. And we get our ruler out, and then we. Obviously, we talk about girth as well. So most people want both increase girth. They want to be girthier, if that's a word.
- [24:45]
B
I am so shocked at that.
- [24:47]
A
Who would have thought, you know, they want more girth and they want more length. But I'll tell you, a lot of what we do really improves the flaccid length. So what's called, like, the quote, unquote, like, locker room penis. And I know that that term has been thrown around loosely, but what locker room penis is, is you in the flaccid state, a male in the flaccid state, where it's not kind of shrink drinking in. It's not quote, unquote, that buried concealed penis that we actually do surgery for. But we want it to be lengthier. We want it to hang longer. And so in order to do that, we have ways of making the penis a little bit longer. One way is by doing. I'm going to talk least invasive to surgery, Right. The least invasive is by doing Botox. And you guys may be thinking, like, people do Botox in the penis.
- [25:37]
B
Oh, listen, we've got it for trigeminal neuralgia. We've got it for. We can put Botox really anywhere.
- [25:42]
A
We can. We put it for hair, we put it for face. Right? So Botox in the penis will relax the dartos muscle and allow the penis to hang longer. So that walking around in the locker room where it hangs longer is what a lot of men like. Right. Second thing we can do is penile fillers for girth. So fillers is hyaluronic acid. I don't like to use, like, silicone or any of those permanent injectables because, you know, you can't really take them out if there's any issues or they create granulomas or there's any, you know, lumpy bumpiness. And it's cosmetically unpleasing. So we like to do, you know, smooth hyaluronic acid fillers to increase the growth of the penis. And you put that on Darto. So you put it outside, you don't put it inside because there's blood flow inside. And you cannot block the blood flow because then you won't get blood flow to the penis and you can't get erections.
- [26:34]
B
Right.
- [26:34]
A
So this is all just for cosmetic enhancement. And then there are things that we can do, such as cutting the suspensory ligament of the penis and then putting weights on the penis as it's healing so that it hangs longer.
- [26:50]
B
Wow. Yeah.
- [26:51]
A
Because there's a suspensory ligament that actually attaches the penis to the pubic bone. And part of that is inside. Right. Kind of internal. So if you're. If we're releasing and we're cutting and severing that ligament and you're putting weights on there, it's going to cause that penis to be lengthier. Right. But that hasn't really been shown to work very well because things scar down, they become even shorter. And so we don't actually typically do those procedures anymore, but now we have a penuma implant. It's like imagine women getting breast implants, putting silicone breast implants or saline breast implants. This is a silicone implant that goes on the penis underneath the skin.
- [27:32]
B
Oh, wow. Yeah. Okay.
- [27:33]
A
That's a good thing.
- [27:34]
B
That's amazing.
- [27:35]
A
In the last five years, and I think there's only eight urologists that do that in the whole country. And one of my partners does that, and he's very busy with this procedure.
- [27:45]
B
He must be. You know, I'm really happy that you're shining light on this because females get a lot of attention when it comes to cosmetic surgery. And you mentioned, I wouldn't call it cosmetic, but when you mentioned earlier how you look, you know, when it comes to, you know, beauty and aesthetics, it's about how you feel. Do men, I can't imagine as many men coming to you for, you know, Botox and fillers and, you know, face things, but do they come to you and equate how they feel and how they look at themselves in the mirror with the size of their penis?
- [28:17]
A
I would say they're kind of two different populations, at least in my practice. The men that are coming for penile augmentation, I'll say non surgical versus surgical are like a different subset of people. Yes. I think men are caring more and more about their, you know, their physical appearance. Appearance, but also their face and their wrinkles. Mainly, though, for aesthetics purposes, cosmetic purposes for men, for face, they care a lot about their hair. Okay.
- [28:45]
B
Yes.
- [28:45]
A
And their teeth.
- [28:46]
B
Yes.
- [28:47]
A
And some wrinkles. Right. But everything else they kind of like, you know, they, they kind of deal with because, you know, they have good testosterone and good skin most of the time.
- [28:55]
B
Right.
- [28:57]
A
But for, I would say for the augmentation part of their penis, I would say a lot of them come and it's interesting because like I said earlier, I alluded to earlier, it's actually not small, but in their heads. Right. So there's like a psychological component where they feel like they're not so confident. And a lot of times I'll have them come with their significant other, you know, their wives or their partner. And their partner or their wives are usually happy and they're not the ones complaining, but it's the patient who feels like they, they have this kind of, you know, psychosocial embarrassment with the size of their penis. And so we have to be very careful to treat those patients because if it's some. Something that's super internal or they have some sort of dysmorphia with the size of their penis, no matter how big we get them, they may not be happy. Right. And we've had patients certainly come in and some are from the porn industry, some are not. But some of them are actually very well endowed, but they still want to be bigger. And so that's a tough conversation to have with those patients because they just want to go bigger. But in reality, it may not be even suitable for, you know, penetration if it gets any bigger. And so. So lots of different conversations that we have with our patients.
- [30:10]
B
I was. My question, I was just about to ask you was, is size dependent on genetics? But actually, then it got me thinking about something else, which is what I was going to bring up towards the end, but we're scratching the surface now, and that's the area of micro penises. I would actually love to get a definition of. Of how is a micropenis clinically defined and diagnosed, and what are the current treatment options and outcomes for individuals with this condition?
- [30:40]
A
I get this question a lot. So a true micro penis, by definition is about two and a half standard deviations below the mean. And that is for us men, about 4.52 centimeters, which doesn't sound very lengthy, but that is actually the mean. And so a true micropenis, there's a lot of different factors that go into it. We've seen. And I'll tell you, there's a lot of concern about micro penises. And, you know, working as a urologist and seeing a lot of newborns, you know, where the parents or the pediatrician or the, you know, the OB that, you know, help gave birth to the women, there's concern for micropenis. And so when they're just newborn, there really is no specific length. Right. Because testosterone's not there yet. And so we actually don't really think about treating them until they start having erections and young babies actually start getting blood flow and start having normal nocturnal erections. And that's a normal thing. And so I would say the only time that I've really seen it, I mean, I would say hormones have a lot to do with it. So someone has hormone imbalances where they don't have any testosterone, or maybe they didn't have testosterone in utero for some reason either. Maybe medication that, you know, was the mother was taking then, then a true micro penis is seen, but it's so rare. I believe, like a 1 in 10,000 people actually have a micro penis. And so, you know, a true micro penis is a penis that really, you know, like I said, two and a half standard deviations below the norm. So you're looking at like an inch, inch and a half. Right. And those patients really require a lot of extensive surgery, but not until after. After puberty. And, you know, after puberty is hit and there's no growth anymore and things are stable because you never want to operate on someone where things are still changing constantly. Right? And so, yeah, but like grafting and, you know, skin grafting and you know, all these things come into play. But some of the things that we can do for someone with like a smaller penis that wants, you know, a little bit of more length and girth are some of the things that I talked about. And ultimately for someone who has, has enough skin and can tolerate an implant, that's probably what they want. And the implant is a non functional implant. It's not like an implant that we put, that we call, you know, the pump la bombita in Spanish, because everyone knows la bombita. But that's for, you know, patients that they've tried the oral, you know, the Viagras, the Levitras, you know, the Stendras, all the things Cialis and it's not working. And then we do inject trimix quad mix injecting medication into the penis, which actually patients do on their own at home. And despite that they're not able to get erections. That's when we talk to them about the three piece penile prosthesis where we put the cylinders, the silicone cylinders into the corpora, which are the two bodies of the penis. And then we put the actual inflatable pump inside their, inside their scrotum. So if they're like right handed, we put them in the right hemisphrotum, left handed, put in the left hemisrotum. And then there's a reservoir that collects saline so that when you pump that saline that goes from their behind, their pubic bone go into the cylinders and make them arrest.
- [34:01]
B
Okay, that's interesting. And like, thankfully it's a very, you know, it's not a condition affecting many people.
- [34:08]
A
For ed, I would say more and more. Yes, but micro penis itself is not.
- [34:13]
B
Yeah, yeah, yeah, that's good. We're focused a lot. Just, you know, the first half of this on, you know, ED and sexual dysfunction for men. Is there anything that's comparable for women when we talk about ed? Okay, for men, what would be the equivalent for a female?
- [34:29]
A
Such a great question. Because there's a whole host of things for, for women, low libido for women is a big thing. Inability to have orgasm, like, you know, an orgasmia is a real thing in women. There's a lot of women that can't have orgasm unless it's with clitoral stimulation. But they've never, never been able to have orgasm with vaginal penetration. And that's because the nerves that serve the clitoris are different than the nerves, the confluence of nerves and blood vessels that are in the G spot. And I'll talk about The G spot a little bit. Because people are always asking me, is the G spot a real thing? And it is a real anatomical thing. And I can actually find the G spot just by doing a vaginal exam and asking my patient, do you feel sensitivity in this area? If they do, we can actually target procedures like the O shot, which is using. Have you ever heard of the O shot? Yes. By Charles Reynolds. He's a physician.
- [35:24]
B
What's O stand for?
- [35:25]
A
Orgasm. Yeah, so the orgasm shot. And so we basically take your prp, which I think you know about, via platelet rich plasma. So we get your blood, we spin it down, we get only the platelet rich plasma, which has all the growth factors, and then we inject it back into your G spot. We also inject in the clitoris and everyone's like, oh my gosh, that must hurt a lot. But we do numb and you don't feel a thing. And so we do that to. To increase blood flow. We do that to increase nerve sensitivity. So people actually feel like they have a much better chance of having an orgasm through vaginal penetration and multiple orgasms.
- [36:04]
B
Wow.
- [36:04]
A
Yeah.
- [36:05]
B
Women are amazing. The reason I wanted to bring that up is because I love to understand why low libido is occurring outside of the realm of hormones. Because we know that evidently, like, as we get older women and reaching the menopausal post menopausal stage, I know that estrogen must play some role in libido. Yeah. But what about for people who are. They're not in, you know, they're maybe in their late 30s, I've heard about this. Or, you know, 45 years old, they're not near menopause yet, but they're experiencing low libido.
- [36:41]
A
Yes. I would say estrogen. There's a complex interplay between estrogen, estrogen, progesterone, and testosterone in women.
- [36:48]
B
Yes.
- [36:50]
A
You know, in the studies, it doesn't. There's not 100% correlation of testosterone increasing women's libido, however.
- [36:58]
B
Interesting.
- [36:58]
A
Right. It's not 100% correlated. However, just anecdotally, I've had lots of women on testosterone. And once their testosterone levels are elevated, I mean, of course, and they're balanced out with their estrogen and progesterone, their liberty libido goes up. Right. And so it's not just the interplay of just hormones for women, but it's also stress, it's also their diet. Just like with men too. But with women, I feel like, because it's more complex, the metabolic issues are more complex in Women just because of the multiple different hormones that we have that really take center stage. It's really the interplay of estrogen and progesterone. If you have more estrogen, you should have more libido, more desire, Desire for sex. You should also have more natural lubrication with estrogen.
- [37:45]
B
Yeah, that's another. That was the next one because I know that there is some treatments, is actually inserting estrogen to increase lubrication.
- [37:53]
A
Absolutely. Pellets or creams. You know, there's. There's an insert that, you know, you place probably every night to every other night. And I know those things are really helpful. And also hyaluronic acid too.
- [38:05]
B
Wow.
- [38:06]
A
You know, there's, I think, a new FDA approved hyaluronic acid insert, vaginal insert that you place in there. And it just keeps things really nicely moisturized and lubricated. Because vaginal dryness is a real concern. My patients will come in and say, Dr. Lana, I have like no desire for sex. But also when I do have sex with my husband, it's like needles, Right. It hurts so much. And so those are the patients that we want to treat. But remember, not every woman wants estrogen or they're scared of estrogen or, you know, most women, Women should have some form of intravaginal estrogen because it doesn't get absorbed to systemic levels that can actually have any negative effects. It could only have positive effects. This is one thing I want to stress. People are nervous about vaginal estrogen, but it's all good.
- [38:50]
B
But mainly because of the correlation with.
- [38:52]
A
Breast cancer, breast cancer, endometrial cancer. There was a WHI study back in the 80s that basically said that they showed that there could be possibly an increase, increase in endometrial cancer, breast cancer in those who took, you know, estrogen. But that was a flawed study. And there's been so many other studies afterwards that show that intravaginal estrogen.
- [39:17]
B
Right.
- [39:17]
A
Especially the micronized and progesterone, will not necessarily increase your risk of breast cancer and endometrial cancer because it doesn't get absorbed systematically, systemically. And so. But you have to have the right dose. You have to know who you're going to. You have to make sure that you don't have unopposed estrogen, that you have progesterone in addition to estrogen, and it's also beneficial. So now we're looking at studies showing decrease in heart disease, strokes, you know, heart attacks in women, Alzheimer's even, right? Yeah, just the whole balancing of the hormones. So I Just want to stress out there that there's been a lot of fear going on with women on estrogen or hormone replacement therapy.
- [39:59]
B
Very controversial.
- [40:01]
A
Very controversial. Yeah, very controversial. But I will say all the, the newer studies are showing that the risk with intravaginal progesterone and estrogen really is minimal to no issues systemically.
- [40:17]
B
Yeah, that's. I think that that would be. That's an interesting topic because I think they're. There's like a window of opportunity that I think some women get to either get on HRT or not get on it. Yeah. Definitely need to dig into that field more. Okay. And just while we're on the female, is there anything aesthetically that can be happening for. For women that come and see you? I know that you're doing some, some things in that area as well.
- [40:44]
A
Yes. One of the things that we're doing, a lot of women are coming to us and they're saying, saying that their labia minora just, you know, looks a little bit more lax. There's more skin, there's more hanging, and it rubs against each other and it hurts post childbirth. Sometimes it could be post childbirth, but it could just be. You know, there's a lot of younger women that just have, you know, a larger labia minora. And you know, what they prefer is a kind of a plumper labia majora, which are the external lips and then the internal lips to not hang as much.
- [41:18]
B
Right.
- [41:18]
A
And so some of the things that we can do is we can do radio frequency. Like Morpheus.
- [41:23]
B
Yes.
- [41:24]
A
You know, you guys all heard of Morpheus for face, of course. But, you know, introducing Morpheus, which is radio frequency energy to the tissues to help shrink the tissues. And that's something that's non surgical that we can do for the labia majora. Fat transfer. Right. Put it into the lips of the labia is also something a lot of women like to do. And you know, aside from fat people looking into sculpture, looking into highlighting hyaluronic acid fillers into the labia majora. So that's something. Yeah. But reduction of the clitoral hood. So all those things can be done non surgically. Of course they can be done surgically as well with labioplasty, vaginoplasties, paraneoplasties.
- [42:01]
B
I was going to ask you what vaginal rejuvenation was.
- [42:05]
A
I know that's a question that we get a lot. There's like a big black box warning, like vaginal rejuvenation, like, what is it? Right. And so vaginal Rejuvenation just really applies. Applies to anything that could be done to the vaginal walls to help bring back that collagen, that elastin making things, you know, increasing blood flow, decrease pelvic pain, doing all the things that is necessary to basically turn back the clock. Right? So that could be done with, you know, hormone replacement. It could be done with energy devices like lasers, erbium, CO2. It could be done with Morpheus with radio frequency. He. And so those are really the majority of things. And of course, surgery for vaginal rejuvenation, but it's kind of like this loose term. Nobody really knows what it is, I.
- [42:53]
B
Don'T know what it is, but it's.
- [42:54]
A
Improving function, it's helping blood flow, it's helping your natural lubrication back, and it's also increasing your sensitivity. So increasing your sensitivity and orgasms and getting things tighter. And so all those things kind of fit into to that vaginal rejuvenation box.
- [43:14]
B
Interesting. I do hear a lot of women saying that that's what they're going to do for their 50th birthday. So what can both men and women do naturally to maybe stave off some of these dysfunctions that they might be facing?
- [43:28]
A
So naturally, what I would say is obviously being healthy, decreasing the rate of obesity, decreasing your stress levels, and really just get evaluated and making sure your hormones are balanced or at a good level. And, you know, a lot of times in medicine, people come to us when it's already too late or already when they're having, you know, specific diseases that. Where medications don't even work anymore, or we start them on medication, but they eventually progress to needing surgery. So I think that huge field right now, Louisa, is really that kind of preventative sexual health, you know, kind of realm where. Let's get you optimized before you have any issues and directions, things that you can do. Obviously staying away from, like overindulgence on alcohol and smoking and, you know, party lifestyle. But get good sleep, decrease your stress, stay healthy, exercise.
- [44:25]
B
Stay away from porn.
- [44:26]
A
Stay away from porn. You know, over 30 minutes of porn, maybe less than 30 minutes.
- [44:31]
B
Yeah, kidding.
- [44:32]
A
But just, you know. But yes. I mean, listen, I'm not saying porn is bad in general. It's very controversial. But we are seeing it a lot more in our, you know, our patients that are, like, addicted to porn.
- [44:43]
B
Yeah, it's. I think you mentioned preventative health and preventative medicine. I've actually never heard of preventive sexual health medicine, to tell you the truth, because I kept thinking, you Know, you got to do your hormones and for women it's got to be at the right time. I remember I did, I did a blood test just because I like to experiment, you know, probably within 10, 15 days. Okay. Of each other would, you know that it's dependent on cycle.
- [45:10]
A
Cycle.
- [45:11]
B
And it's. One test was like, oh, my God, Louise, your progesterone's so high. Oh my God, it's so low. It's like. Well, it's because I was testing like, the difference, you know, around my menstrual cycle. So we've also got to, you know, enable women need to know that it is based on your menstrual cycle.
- [45:26]
A
So getting your time of day, whether it's early morning versus diurnal, like nighttime.
- [45:31]
B
I'm telling you, like, what is drinking could be like up here and then it can be all the way down, just depending. It's like. So you have to. And then sometimes you can be diarrhea diagnosed wrongly because of that.
- [45:41]
A
Absolutely. Which is so important that when women are going to their, you know, physicians that they. We know exactly where they are in their cycle, literally. And sometimes, you know, postmenopausal, they don't have a cycle anymore. But we should only take, you know, blood at the time where, you know, for, for instance, for men, the time and the first thing in the morning, even before any o', clock, you know, so they fast, they come in. We check their blood sugar, we check their hemoglobin to make sure they're not anemic, and therefore that's not an issue. We check their blood pressure to make sure that they don't have high blood pressure. So all these little things, you know, it's so important. Yeah.
- [46:18]
B
I want to talk to you now specifically about. I don't know if you can shed light on two things. Well, vasopressin, for example, and this. I know that there is a. I know that when we look at alcohol use, it can really disrupt. Because I get a lot of questions with men saying, louisa, why do I keep waking up at 4am to go to the bathroom? I don't know why it's a 4am thing. And we're generally. When I say this, this is men, I would say generally from age 50 and onwards, it could be younger. But why do men specifically feel the need to urinate, especially in the middle of the night? In the middle of the night, around three. Four.
- [46:56]
A
Three, four, yeah.
- [46:57]
B
So is it a vasopressin?
- [47:00]
A
You know, so. Yes, some of it could be, but I'll Tell you what, most of the time it is, right? So yes, we do get, you know, we do sometimes give like, you know, adh, like antidiuretic hormone at nighttime for those people who have true noctoria versus polyuria. So noctoria just means that you get up in the middle of the night and you pee multiple times. Right. Polyuria is that you actually make more urine at nighttime so you have to get up to pee. So I always ask my coffee my questions. When you go pee, is it just a little or is it a lot? A large volume. If it's a large volume and sometimes we do a 24 hour urine collection so we could just see how much volume or like avoiding diary. So they actually pee in like a commode or like in a urinal and we actually see how much they're urinating. But if it's large volumes and obviously it's, you know, it's because they're making more urine at night. You have to kind of see what's going on. A lot of times how I explain things is that when you are laying down, all that fluid from your interstitial tissues are now going back into your intravascular space. So it going back into your veins and therefore it's filtering through your kidneys. And so you're actually seeing more volume filtered by your kidneys at nighttime just because you're laying down in a recumbent position versus standing up. And when that happens and you're filtering more blood, you're actually making more urine at nighttime. So I think that's really the main issue with a lot of men and women is that women as well, so they're taking more urine. You know, why is that? It's because when they're laying down, all the fluid is pulling back and coming into their intravascular muscular space just from gravity.
- [48:31]
B
Is that. But, but why I don't wake up in the night, I don't feel the need. But why isn't it happening to me then?
- [48:37]
A
It's for specific people who have issues with, I would say congestive heart failure. Only patients. But patients with like vascular, vascular issues or heart issues where they're just not pumping the blood as efficiently and so they pull like, you know, a patient, some patients have lower extremity and edema. You know, like when you're pregnant and you have more volume and your legs get swollen when you lift those legs up, you know, when you go to sleep, that all goes back into your bloodstream. And so what I always tell my patients, if they do find that two hours before they go to bed. Number one, restrict your nighttime and fluid intake. Just don't drink anymore. I see a lot of patients who are like, I pee all the time at night. But then, you know, after they pee, what do they do? They just drink a glass of water and then they go back to sleep. So it's like, it's constantly, you know, that, that cycle of making more use urine because you're drinking more. But a lot of times, you know, and dry mouth too. They're drinking more water because they have dry mouth at night. So I always tell them to use a humidifier versus drinking a lot of water. So I fluid restrict them. Nothing after 8pm and then I ask them to put their legs up. If they're watching tv, put their, or they're reading a book at nighttime or whatever their nighttime routine is, lift their legs above their heart, let all that fluid go back into the intravascular space so that if you do need to urinate because you're making more urine, you're doing that before you actually fall asleep.
- [49:51]
B
Oh, that is so smart. Okay, what about having some salt before you go to sleep? Would that do anything?
- [49:58]
A
You know, I, I, I, I know that because the, the question is, you know, if you have more salt. The problem is if you have more salt, you're gonna get more thirsty, you drink more water. So I would say mainly just abstaining from, you know, oral intake, fluid intake after 8 o' clock at night.
- [50:14]
B
Okay. I'm so happy that we did that. Okay, let's talk about prostate and psa. I know a lot of men are, you know, scared and I don't know whether the rates have gone up of prostate cancer.
- [50:27]
A
I would say that detection has definitely gone up because we're testing more people.
- [50:31]
B
We're testing more people. Isn't the age now what is the age? Is it, it's gone down from like 45 to 40 now.
- [50:38]
A
So. Yeah. So the United States, like, you know, Prevention task force basically put out.
- [50:46]
B
You.
- [50:46]
A
Know, kind of like the guidelines. Right. In addition with the aua, the American Urological Association. So typically it's at age of 50, you get a screening blood test called the PSA, prostate specific antigen, and you do a digital rectal exam.
- [51:00]
B
Right.
- [51:00]
A
And that could be done by your primary care physician. Doesn't have to be done by a urologist as long as your primary care physician knows what they're looking for and what they're feeling for, but in specific patients. And the earlier we talked about different ethnicities and what we typically see is African Americans is one ethnicity where you can get increased, higher risk prostate cancer at a younger age. Because not all prostate cancer kills. If you look at cadavers that were taken for studies and you look to see what they died from, 50% of the time they would have died from something else, but have concomitant prostate cancer. So that's number one. Not all patients with prostate cancer will die of their prostate cancer. They may die of other diseases before their prostate cancer ever kills them. Okay, so the question then becomes, well, Dr. Lana, how do we determine what type of prostate cancer is going to be aggressive and kill someone versus not? So we're looking into a lot more kind of advantage advanced like tumor biology and more diagnostic testing to see which is, you know, the more higher grade aggressive. So African Americans are, you know, one group that have increased risk of prostate cancer earlier on. So if you do, or someone that has a first degree relative that had prostate cancer, that is your most important demographic of those people who are at highest risk for prostate cancer. So those people we test as early sometimes as 45 to 40. Even at 40, we say get a baseline, get a baseline PSA and a rectal exam. And then every year or every two years you see what's going on with them. But if you have someone in your family, let's just say your father, your brother, some first degree relative has had prostate cancer, what age should they get prostate cancer? If it's like 90, half the population will have prostate cancer at 90 years old, or even maybe 100%, it's a high chance of prostate cancer. But if it's 50, then you should test at 40 because we're seeing it earlier.
- [53:11]
B
What's a healthy PSA score for a 50 year old male?
- [53:15]
A
We look at PSA not as a singular event, but as age related, which you mentioned, and also the velocity, the velocity and the density. So density just means if they have a big prostate, they're going to have more psa. So we take their psa, we divide it by the volume of the prostate that we do via ultrasound and we get a number. We also look at percent free PSA versus total PSA. The bottom line is anything that technically is below 2 and a half, 2.5 nanograms per deciliter is considered normal. However, if you were 0.8 one year and then you are 1.5 the next year, that's a huge, that's a huge jump. That's at least a 0.6 nanogram per deciliter velocity increase. That's someone that you want to test. So it's not so much the number because if you're less than 40 years of age, your PSA should be less than 2 for sure. If not 1.5. But if you have a 2.5 and you're 50, even though it's specifically less than 2.5, we should still probably have a suspicion. Looking at your velocity and your age.
- [54:20]
B
Specific PSA range, is that sporadic or is it like, is it, Is this a genetic.
- [54:27]
A
It's genetic, yeah. We don't really know why some people. We don't really know why people get prostate cancer. We just know that men get prostate cancer because they have prostates. And we know the older you are, the more, the higher the chances you are of developing prostate cancer.
- [54:42]
B
It's for any, really any disease.
- [54:44]
A
It's like for anything. Right. Except for some cancers that are due to viruses. Right. Like hepatocellular cancer, cancer from hepatitis. Right. And so with prostate cancer, we really don't know why, but we do know that testosterone, once you get prostate cancer, testosterone helps it grow, which is why one of the treatments with somebody with prostate cancer is to decrease their testosterone level, which is why back in the day, we used to do bilateral simple orchiectomies, taking out their testicles, but then you have to take out their adrenal glands. Because it's not just the testicles, it's the adrenal glands make about 15% of your testosterone. So we do sometimes chemical decrease, which is like Lupron or GnRH agonists. LHRH agonist. Basically telling your brain to shut off the production for your hypothalamus to your pituitary, to your adrenal, to your testicles, to just shut down the production. So, yeah, surgically or chemically decreasing your testosterone.
- [55:48]
B
Yeah, that would, that would also have further implications of, if you do removal of. Of everything, you're cancer free, prostate cancer.
- [55:56]
A
Free, then you'd have to.
- [55:57]
B
Yeah, yeah, you'd have to start back on with the testosterone and using that back. Yeah.
- [56:02]
A
Once the levels of PSA are, you know, undetectable and nadered and plateaued and stable and considered cancer free, we can start those patients back until testosterone.
- [56:12]
B
I feel like that's actually like the detection of prostate cancer is much better than the detection of ovarian cancer because I've, you know, sadly, and I mentioned this often, I've lost my grandmother and my auntie, who was like a second mother to me, to ovarian cancer. And it was a very Short, it was like diagnosis. And then two weeks later.
- [56:36]
A
Yeah, and it's, it's scary.
- [56:38]
B
It's extremely scary.
- [56:40]
A
Right? And there really is no, no screening test for ovarian cancer. I mean, there is a blood test, a CA100 pancreatic.
- [56:49]
B
That's what they're like by the end. They're like, well, we don't know. It was a mixture of everything. It's like, it's just, you know, it's a very harsh thing.
- [56:55]
A
It is, you know, the good thing, like I said earlier with prostate cancer, it's most of the time it's a slow growing cancer. And so when someone comes to me and they're saying, you know, I, I just got diagnosed with prostate cancer, what am I? Options. There's really a lot of options. And one of the options for those with low grade, low risk, low volume disease is just active surveillance and watchful waiting. We just watch them. I say watchful waiting, but watchful waiting is like you don't do anything but active surveillance. You're actively doing biopsies every six months. And as soon as this shows progression, then we treat those patients. Because we've seen patients as young as 40s having prostate cancer and they're not done having kids yet. Right. Or even 50s. And so we don't want to, you know, take out their prostate or radiate them or put them on hormone antigen deprivation therapy when, you know, they're still wanting to have kids. You know. So with certain people, we can watch and wait until it's time that we really need to go in. Either take out that prostate with the robot. Right. You know, or put them, you know, or undergo radiation.
- [57:57]
B
What's your take on grail as and like the blood test for, you know, to pick. It can pick up on apparently 50 different types of cancer. The grail test.
- [58:08]
A
I, I am actually not familiar with the grail test.
- [58:10]
B
Oh yeah, it's. It's a new liquid biopsy test, if you will, that is showing promise, you know, as you probably like further on. What I, what I think, because I was reading about it today, what I think is happening is many people are getting excited about it, you know, a blood test to detect cancer. But I think what it's detecting is, is cancers that are already there and that the actual patient knows about it and that it's, you know, it's progressed and that's what it's picking up on. And I, yeah, so it's very.
- [58:41]
A
So it could be used as more of a tumor marker versus a diagnostic tool.
- [58:44]
B
Yes, but I think, yeah, a lot of people are getting excited. I mean, even today there's a news article on. It's like everyone's getting really excited, but I think it's. We're far away from that. You know, if. Even if, like, like when it comes to like ovarian, it's like, even if you go and do this full body mri, for example, sometimes it probably won't even be picked up there. It's gotta be like a huge mass.
- [59:05]
A
Right, right. It may not be picked up there. And then the other thing is that it may pick up all these other, what we call incidentalomas. Yeah, it picks up all these other incidentalomas. And then now you're working all, you know, up for this, that and the other thing. And so it can get quite costly. And so, you know, here's the thing with insurance. You know, if you can find a test that is easily, it's easy to do, it's reproducible, it catches cancer and it decreases your risk of death, then that's a good screening test, right?
- [59:34]
B
Correct.
- [59:35]
A
And so if something is so expensive and it may just detect a small amount, insurances are not going to cover that. But that's where like the grail test I think you're talking about and some of these other kind of full body MRIs, you know, as a urologist who has been in academia for like, you know, over 10, 15 years, over a decade, I think there's good and there's bad. I think it's kind of controversial to do the whole scan. You know, obviously, if you have the money to do, I think it's about $2,000.
- [60:02]
B
I think it's 2,500.
- [60:03]
A
2,500 to do a full body scan. Great.
- [60:06]
B
You know, and the time, could you.
- [60:08]
A
Imagine, you know, you have to have someone that really knows how to read everything and, you know, without symptoms, you're not really getting the full picture as well. And you find all types of, you know, cysts and things like that that you. Now you're like, what do I do with this? Right. So it kind of leads you down a road rabbit hole of like, oh my gosh. Right. But I think overall it's good to have diagnostic tests, it's good to be tested, it's good to understand and know your body. Because I feel like a lot of times, you know, our patients will tell us, like, I'm just not feeling right, you know, and, you know, listen, listen to your body and listen to your patients when they actually, you know, with good reason if they're concerned about something, don't just order test to order tests. But, you know, usually there's, there's some sort of harbinger, you know, symptoms that is causing them alarm.
- [60:52]
B
Dr. Lana, you. You're. You're working with both men and women in urology and esthetics. You're building your brand. You've got a wonderful team behind you, or, you know, can't imagine it's just you, because I see so many educational reels that you put out. And you're also educating, you know, you've got a course or you're teaching other people as well, which is so phenomenal. I'd love to ask you, what do you find. Find hard, I guess, in this realm of, you know, you're building yourself as a doctor out there and it's, you know, how are you, how are you finding the social media world?
- [61:26]
A
So we talked about this a little earlier, and we're sharing stories, and I'm sharing with you guys too. Once you put yourself out there and you're more visible, two things can happen, right? The good part of it, the positive part of it is your patients find you. I had a patient today that says, Dr. Lana, I've seen you on social media, I've seen your work, your befores and your afters. And for something like, aesthetics is super important. But they also feel like they know me as a person because, you know, I share that. I'm at conferences, I'm teaching, I'm teaching other, you know, surgeons and plastic surgeons and dermatologists and, you know, emergency room physicians. Like, I'm teaching everybody in the field. And so that gives me credibility. And the patients come, they want to see that. But it also attracts, you know, the naysayers, the people that are like, you know, why are you doing this? And, you know, so a lot of what I tried to do in my last seven years of pivoting from academic urology and, you know, doing mostly cancer procedures and robotic surgeries and kidney stones, and now switching into aesthetics is really trying to validate why I do what I do. Because a lot of people look down on aesthetics like, you're not a real doctor. Right. Even though I went to Brown, I had a full scholarship teaching anatomy. I studied for 12 years, and I've done all the things that I wanted to do as a urologic surgeon for 10 years, and then now I want to do something else, which, you know, still helps people, but in a different way. You know, people are traveling from all over, they're flying in to see me so they can look better, they can feel better, or they want, you know, vaginal procedures or something to make them just feel like themselves again. And a lot of times people are coming to see us because they have something in emotional that they want to hold on to, whether it's, you know, they had a lot of death in their family, and they just want to remember the times when they were healthy and they looked a certain way. So a lot of what I do is really just to instill more confidence in people and to make them happier and feel better about themselves. And so I will get some comments of, you know, you're just an aesthetics doctor. What do you know? I'll get comments, you know, your urologist. What do you know about aesthetics? And then I'll get comments from people that are like, well, you know, you're. You're doing aesthetics, so therefore you can't be a good urologist. Like, we can be both. We can be many things as women. We can multitask, and we could be good at many things, and we can pivot and we can have passion in so many things. Like, life is not meant to be lived, you know, on a planar level. It's meant to go up and down and find your path and find your happiness. And I found my why and my happiness and aesthetics. I have children with special needs. They are my everything. And being a urologic surgeon and being on call was just not the right fit for me and my kids anymore. You know, even though I'm passionate about it, even though I love treating patients, even though, you know, I gave patients my phone number and their family called me all the time. Even now, seven years later, they're starting. They're still trying to find me because they have kidney stones or cancer. But, you know, it's a different part of what I love to do that fulfills me as a person, as a human being, but also as an entrepreneur. And I love learning. You never stop learning in life, and you do the same, and we keep on learning, and we can do multiple things. And when someone tells me, stay in your lane and don't take risk and don't pivot, I don't listen to them anymore. I did for a very long time, and I stayed small and I stayed in my lane, but I wasn't happy. And it was. It wasn't fulfilling what I needed to do for my children who are going to be dependent on me for the rest of their lives. And so I have to do what's right for me and my children. And so sometimes you don't listen to those naysayers and the people that are trying to bring you down because they're not in your shoes and they don't want to see you succeed. And so you have to just take it upon yourself to just kind of block out. It's hard because we're human beings and we care a lot, and I'm very sensitive, and I want to make people happy. I. And I'm a people pleaser. And so it's very hard for me to be visible, but also get that negative, you know, part. The competitive part, the people who are next door trying to take us down, you know, so it's. It's. It's a lot that we deal with on a daily. But I think at the end of the day, if you're a good person and you do good things, you don't take shortcuts, you're ethical, you care about people, good things will come your way and you'll succeed no matter what.
- [66:00]
B
Oh, you are just. You are so inspiring. Dr. Lana Chuck, thank you so much for coming on the neuroexperience podcast. We're going to link all of your socials below, especially your amazing Instagram.
- [66:11]
A
Thank you so much. I can't wait to hear this. And thank you so much for having me come on your podcast, because I look up to you. You're a female, you're strong, you're so knowledgeable in the field, and you're just taking it by storm. So thank you so much for having me on. I really appreciate it.