1 00:00:04,120 --> 00:00:11,520 Speaker 1: It's that time time, time, time, luck and load. So 2 00:00:11,720 --> 00:00:14,760 Speaker 1: Michael Verie Show is on the air, and this. 3 00:00:14,760 --> 00:00:17,000 Speaker 2: Morning you woke up dead. Kind the hell you wake 4 00:00:17,079 --> 00:00:19,160 Speaker 2: up bed because you're alive when you go to sleep. 5 00:00:19,520 --> 00:00:19,919 Speaker 3: Just tell me? 6 00:00:20,040 --> 00:00:21,599 Speaker 2: Can you telling me that you can go to bed 7 00:00:21,640 --> 00:00:24,200 Speaker 2: dead and wake up alive. You can't go to bed dead, man, 8 00:00:24,360 --> 00:00:25,800 Speaker 2: would just yell know what? 9 00:00:26,120 --> 00:00:28,320 Speaker 4: Because you can go to bed and not be dead, 10 00:00:28,520 --> 00:00:30,200 Speaker 4: and you can die but not be in a bed. 11 00:00:30,280 --> 00:00:31,319 Speaker 2: But you are in a bed. 12 00:00:31,360 --> 00:00:33,160 Speaker 3: Man, that's how you wake up dead in the first place. 13 00:00:33,200 --> 00:00:36,480 Speaker 4: Food die man talking ticket class. 14 00:00:38,840 --> 00:00:42,199 Speaker 3: Three hundred thousand people have already died from just this 15 00:00:42,640 --> 00:00:46,400 Speaker 3: cut off, this hard cut of USAID. So this food 16 00:00:46,640 --> 00:00:51,760 Speaker 3: rotting in boats and warehouses, there is this. This, this 17 00:00:51,800 --> 00:00:54,840 Speaker 3: will whip you off. This will not You will not 18 00:00:54,880 --> 00:00:58,680 Speaker 3: be happy, No American will. But there is I think 19 00:00:58,720 --> 00:01:04,400 Speaker 3: it's fifty thousand tons of food that are stored in Chiboosi, 20 00:01:04,920 --> 00:01:07,360 Speaker 3: South Africa, Dubai. 21 00:01:07,040 --> 00:01:07,759 Speaker 2: And wait for it. 22 00:01:08,360 --> 00:01:12,600 Speaker 5: Houston, Texas Secretary of State Marco Rubio is hailing the 23 00:01:12,720 --> 00:01:16,440 Speaker 5: end of us AID, the nation's largest foreign aid agency, 24 00:01:17,000 --> 00:01:19,560 Speaker 5: even as a new analysis finds that its closure could 25 00:01:19,600 --> 00:01:51,920 Speaker 5: contribute to some fourteen million deaths in the next five years. 26 00:01:51,960 --> 00:01:55,000 Speaker 4: The estimate, and I believe these are very considered estimates, 27 00:01:55,240 --> 00:02:00,200 Speaker 4: that HR one would lead to seventy thousand kids dying. 28 00:02:00,680 --> 00:02:04,040 Speaker 4: Of that, seventy thousand and thirty thousand would come from 29 00:02:04,120 --> 00:02:08,000 Speaker 4: malaria control programs that would have to be scaled back. Specifically, 30 00:02:08,440 --> 00:02:11,079 Speaker 4: The other forty thousand is broken out as twenty four 31 00:02:11,120 --> 00:02:14,160 Speaker 4: thousand would die because of a lack of support for 32 00:02:14,320 --> 00:02:17,920 Speaker 4: immunizations and other investments, and sixteen thousand would be because 33 00:02:17,960 --> 00:02:19,799 Speaker 4: of a lack of skilled attendance at birth. 34 00:02:20,560 --> 00:02:24,440 Speaker 6: I am exceptionally upset about USA. I lived in the 35 00:02:24,480 --> 00:02:28,920 Speaker 6: refugee camp for four years as a child surviving civil war. 36 00:02:29,280 --> 00:02:33,440 Speaker 6: It is the essential programs that USA provided that kept 37 00:02:33,560 --> 00:02:34,320 Speaker 6: my family and. 38 00:02:34,400 --> 00:02:36,040 Speaker 2: I fit and safe. 39 00:02:36,680 --> 00:02:39,720 Speaker 7: The consequences are that people die, Babies die. I mean 40 00:02:39,800 --> 00:02:43,040 Speaker 7: right now we are involved in Gaza and in Sudan 41 00:02:43,320 --> 00:02:47,680 Speaker 7: in providing food to malnourished babies. Literally, there will be 42 00:02:47,760 --> 00:02:50,840 Speaker 7: dead children, one hundreds thousands of them. 43 00:02:53,840 --> 00:02:54,160 Speaker 1: Long. 44 00:03:31,160 --> 00:03:33,040 Speaker 8: The people who work at USA did not come to 45 00:03:33,080 --> 00:03:35,720 Speaker 8: work at USA for the money. The civil servants, the 46 00:03:35,760 --> 00:03:40,320 Speaker 8: foreign servants, the contractors. They came to usaid because they 47 00:03:40,360 --> 00:03:42,320 Speaker 8: wanted to make a difference in the world because they 48 00:03:42,400 --> 00:03:46,760 Speaker 8: saw America's interests as tied up with the interests of 49 00:03:46,840 --> 00:03:51,320 Speaker 8: people vulnerable people around the world. And so even as 50 00:03:51,360 --> 00:03:53,600 Speaker 8: they're struggling to figure out how to make rent, all 51 00:03:53,640 --> 00:03:59,720 Speaker 8: of a sudden, they're most struggling with the fear that 52 00:04:00,240 --> 00:04:04,160 Speaker 8: many millions of people who allied on US as a country, 53 00:04:04,240 --> 00:04:07,480 Speaker 8: on US eight as an agency, but on them as individuals, 54 00:04:08,440 --> 00:04:11,400 Speaker 8: that those individuals out in the world have no place 55 00:04:11,440 --> 00:04:13,960 Speaker 8: to turn. And indeed they're showing up and finding health 56 00:04:13,960 --> 00:04:16,800 Speaker 8: clinics shuttered and soup kitchens closed. 57 00:04:17,040 --> 00:04:20,240 Speaker 4: Doock knock knocking on Heaven's down wall. 58 00:04:23,320 --> 00:04:35,760 Speaker 2: Yeah. One of the great joys of owning a live 59 00:04:35,920 --> 00:04:39,320 Speaker 2: music venue and having no shame is that you can 60 00:04:39,320 --> 00:04:43,800 Speaker 2: get up on stage with the bands, and you can 61 00:04:43,839 --> 00:04:46,400 Speaker 2: get your friends up on stage with the bands, even 62 00:04:46,440 --> 00:04:51,480 Speaker 2: if it's inadvisable, and my brother's favorite thing to do. 63 00:04:51,800 --> 00:04:54,520 Speaker 2: Josh Fuller would always invite my brother on stage because 64 00:04:54,560 --> 00:04:56,880 Speaker 2: he got a kick out of my brother getting so 65 00:04:56,920 --> 00:04:59,200 Speaker 2: excited to get to sing, and he loved to do 66 00:04:59,320 --> 00:05:03,120 Speaker 2: the hall all haul. He loved that song, so Josh 67 00:05:03,160 --> 00:05:05,080 Speaker 2: would always have to do the song so that he 68 00:05:05,080 --> 00:05:11,479 Speaker 2: could do it. Just a brag on our team. When 69 00:05:11,520 --> 00:05:15,200 Speaker 2: our folks travel, they still work. So Chad Nakanishi, who 70 00:05:15,240 --> 00:05:22,480 Speaker 2: was from Hawaii, is flew back yesterday to visit his 71 00:05:22,600 --> 00:05:28,320 Speaker 2: family in Hawaii in Hilo. I got an email this 72 00:05:28,440 --> 00:05:33,080 Speaker 2: morning that was a He had set it on a 73 00:05:33,120 --> 00:05:35,880 Speaker 2: timer so that it came to me at the normal 74 00:05:35,960 --> 00:05:39,160 Speaker 2: time I would get my show prep. But I said, Chad, 75 00:05:39,240 --> 00:05:41,040 Speaker 2: how in the world did you send me show prep? 76 00:05:41,480 --> 00:05:44,800 Speaker 2: You've been flying and you just landed. And he said, well, 77 00:05:44,800 --> 00:05:47,200 Speaker 2: I got here, and I got in bed, and I 78 00:05:47,240 --> 00:05:50,240 Speaker 2: got up at one am, five hours behind, and I'll 79 00:05:50,279 --> 00:05:53,720 Speaker 2: send production a little later as well. See Ramon. That's 80 00:05:53,760 --> 00:05:57,800 Speaker 2: commitment right there. Then I sent back and he said, well, 81 00:05:57,880 --> 00:05:59,080 Speaker 2: I like, I want to be able to hear the 82 00:05:59,120 --> 00:06:01,120 Speaker 2: show live in case there's anything I need to add, 83 00:06:01,480 --> 00:06:03,520 Speaker 2: and then I'll nap after that and then I'll try 84 00:06:03,520 --> 00:06:06,480 Speaker 2: to get on my Hawaiian sleep schedule from there. 85 00:06:07,160 --> 00:06:07,280 Speaker 8: Now. 86 00:06:07,360 --> 00:06:11,880 Speaker 2: How awesome is that? In other news, not as impressive. 87 00:06:12,880 --> 00:06:16,000 Speaker 2: My friend Jonathan Kim, the president of Gringo's Text Mex, 88 00:06:16,440 --> 00:06:22,400 Speaker 2: apparently took his girlfriend Emma Salazar fishing and cast a 89 00:06:22,520 --> 00:06:27,039 Speaker 2: hook into her nose and hung her nose. I'll post 90 00:06:27,040 --> 00:06:29,200 Speaker 2: the picture here in a minute. But you know how 91 00:06:29,240 --> 00:06:32,400 Speaker 2: Indian women will do the nose ring where they punched 92 00:06:32,440 --> 00:06:34,560 Speaker 2: the hole through the nose and then they hook it 93 00:06:34,680 --> 00:06:37,159 Speaker 2: on a chain to the ear. Well, she's gonna have 94 00:06:37,200 --> 00:06:39,120 Speaker 2: a big hole. She won't need to get her nose 95 00:06:39,160 --> 00:06:42,200 Speaker 2: pierced now because Jonathan was kind enough to hook her 96 00:06:42,880 --> 00:06:46,440 Speaker 2: nose with his dealer. Well, how much time we have left? 97 00:06:46,440 --> 00:06:50,600 Speaker 2: I want to talk about AL two A Okay, it happened. 98 00:06:50,680 --> 00:06:55,279 Speaker 2: Josel Tuve passed Jeff Bagwell last night to become number 99 00:06:55,320 --> 00:06:58,760 Speaker 2: two all time on the Astros hit list. Any of 100 00:06:58,760 --> 00:07:01,800 Speaker 2: the Estros need another bits Right here, there's a ball 101 00:07:01,839 --> 00:07:04,080 Speaker 2: in the center field bar, a base hit. Two runs 102 00:07:04,120 --> 00:07:07,560 Speaker 2: are gonna score. Jake Meyer's coach pers the third Jose 103 00:07:07,960 --> 00:07:10,120 Speaker 2: out too. Bag gives the Astros. 104 00:07:09,680 --> 00:07:12,000 Speaker 9: A qre too, leads Also, would we like to see 105 00:07:12,120 --> 00:07:15,280 Speaker 9: how two bay coming through in the clutch, not wasting 106 00:07:15,320 --> 00:07:17,880 Speaker 9: any time. Took a breaking ball on the outside corner, 107 00:07:19,800 --> 00:07:22,160 Speaker 9: hit it up the middle, and he passes Jeff Bagwell. 108 00:07:22,240 --> 00:07:23,920 Speaker 9: The Astros want that baseball. 109 00:07:25,240 --> 00:07:29,880 Speaker 2: He's uh a little over six hundred hits behind video 110 00:07:30,640 --> 00:07:34,760 Speaker 2: now for a six year period, he got two hundred 111 00:07:34,800 --> 00:07:38,040 Speaker 2: or more hits and led the AL every year in hits, 112 00:07:38,040 --> 00:07:40,760 Speaker 2: but he'd have to do that for just over. He'd 113 00:07:40,760 --> 00:07:43,600 Speaker 2: have to have a good second half in another three years. 114 00:07:43,840 --> 00:07:47,480 Speaker 2: Ramon asked me if he's the greatest astro of all time, 115 00:07:47,680 --> 00:07:51,640 Speaker 2: and I am. I'm struggling with the answer to that 116 00:07:51,920 --> 00:07:56,240 Speaker 2: because I hold to the Nolan Ryans of my of 117 00:07:56,280 --> 00:08:00,320 Speaker 2: my youth. But wow, I mean, just wow, what this 118 00:08:00,360 --> 00:08:03,160 Speaker 2: guy has delivered. How much fun it has been to 119 00:08:03,240 --> 00:08:05,960 Speaker 2: have this guy in our town playing ball for the 120 00:08:06,040 --> 00:08:10,440 Speaker 2: teams our jersey. My urologists will be our guest coming 121 00:08:10,520 --> 00:08:13,240 Speaker 2: up next. The subject was how to deal in the 122 00:08:13,280 --> 00:08:17,440 Speaker 2: heat and whether that leads to kidney stones, But we'll 123 00:08:17,440 --> 00:08:20,120 Speaker 2: probably end up talking about directions and crooked wieners and 124 00:08:20,120 --> 00:08:23,360 Speaker 2: also to other stuff we always go with. Kara's my guest, 125 00:08:23,440 --> 00:08:26,680 Speaker 2: dude the Michael Berry Show, Silver. 126 00:08:26,600 --> 00:08:28,480 Speaker 4: Bells hanging on our stream. 127 00:08:28,880 --> 00:08:29,680 Speaker 10: She told me. 128 00:08:29,760 --> 00:08:34,559 Speaker 2: It was, yes, it indeed it is doctor Mohit Kara, 129 00:08:34,720 --> 00:08:38,600 Speaker 2: the most interviewed doctor in our radio program for the 130 00:08:38,640 --> 00:08:40,920 Speaker 2: most number of times in the most number of minutes. 131 00:08:41,400 --> 00:08:45,040 Speaker 2: The line of the day this morning, I asked, I 132 00:08:45,080 --> 00:08:47,840 Speaker 2: asked Mohit Kara to call in at eight point fifteen 133 00:08:48,559 --> 00:08:52,080 Speaker 2: and Ramon will turn on his mic so that I 134 00:08:52,080 --> 00:08:54,440 Speaker 2: can hear him talking to the caller, so I know, okay, 135 00:08:54,440 --> 00:08:57,040 Speaker 2: the caller's calling in and he put him on hold 136 00:08:57,080 --> 00:08:59,720 Speaker 2: and he said, we've got doctor Kara, and I said, good, 137 00:08:59,760 --> 00:09:03,560 Speaker 2: he's I like when the doctors come to us and 138 00:09:03,640 --> 00:09:08,960 Speaker 2: we make them wait. That was pretty good, Doctor Mohit Kara. 139 00:09:09,120 --> 00:09:13,720 Speaker 2: Welcome to the program. Good sir, Good morning, Michael, Thank you, 140 00:09:13,800 --> 00:09:16,839 Speaker 2: Thank you're so serious. Thank you for making time for us. Now, 141 00:09:16,840 --> 00:09:18,800 Speaker 2: what was the issue I wanted you on Tuesday? You 142 00:09:18,840 --> 00:09:20,160 Speaker 2: were teaching residents or something. 143 00:09:21,480 --> 00:09:21,960 Speaker 10: Yeah, you know. 144 00:09:22,040 --> 00:09:25,360 Speaker 11: So what happens is July first is where all the 145 00:09:25,400 --> 00:09:28,640 Speaker 11: new residents and the medical students and the fellows start, 146 00:09:29,160 --> 00:09:32,400 Speaker 11: and so it's it's crazy because you know, everyone's trying 147 00:09:32,400 --> 00:09:34,920 Speaker 11: to figure out what to do, where to go, and uh, 148 00:09:35,160 --> 00:09:37,680 Speaker 11: if you get sick, don't get sick on July first. 149 00:09:37,679 --> 00:09:38,400 Speaker 10: That's all I'm telling you. 150 00:09:38,960 --> 00:09:42,800 Speaker 2: Because it's a it's a madhouse. How are they different? 151 00:09:43,320 --> 00:09:46,520 Speaker 2: Everyone's new, Well, the residents different today than when you 152 00:09:46,559 --> 00:09:47,120 Speaker 2: were coming up. 153 00:09:49,440 --> 00:09:50,240 Speaker 10: I think they're smarter. 154 00:09:50,559 --> 00:09:53,319 Speaker 11: I think it's much harder to get into medical school 155 00:09:53,440 --> 00:09:56,120 Speaker 11: and residency today than it was in the past. I 156 00:09:56,160 --> 00:09:58,760 Speaker 11: think that you know, if you look at the caliber 157 00:09:58,840 --> 00:10:01,560 Speaker 11: these people have been well accomplished and published a lot. 158 00:10:01,600 --> 00:10:02,400 Speaker 10: They've done a lot. 159 00:10:02,640 --> 00:10:04,360 Speaker 11: Back when I was getting in you it wasn't it 160 00:10:04,400 --> 00:10:06,199 Speaker 11: was hard, but it wasn't like this. I mean, they 161 00:10:06,240 --> 00:10:08,679 Speaker 11: really have stepped up their game. Really, and I'll tell 162 00:10:08,679 --> 00:10:12,120 Speaker 11: you to actually, even the surgical skills of these residents. 163 00:10:11,760 --> 00:10:13,560 Speaker 10: Coming in or are far greater than we've seen in 164 00:10:13,559 --> 00:10:13,959 Speaker 10: the past. 165 00:10:15,000 --> 00:10:18,239 Speaker 2: I've heard that much more focus is given to bedside 166 00:10:18,280 --> 00:10:22,000 Speaker 2: manners now than it ever was because that was something 167 00:10:22,000 --> 00:10:24,160 Speaker 2: that was complained about for a long time. Is that true? 168 00:10:26,440 --> 00:10:26,800 Speaker 10: It is? 169 00:10:26,960 --> 00:10:29,520 Speaker 11: And it's also on ethics, So you know, the interview 170 00:10:30,000 --> 00:10:34,280 Speaker 11: is really important, and we will sometimes give mock questions 171 00:10:34,600 --> 00:10:37,080 Speaker 11: during the interview. Hey, we have a patient that had 172 00:10:37,360 --> 00:10:40,000 Speaker 11: this happen to them, how would you handle it? And 173 00:10:40,080 --> 00:10:43,280 Speaker 11: you want to make sure that they are ethical, that 174 00:10:43,360 --> 00:10:47,040 Speaker 11: they would do the right thing, and that plays a 175 00:10:47,040 --> 00:10:48,960 Speaker 11: big component in the interview. 176 00:10:50,000 --> 00:10:51,960 Speaker 2: We've all seen the TV shows, you know, and the 177 00:10:52,000 --> 00:10:54,320 Speaker 2: resident comes in there and here's the big fancy doctor 178 00:10:54,360 --> 00:10:56,280 Speaker 2: and that's you, and I'm the little resident and I 179 00:10:56,360 --> 00:10:58,040 Speaker 2: want to be the big fancy doctor, and I got 180 00:10:58,080 --> 00:10:59,719 Speaker 2: to go through all that. It's kind of got to 181 00:10:59,760 --> 00:11:02,400 Speaker 2: be a charge to know that they're you know, they're 182 00:11:02,440 --> 00:11:04,600 Speaker 2: all excited like a teacher on the first day of school. 183 00:11:06,480 --> 00:11:09,160 Speaker 11: It's amazing. And I'll tell you, it's amazing to teach. 184 00:11:10,320 --> 00:11:12,840 Speaker 11: One of my passions obviously is teaching. And just to 185 00:11:12,880 --> 00:11:15,720 Speaker 11: see them grow over the year and how they progress 186 00:11:15,880 --> 00:11:17,960 Speaker 11: is incredible. But they're hungry, you know, when they come in, 187 00:11:18,160 --> 00:11:21,400 Speaker 11: they're hungry to learn. They're eager to learn, and it's 188 00:11:21,440 --> 00:11:23,880 Speaker 11: just fun. I'll tell you what's really fun operating with 189 00:11:23,920 --> 00:11:26,320 Speaker 11: the residents and the fellows. And you operate with them 190 00:11:26,559 --> 00:11:29,319 Speaker 11: and watch them over the year, it's amazing. At the beginning, 191 00:11:29,360 --> 00:11:30,920 Speaker 11: you're a little nervous, don't get me wrong, and you're 192 00:11:30,920 --> 00:11:32,400 Speaker 11: just trying to make sure everything's fine. But as you 193 00:11:32,440 --> 00:11:35,040 Speaker 11: go on and watch them get better and better in 194 00:11:35,080 --> 00:11:36,880 Speaker 11: their skills, it's such a great feeling. 195 00:11:37,880 --> 00:11:40,720 Speaker 2: A friend of mine who do to Hippa your requirement, 196 00:11:40,760 --> 00:11:43,440 Speaker 2: I'm not under that restriction, but I won't say his name, 197 00:11:43,600 --> 00:11:46,959 Speaker 2: had a vasectomy with you, and he came highly recommended 198 00:11:47,040 --> 00:11:50,200 Speaker 2: from me to you, and he commented on the fact 199 00:11:50,240 --> 00:11:53,079 Speaker 2: that you came waltzing in and you had an opera 200 00:11:53,200 --> 00:11:54,960 Speaker 2: love on him or I don't know what it was. 201 00:11:55,280 --> 00:11:58,800 Speaker 2: That was playing and you had the most beautiful music going. 202 00:11:58,960 --> 00:12:00,559 Speaker 2: And I said, did it Badia? And he goes, no, 203 00:12:00,800 --> 00:12:03,480 Speaker 2: he kept me calm. So is that music for him 204 00:12:03,559 --> 00:12:04,000 Speaker 2: or for you? 205 00:12:05,520 --> 00:12:06,520 Speaker 10: And it's really for him. 206 00:12:06,600 --> 00:12:08,640 Speaker 11: So you know, people come in if they're having procedures, 207 00:12:08,640 --> 00:12:10,600 Speaker 11: they're nervous, especially if you get a guy who's gonna 208 00:12:10,600 --> 00:12:12,600 Speaker 11: get as to me, they're gonna be a little nervous. 209 00:12:12,880 --> 00:12:15,120 Speaker 11: And so what you got to do is just keep 210 00:12:15,120 --> 00:12:18,400 Speaker 11: them calm. And I found that music really keeps them calm. 211 00:12:18,440 --> 00:12:20,320 Speaker 11: The teacher doesn't take that long. And if you talk 212 00:12:20,440 --> 00:12:23,600 Speaker 11: to them while they're doing the procedure, you know, when 213 00:12:23,600 --> 00:12:26,040 Speaker 11: they're done, they're just you know, they don't even I 214 00:12:26,040 --> 00:12:28,520 Speaker 11: don't want them thinking about the procedure. So music talking 215 00:12:28,520 --> 00:12:30,120 Speaker 11: to them make a big difference. 216 00:12:31,320 --> 00:12:33,440 Speaker 2: There's a movie Willem Dafoe is in I can't remember 217 00:12:33,480 --> 00:12:35,480 Speaker 2: if it's our town, Ramon, do you remember what it 218 00:12:35,520 --> 00:12:38,840 Speaker 2: was where he's brought in as the FBI specialist to 219 00:12:38,880 --> 00:12:41,160 Speaker 2: recreate the scene and he plays the opera? Do you 220 00:12:41,160 --> 00:12:41,520 Speaker 2: remember that? 221 00:12:41,600 --> 00:12:41,840 Speaker 10: Romon? 222 00:12:44,000 --> 00:12:46,920 Speaker 2: Yeah, they are Boondock Saints, but Boondock Saints. Have you 223 00:12:46,960 --> 00:12:48,200 Speaker 2: seen that? Well? 224 00:12:48,800 --> 00:12:49,679 Speaker 10: I've seen that. 225 00:12:49,920 --> 00:12:53,000 Speaker 2: I have not Willem Dafoe comes in and he's this 226 00:12:53,160 --> 00:12:56,800 Speaker 2: very flamboyant gay guy, but he's brilliant. And the other cops, 227 00:12:56,800 --> 00:12:59,440 Speaker 2: you know, they're old fashioned, you know, Irish cops. You know, 228 00:12:59,440 --> 00:13:01,360 Speaker 2: who is this guy come in here like this? But 229 00:13:01,600 --> 00:13:03,600 Speaker 2: what he does is he turns on his music in 230 00:13:03,640 --> 00:13:06,600 Speaker 2: his headsets, and in front of them he recreates the 231 00:13:06,640 --> 00:13:09,120 Speaker 2: scene as if it's an opera, and then he tells them, 232 00:13:09,120 --> 00:13:11,920 Speaker 2: all right, he stood here, he shot here anyway more 233 00:13:11,960 --> 00:13:15,200 Speaker 2: than you wanted to know. Speaking of talking to I've 234 00:13:15,240 --> 00:13:17,560 Speaker 2: told the story Ramon. I don't know if I told 235 00:13:17,559 --> 00:13:19,640 Speaker 2: you this. I don't remember what you were checking for. 236 00:13:19,800 --> 00:13:21,880 Speaker 2: But I had something that I was worried about with 237 00:13:21,960 --> 00:13:25,760 Speaker 2: my kidney or my liver or my urological tract or something. 238 00:13:25,800 --> 00:13:28,160 Speaker 2: And you put some tube up my willie and it 239 00:13:28,200 --> 00:13:31,320 Speaker 2: goes all the way up in there, and I'm laying down, 240 00:13:31,480 --> 00:13:33,040 Speaker 2: and I'm the guy that when I get a shot, 241 00:13:33,120 --> 00:13:34,840 Speaker 2: looks away. And I don't know if you remember this. 242 00:13:34,880 --> 00:13:36,920 Speaker 2: Maybe you do this for everybody, but there's a. 243 00:13:36,920 --> 00:13:38,280 Speaker 10: Thing I do remember. 244 00:13:38,320 --> 00:13:40,559 Speaker 2: It It's way up in me. I mean, it feels 245 00:13:40,559 --> 00:13:43,280 Speaker 2: like it's up in my throat. And you said Michael 246 00:13:43,520 --> 00:13:45,719 Speaker 2: this looks great. Look at the screen and tried to 247 00:13:45,720 --> 00:13:47,600 Speaker 2: get me to turn and look at it, and I said, 248 00:13:47,640 --> 00:13:49,880 Speaker 2: I'm sure you recall tell me when that thing is 249 00:13:49,920 --> 00:13:52,360 Speaker 2: out of me. I don't. You're going the wrong way 250 00:13:52,400 --> 00:13:55,120 Speaker 2: on a one way street. I asked you the other 251 00:13:55,200 --> 00:13:58,280 Speaker 2: day because we were talking about this heat and his 252 00:13:58,520 --> 00:14:01,360 Speaker 2: searing heat and how tough it is and dehydration and 253 00:14:01,360 --> 00:14:04,360 Speaker 2: all that, and someone suggested to me that people should 254 00:14:04,360 --> 00:14:06,800 Speaker 2: be careful because this is when you get kidney stones. 255 00:14:06,840 --> 00:14:10,440 Speaker 2: And you said, that's absolutely true. So explain if you would, 256 00:14:10,480 --> 00:14:12,439 Speaker 2: why that is and what folks should do about that. 257 00:14:14,040 --> 00:14:14,720 Speaker 10: Right, great points. 258 00:14:14,760 --> 00:14:16,800 Speaker 11: So look at the summer's coming now, and it's getting hot, 259 00:14:16,840 --> 00:14:19,560 Speaker 11: and you got to realize that you're much more dehydrated 260 00:14:19,600 --> 00:14:22,560 Speaker 11: than you think you are. The number one risk factor 261 00:14:22,640 --> 00:14:25,960 Speaker 11: for kidney stones number one is dehydration. So if you're 262 00:14:26,000 --> 00:14:27,880 Speaker 11: going to do anything, you're going to hydrate. The number 263 00:14:27,920 --> 00:14:30,440 Speaker 11: you want to remember, Michael, is you want to urinate 264 00:14:30,640 --> 00:14:33,760 Speaker 11: about two point five liders a day, between two to 265 00:14:33,840 --> 00:14:35,880 Speaker 11: two point five liters a day. Well, if you're going 266 00:14:35,880 --> 00:14:37,840 Speaker 11: to urinate two to two point five liters a day, 267 00:14:37,880 --> 00:14:40,040 Speaker 11: you have to drink more than that anywhere from two 268 00:14:40,080 --> 00:14:42,560 Speaker 11: point five to three liters per day, which is quite 269 00:14:42,560 --> 00:14:45,280 Speaker 11: a bit. But if you if you do that, that's. 270 00:14:45,120 --> 00:14:47,320 Speaker 10: The number one way not only. 271 00:14:47,160 --> 00:14:49,800 Speaker 11: To keep kidney stones from happening in the first place, 272 00:14:50,080 --> 00:14:53,960 Speaker 11: but it reduces your chance of recurrent kidney stones by 273 00:14:54,000 --> 00:14:54,680 Speaker 11: fifty percent. 274 00:14:55,120 --> 00:14:56,480 Speaker 10: So you know, it's hard. 275 00:14:56,560 --> 00:14:58,680 Speaker 11: It's hard to think about getting all those all that 276 00:14:59,000 --> 00:15:00,920 Speaker 11: water in a day, but you have to do it, 277 00:15:00,960 --> 00:15:03,160 Speaker 11: particularly in the summer. And I tell my patients, you're 278 00:15:03,280 --> 00:15:05,440 Speaker 11: much more dehydrated than you really think you are. 279 00:15:06,360 --> 00:15:07,600 Speaker 10: Think about why this happens. 280 00:15:07,640 --> 00:15:12,480 Speaker 11: When you're dehydrated and your urine is concentrated, your urine 281 00:15:12,480 --> 00:15:17,000 Speaker 11: makes crystals. They make calcium oxalate uric acid crystals. Those 282 00:15:17,000 --> 00:15:20,080 Speaker 11: crystals will adjoin and then start making stones. So the 283 00:15:20,080 --> 00:15:23,080 Speaker 11: best way to stop making those stones is don't make 284 00:15:23,120 --> 00:15:24,560 Speaker 11: the crystals in the first place. 285 00:15:24,920 --> 00:15:26,160 Speaker 10: You've got to drink the fluid. 286 00:15:27,360 --> 00:15:29,440 Speaker 2: Since we live in America, and neither I know or 287 00:15:29,480 --> 00:15:32,200 Speaker 2: anyone else knows what a leader is. How much is 288 00:15:32,240 --> 00:15:33,600 Speaker 2: that in terms of gallons? 289 00:15:35,720 --> 00:15:38,480 Speaker 11: Well, you think of three liters as three thousand milli liters, 290 00:15:38,560 --> 00:15:41,200 Speaker 11: and that's typically going to have at least lost eighty 291 00:15:41,440 --> 00:15:44,400 Speaker 11: to one hundred ounces. Okay, eight look at there's eighty 292 00:15:44,480 --> 00:15:48,000 Speaker 11: to one hundred ounces. Eighty to one hundred ounces a day. 293 00:15:48,120 --> 00:15:50,560 Speaker 11: Eighty tow one hundred ounces a day. That's eight to 294 00:15:50,640 --> 00:15:54,120 Speaker 11: ten cups of water a day. Wow, right, so that's 295 00:15:54,240 --> 00:15:56,280 Speaker 11: quite a bit. It means you've got to remember that 296 00:15:56,280 --> 00:15:58,840 Speaker 11: eight to ten cups, but you got to do it. 297 00:15:58,840 --> 00:16:00,440 Speaker 10: It will really make it difference. 298 00:16:00,880 --> 00:16:03,440 Speaker 2: And do you recommend putting anything in there? A lot 299 00:16:03,480 --> 00:16:05,080 Speaker 2: of folks say, you know, you don't want to wash 300 00:16:05,120 --> 00:16:11,240 Speaker 2: out all of your your minerals and gatorade or some 301 00:16:11,360 --> 00:16:13,280 Speaker 2: other package. We'll talk about that coming up with my 302 00:16:13,360 --> 00:16:19,960 Speaker 2: eurologists and dear friend Mohit Kara, Stay check yellow pudding, 303 00:16:20,080 --> 00:16:21,680 Speaker 2: Bobs Prosen, putting on a. 304 00:16:21,720 --> 00:16:24,960 Speaker 8: Stake the Michael Barry Show, Jello brand pudding pops maybe 305 00:16:24,960 --> 00:16:27,520 Speaker 8: with the goodness of real Jello pudding. 306 00:16:27,800 --> 00:16:30,640 Speaker 2: I got a message from Shirley Guidry that says Larry 307 00:16:30,680 --> 00:16:33,160 Speaker 2: Guidry is going to see him at nine o'clock, so 308 00:16:33,360 --> 00:16:36,840 Speaker 2: hurry please or he will be stuck in the waiting room. 309 00:16:37,320 --> 00:16:40,600 Speaker 2: Doctor Mohick Kara, my urologist and dear friend, is our guest. 310 00:16:40,640 --> 00:16:44,280 Speaker 2: How many patients do you see on average? Just office visits, 311 00:16:44,320 --> 00:16:47,080 Speaker 2: not surgeries? Or medical or actual procedures. 312 00:16:48,600 --> 00:16:50,880 Speaker 11: It's pretty busy. We're about one hundred and fifty. I'm 313 00:16:50,880 --> 00:16:53,640 Speaker 11: about one hundred fifty patients a week a week. 314 00:16:53,720 --> 00:16:56,480 Speaker 2: And how many days is that? Seeing patients. 315 00:16:57,760 --> 00:16:58,560 Speaker 10: Four days a week? 316 00:16:59,080 --> 00:17:01,000 Speaker 2: Okay? And then and and. 317 00:17:00,960 --> 00:17:02,880 Speaker 10: If you're doing a surgery Wednesdays, all. 318 00:17:02,840 --> 00:17:10,120 Speaker 2: Day Wednesday is surgery all the surgery, yep? And how 319 00:17:10,160 --> 00:17:12,160 Speaker 2: many surgery? How many surgeries will you do in a day? 320 00:17:13,680 --> 00:17:16,400 Speaker 10: About six to seven every Wednesday. 321 00:17:17,560 --> 00:17:19,639 Speaker 2: I know. One of the surgeries that you're kind of 322 00:17:19,680 --> 00:17:28,720 Speaker 2: renowned for is when the uh vascular I said, the 323 00:17:29,080 --> 00:17:31,240 Speaker 2: vast I guess, the vast deference. What do you call that? 324 00:17:31,280 --> 00:17:35,720 Speaker 2: When when the when the vessel wraps around and prevents 325 00:17:36,119 --> 00:17:39,200 Speaker 2: UH and burns the sperm off? What is that called? 326 00:17:39,200 --> 00:17:40,040 Speaker 2: The procedure you do? 327 00:17:41,640 --> 00:17:42,760 Speaker 10: So you call it a sectomy? 328 00:17:43,440 --> 00:17:46,480 Speaker 2: No, no, you told me about a procedure that you 329 00:17:46,640 --> 00:17:50,159 Speaker 2: do a lot of where the vein wraps around. I 330 00:17:50,160 --> 00:17:52,080 Speaker 2: don't know if it's the vast deference or what. And 331 00:17:52,080 --> 00:17:54,680 Speaker 2: it and it it basically the heat of that vein 332 00:17:55,000 --> 00:17:57,200 Speaker 2: burns the sperm and then you can't get price. It's 333 00:17:57,240 --> 00:17:58,760 Speaker 2: fertility procedure. What's that called? 334 00:17:59,359 --> 00:18:02,080 Speaker 11: You got it? It's called the vericceal repair. It's actually 335 00:18:02,080 --> 00:18:06,440 Speaker 11: a very interesting concept. Casals mean dilated blood vessels around 336 00:18:06,520 --> 00:18:08,480 Speaker 11: the testicle. You know how you look at a woman 337 00:18:08,520 --> 00:18:10,000 Speaker 11: and you look at her legs, sometimes you can see 338 00:18:10,000 --> 00:18:12,119 Speaker 11: those big veins coming out those dilated veins. 339 00:18:12,600 --> 00:18:14,200 Speaker 10: Those are called varicose veins. 340 00:18:14,320 --> 00:18:18,359 Speaker 11: Will men get varicose veins in the scrotum, and in fact, 341 00:18:18,480 --> 00:18:21,840 Speaker 11: fifteen percent of men in the world walk around with 342 00:18:21,960 --> 00:18:24,040 Speaker 11: dilated veins in those scrode and that's a lot of men. 343 00:18:24,080 --> 00:18:24,560 Speaker 10: Think about it. 344 00:18:24,560 --> 00:18:27,080 Speaker 11: One out of seven men in the world have very 345 00:18:27,160 --> 00:18:31,200 Speaker 11: large dilated veins in the scrotum. The problem is when 346 00:18:31,240 --> 00:18:34,199 Speaker 11: you get those dilated veins in the scrotum, they carry 347 00:18:34,240 --> 00:18:37,199 Speaker 11: heat and they carry pressure, and the testicle does not 348 00:18:37,359 --> 00:18:40,000 Speaker 11: like it. So that heat and that pressure causes that 349 00:18:40,040 --> 00:18:44,199 Speaker 11: testicle to stop or really reduce the sperm production. So 350 00:18:44,240 --> 00:18:45,760 Speaker 11: what we go in and we do is we go 351 00:18:45,800 --> 00:18:48,199 Speaker 11: in and we tie off all those bad veins with 352 00:18:48,240 --> 00:18:51,080 Speaker 11: the high powered microscope and take off that heat, take 353 00:18:51,080 --> 00:18:54,080 Speaker 11: off that pressure, and guess what, Seventy percent of men 354 00:18:54,320 --> 00:18:57,800 Speaker 11: start having a significant improvement in their semen parameters. So 355 00:18:58,280 --> 00:19:01,080 Speaker 11: it is the number one procedure for utility. But other 356 00:19:01,119 --> 00:19:03,040 Speaker 11: reasons why you could fix it are some people just 357 00:19:03,040 --> 00:19:05,200 Speaker 11: have pain. Is hey, doctor care, I don't have any 358 00:19:05,200 --> 00:19:07,639 Speaker 11: I don't have any fertility issues, but I'm having pain. 359 00:19:08,000 --> 00:19:10,160 Speaker 11: So that's another reason to fix it. And the third 360 00:19:10,200 --> 00:19:12,960 Speaker 11: reason to fix it is in pediatrics because if you 361 00:19:12,960 --> 00:19:15,960 Speaker 11: have a kid, let's say he's twelve or thirteen years old, 362 00:19:16,160 --> 00:19:18,600 Speaker 11: and he has a air caceial, the side that has 363 00:19:18,640 --> 00:19:21,960 Speaker 11: the dial in veins, that testicle doesn't grow as well 364 00:19:21,960 --> 00:19:23,600 Speaker 11: as the other side, so it looks like you have, 365 00:19:24,359 --> 00:19:26,760 Speaker 11: you know, different sized testicles. So you really want to 366 00:19:26,760 --> 00:19:29,080 Speaker 11: fix it in a kid. So the three reasons to 367 00:19:29,119 --> 00:19:31,480 Speaker 11: fix it are if you're a kid, if you will 368 00:19:31,520 --> 00:19:35,320 Speaker 11: have pain, or you're trying to have a child. Recently, 369 00:19:35,359 --> 00:19:38,280 Speaker 11: a very interesting story, a position out of New York, 370 00:19:38,359 --> 00:19:42,120 Speaker 11: Mark Goldstein showed that if you fix those Verico s veins, 371 00:19:42,280 --> 00:19:46,120 Speaker 11: you actually can raise natural testosterol levels, which is interesting. 372 00:19:46,200 --> 00:19:47,879 Speaker 11: So when you take the heat off, when you take 373 00:19:47,880 --> 00:19:51,800 Speaker 11: the pressure off, the testicle starts producing more natural testosterone 374 00:19:51,840 --> 00:19:54,720 Speaker 11: as well. So a very interesting concept, but many people 375 00:19:54,720 --> 00:19:57,240 Speaker 11: don't realize it's a very common phenomenon. 376 00:19:58,280 --> 00:20:00,920 Speaker 2: Fifteen percent, you said one in seven. Do you can 377 00:20:00,960 --> 00:20:02,960 Speaker 2: you see that with the naked eye. If you do, 378 00:20:03,400 --> 00:20:03,840 Speaker 2: if you. 379 00:20:03,800 --> 00:20:07,919 Speaker 11: Check them, yes, so this is really important. There's we 380 00:20:07,960 --> 00:20:11,040 Speaker 11: call it three grades of Erica seals Grade one, Grade two, 381 00:20:11,040 --> 00:20:14,320 Speaker 11: Grade three, Grade three. You can see it through the 382 00:20:14,720 --> 00:20:16,560 Speaker 11: scroll to wall. You don't have to even examine them. 383 00:20:16,600 --> 00:20:19,120 Speaker 11: It means if I can see those veins bulging out 384 00:20:19,160 --> 00:20:21,480 Speaker 11: through the skin, there's no exam need that he's a 385 00:20:21,480 --> 00:20:24,800 Speaker 11: grade three. If he's a grade two, typically what you'll 386 00:20:24,800 --> 00:20:27,200 Speaker 11: do is you can feel it on exam. Grade one 387 00:20:27,200 --> 00:20:29,760 Speaker 11: typically they have to bear downs called the valsalva, and 388 00:20:29,840 --> 00:20:33,280 Speaker 11: you can feel some pressure. So those are the different grades. 389 00:20:33,280 --> 00:20:36,200 Speaker 11: But yes, you can see them on a grade three, 390 00:20:36,320 --> 00:20:36,840 Speaker 11: no question. 391 00:20:38,200 --> 00:20:40,960 Speaker 2: And what percentage of grade three of of one hundred 392 00:20:41,000 --> 00:20:43,120 Speaker 2: percent of people who have them, what percent or grade three? 393 00:20:43,920 --> 00:20:46,280 Speaker 11: Yeah, I would say that it's a bell curve. It's 394 00:20:46,280 --> 00:20:49,480 Speaker 11: that most of them are typically grade two. Now it 395 00:20:49,560 --> 00:20:51,640 Speaker 11: depends what they're coming in for. I'm going to see 396 00:20:51,640 --> 00:20:54,040 Speaker 11: a little bit more Grade three because as I mentioned earlier, 397 00:20:54,240 --> 00:20:58,560 Speaker 11: I specialize in fertility. So forty percent of men who 398 00:20:58,640 --> 00:21:02,080 Speaker 11: come to a fertility clinic will have a veraricacisl forty 399 00:21:02,880 --> 00:21:03,520 Speaker 11: that's the cause. 400 00:21:03,560 --> 00:21:05,000 Speaker 10: So most of those. 401 00:21:04,920 --> 00:21:07,879 Speaker 11: Men will have you know, either grade two or a 402 00:21:07,920 --> 00:21:11,040 Speaker 11: grade three. But you know the good news is Michael, 403 00:21:11,040 --> 00:21:14,320 Speaker 11: it's reversible. So yeah, you can do with procedure. It 404 00:21:14,320 --> 00:21:16,200 Speaker 11: doesn't take very long. You know, they go home the 405 00:21:16,240 --> 00:21:19,439 Speaker 11: same day and you can fix those veins just like 406 00:21:19,520 --> 00:21:21,439 Speaker 11: you would if a woman had vericos veins in her 407 00:21:21,520 --> 00:21:23,600 Speaker 11: legs or a man had verico spains in his legs. 408 00:21:23,880 --> 00:21:26,640 Speaker 11: We fix them in the scrotum and the sperm count 409 00:21:26,680 --> 00:21:27,400 Speaker 11: starts to go up. 410 00:21:29,000 --> 00:21:31,679 Speaker 2: There's takes two to tango, so either one of the 411 00:21:31,800 --> 00:21:34,439 Speaker 2: partners could be the reason they're not getting pregnant. But 412 00:21:34,560 --> 00:21:37,760 Speaker 2: if a man comes in and he is the reason 413 00:21:37,920 --> 00:21:41,199 Speaker 2: for the infertility in the relationship, in what percentage of 414 00:21:41,240 --> 00:21:44,080 Speaker 2: cases are you able to get him to the point 415 00:21:44,119 --> 00:21:45,640 Speaker 2: where they're able to get pregnant. 416 00:21:47,400 --> 00:21:50,560 Speaker 11: It depends on what the problem is. And fertility is 417 00:21:50,640 --> 00:21:55,160 Speaker 11: so easy. It's either he's not making sperm or he's blocked. 418 00:21:55,400 --> 00:21:55,920 Speaker 10: That's it. 419 00:21:55,960 --> 00:21:59,400 Speaker 11: Either he's not making sperm or he's blocked. So all 420 00:21:59,400 --> 00:22:01,000 Speaker 11: I have to do figure out which side of the 421 00:22:01,080 --> 00:22:04,480 Speaker 11: fence he's on. If he's blocked, I can unblock them. 422 00:22:04,520 --> 00:22:07,480 Speaker 11: There are numerous surgeries I can unblock them. If he's 423 00:22:07,480 --> 00:22:10,399 Speaker 11: not making sperm, then I have to do things to 424 00:22:10,440 --> 00:22:14,200 Speaker 11: help make the testicle start purducing, fixing the varicas heels, 425 00:22:14,280 --> 00:22:19,760 Speaker 11: using some medications. And remember this lifestyle modification is so critical. 426 00:22:20,560 --> 00:22:23,000 Speaker 11: Healthier people are more fertile. 427 00:22:23,119 --> 00:22:25,320 Speaker 10: Period. Helpier people are more fertile. 428 00:22:25,480 --> 00:22:30,680 Speaker 11: So I tell patients diet four pillars are diet, exercise, sleep, 429 00:22:31,080 --> 00:22:34,199 Speaker 11: and stress reduction. I don't have a pill on the 430 00:22:34,240 --> 00:22:38,720 Speaker 11: planet stronger than diet, exercise, sleep and such reduction. And 431 00:22:38,720 --> 00:22:41,719 Speaker 11: that's for anything. It's for ed testawsterm fertility. So if 432 00:22:41,720 --> 00:22:44,159 Speaker 11: you want to help me help yourself, you've got to 433 00:22:44,200 --> 00:22:47,359 Speaker 11: really help focus on the lifestyle modification. And if you 434 00:22:47,400 --> 00:22:49,159 Speaker 11: do those, each one of those have been shown to 435 00:22:49,160 --> 00:22:53,080 Speaker 11: help improve fertility, not only in men but also in women. Now, 436 00:22:53,080 --> 00:22:55,280 Speaker 11: I remember fifteen percent of those men that come in 437 00:22:56,320 --> 00:22:58,280 Speaker 11: can have a genetic cause. So we got to look 438 00:22:58,280 --> 00:23:01,359 Speaker 11: for the genetic reasons why they may have infertility. But 439 00:23:01,840 --> 00:23:04,199 Speaker 11: if they're not producing it, then I got to go 440 00:23:04,280 --> 00:23:06,960 Speaker 11: find it. In other words, are there are new techniques 441 00:23:07,000 --> 00:23:09,399 Speaker 11: that we now can do to go find the sperm? 442 00:23:09,480 --> 00:23:11,239 Speaker 11: At Baylor, we have something that's say to the art. 443 00:23:11,280 --> 00:23:13,160 Speaker 11: We have a new ultrasound that could actually look into 444 00:23:13,200 --> 00:23:16,680 Speaker 11: the testicle and show me where the sperm may be. 445 00:23:17,119 --> 00:23:18,840 Speaker 11: And so that's really a game changer because in the 446 00:23:18,880 --> 00:23:21,560 Speaker 11: old days, I'd have to take the operating room, open 447 00:23:21,560 --> 00:23:24,000 Speaker 11: them up, look everywhere, try to find it. With this 448 00:23:24,080 --> 00:23:28,200 Speaker 11: new technology, we can now identify where the patch of 449 00:23:28,280 --> 00:23:31,200 Speaker 11: sperm may be before I even go in there. 450 00:23:31,200 --> 00:23:31,960 Speaker 10: So I'll give you an example. 451 00:23:31,960 --> 00:23:34,080 Speaker 11: I had a patient the other day that had a 452 00:23:34,119 --> 00:23:37,399 Speaker 11: surgery called the MICROTESTI, and that's a pretty in depth surgery. 453 00:23:37,400 --> 00:23:38,000 Speaker 10: We've taken the. 454 00:23:37,920 --> 00:23:42,520 Speaker 11: Surgery, we look everywhere, and we take maybe twenty samples, 455 00:23:42,520 --> 00:23:45,720 Speaker 11: thirty samples, and we could not find the sperm. So 456 00:23:46,160 --> 00:23:47,680 Speaker 11: a year later he comes back and says, look, I 457 00:23:47,760 --> 00:23:48,960 Speaker 11: really want to try again. 458 00:23:49,280 --> 00:23:50,000 Speaker 10: I said, fine. 459 00:23:50,320 --> 00:23:52,600 Speaker 11: This time we were able to use that ultrasound device 460 00:23:52,960 --> 00:23:56,320 Speaker 11: and we were to pinpoint exact location where the sperm was, 461 00:23:56,800 --> 00:23:59,320 Speaker 11: went back in and we found it right away. It's 462 00:23:59,320 --> 00:24:02,520 Speaker 11: a game changer. So we're really using this technology to 463 00:24:02,640 --> 00:24:04,800 Speaker 11: help us. It also has a heat map, so it 464 00:24:04,800 --> 00:24:07,679 Speaker 11: can actually show you where there could be life inside 465 00:24:07,680 --> 00:24:09,719 Speaker 11: the testicle. So actually it's pretty cool, and I think 466 00:24:09,760 --> 00:24:11,000 Speaker 11: that's going to be a game changer. 467 00:24:12,520 --> 00:24:15,159 Speaker 2: You know, Well, I'm going to move past that for 468 00:24:15,160 --> 00:24:17,960 Speaker 2: a second because I want to ask you about testosterone 469 00:24:18,040 --> 00:24:23,840 Speaker 2: and where we are in testosterone delivery, testosterone replacement, Your 470 00:24:23,920 --> 00:24:26,359 Speaker 2: thoughts on that you and I first start talking about this, 471 00:24:26,600 --> 00:24:27,880 Speaker 2: I don't know, ten twelve years ago. 472 00:24:29,520 --> 00:24:32,879 Speaker 11: Yeah, so let's start very at the basic There is 473 00:24:33,000 --> 00:24:36,160 Speaker 11: not a better barometer of a man's overall health than 474 00:24:36,200 --> 00:24:39,320 Speaker 11: his testosterone level. I want to be very clear. Low 475 00:24:39,400 --> 00:24:43,680 Speaker 11: testosterone can have signs and symptoms, low energy, low lebido, 476 00:24:43,800 --> 00:24:49,800 Speaker 11: rectile dysfunction, increase, fat decrease, muscle depression, poor sleep. Okay, 477 00:24:49,880 --> 00:24:52,480 Speaker 11: so that's those are symptoms. Okay, but let's take a 478 00:24:52,520 --> 00:24:55,960 Speaker 11: little bit deeper. Did you know that low testosterone is 479 00:24:56,000 --> 00:24:58,680 Speaker 11: a significant risk factor or patients having an increased risk 480 00:24:58,720 --> 00:25:00,600 Speaker 11: for a heart attack. In other words, men with low 481 00:25:00,600 --> 00:25:03,199 Speaker 11: test austrial levels are much more likely to have a 482 00:25:03,200 --> 00:25:06,399 Speaker 11: heart attack period. Men with low test ostinal levels are 483 00:25:06,480 --> 00:25:10,080 Speaker 11: much more likely to break a bone offha peniostriprosis. Men 484 00:25:10,119 --> 00:25:12,280 Speaker 11: with low test ascal levels more like a diabetes. 485 00:25:13,880 --> 00:25:16,520 Speaker 2: Hold on, just a moment, Doctor Mohip Kara is hard. 486 00:25:16,560 --> 00:25:20,440 Speaker 2: Guess it's spelled k h E r Asi. 487 00:25:26,320 --> 00:25:29,160 Speaker 10: The Michael Barry Show, Simple Man. 488 00:25:32,320 --> 00:25:35,840 Speaker 2: At the end of the game, our guest is doctor 489 00:25:35,880 --> 00:25:40,359 Speaker 2: Mohith Kara. My urologist and dear friend, we're talking about 490 00:25:40,480 --> 00:25:44,600 Speaker 2: urological issues because that's his area of expertise. The clock 491 00:25:44,680 --> 00:25:47,240 Speaker 2: cut you off, but you were talking about the importance 492 00:25:47,280 --> 00:25:50,119 Speaker 2: of testosterone. Let me ask you a question first, and 493 00:25:50,119 --> 00:25:53,199 Speaker 2: then I want you to go back to that. A 494 00:25:53,200 --> 00:25:56,160 Speaker 2: lot of folks are very concerned about an increased risk 495 00:25:56,600 --> 00:26:00,000 Speaker 2: of prostate cancer if they take hormone replacement for two 496 00:26:00,000 --> 00:26:02,399 Speaker 2: picularly testosterone. Your thoughts. 497 00:26:04,240 --> 00:26:06,760 Speaker 11: So it was a myth that started in nineteen forty 498 00:26:06,880 --> 00:26:09,320 Speaker 11: one by a doctor named Huggins. Huggins in nineteen forty 499 00:26:09,320 --> 00:26:11,760 Speaker 11: one said if you take testoser increases your risk for 500 00:26:11,840 --> 00:26:14,479 Speaker 11: prostate cancer, and we found if you go look at 501 00:26:14,480 --> 00:26:18,680 Speaker 11: that paper, Michael, it's based on one patient. In twenty eighteen, 502 00:26:19,080 --> 00:26:23,160 Speaker 11: my society called the American Logic Association put out guidelines 503 00:26:23,560 --> 00:26:26,560 Speaker 11: saying that patients should be informed that testosterone does not 504 00:26:27,040 --> 00:26:29,320 Speaker 11: increase the risk of prostate cancer. And that was a 505 00:26:29,320 --> 00:26:32,639 Speaker 11: strong recommendation. And more importantly, there was a large study 506 00:26:32,640 --> 00:26:34,359 Speaker 11: that came out. Everyone needs to know about this. It 507 00:26:34,359 --> 00:26:37,920 Speaker 11: was called the Traverse Trial. This was five thousan two 508 00:26:37,960 --> 00:26:40,359 Speaker 11: hundred and forty six patients. I was one of the 509 00:26:40,440 --> 00:26:42,880 Speaker 11: ones running this trial. I designed this trial. It took 510 00:26:42,960 --> 00:26:45,400 Speaker 11: us six years to do it. We published it last year, 511 00:26:45,520 --> 00:26:48,359 Speaker 11: our last publication, and we show that there was absolutely 512 00:26:48,359 --> 00:26:52,440 Speaker 11: no increased risk in those men taking testosterone global placebo 513 00:26:52,480 --> 00:26:57,200 Speaker 11: for prostate cancer or any cardiovascar risk. No cardiovascar risk either, 514 00:26:57,240 --> 00:26:59,639 Speaker 11: So I think we've kind of put that one to rest. 515 00:27:00,960 --> 00:27:06,840 Speaker 2: Interesting if in fact that is true, even if it 516 00:27:06,920 --> 00:27:09,960 Speaker 2: wasn't true. Isn't it the case that if your PSA 517 00:27:10,720 --> 00:27:15,480 Speaker 2: markers started increasing, you could just dial back the testosterone anyway. 518 00:27:16,280 --> 00:27:18,959 Speaker 11: Yeah, but if your PSA marker starts increasing, then I 519 00:27:19,000 --> 00:27:22,200 Speaker 11: suspect that you have something underlying going on, like prostate cancer, 520 00:27:22,280 --> 00:27:23,800 Speaker 11: and I'm going to want to work it up. So 521 00:27:23,880 --> 00:27:25,840 Speaker 11: I think it's actually a good thing that your PSA 522 00:27:25,920 --> 00:27:28,280 Speaker 11: went up now as opposed to later, because you could 523 00:27:28,280 --> 00:27:31,399 Speaker 11: have an underlying prostate cancer. So just remember, if your 524 00:27:31,440 --> 00:27:35,480 Speaker 11: test starting testosphone is very low below fifty, I expect 525 00:27:35,520 --> 00:27:37,240 Speaker 11: your PSA to go up a little bit. And if 526 00:27:37,240 --> 00:27:39,760 Speaker 11: it does go up too much, let's go find out 527 00:27:39,800 --> 00:27:41,520 Speaker 11: what's going on. And in the old days, I'd have 528 00:27:41,520 --> 00:27:44,240 Speaker 11: to biops you. But now we have the MRI. The 529 00:27:44,359 --> 00:27:46,640 Speaker 11: MRI is really good. It gives you a score from 530 00:27:46,640 --> 00:27:49,480 Speaker 11: one to five. If it's not good, I got to 531 00:27:49,520 --> 00:27:51,560 Speaker 11: biopsy you. If you got a one, I'll leave you alone. 532 00:27:51,680 --> 00:27:53,800 Speaker 11: So we now don't have to run into a biopsy, 533 00:27:54,000 --> 00:27:55,840 Speaker 11: just get an MRI and see if we need to 534 00:27:55,840 --> 00:27:56,480 Speaker 11: go any further. 535 00:27:56,560 --> 00:27:58,439 Speaker 10: So it's been really, really good if you. 536 00:27:58,520 --> 00:28:01,000 Speaker 11: Get the past five ten years technology and the tests 537 00:28:01,080 --> 00:28:03,240 Speaker 11: we have to diagnose prostate cancer. 538 00:28:04,000 --> 00:28:05,800 Speaker 2: I forget what the term is for the finger up 539 00:28:05,800 --> 00:28:07,879 Speaker 2: the booty when a guy reaches a certain age. But 540 00:28:09,600 --> 00:28:13,720 Speaker 2: my theory is that unless someone has a based on 541 00:28:13,800 --> 00:28:18,360 Speaker 2: my readings, unless someone has a propensity for prostate cancer 542 00:28:19,280 --> 00:28:22,160 Speaker 2: in their family, that you should just do the Pooh 543 00:28:22,200 --> 00:28:25,720 Speaker 2: test and unless that comes back positive and then follow 544 00:28:25,760 --> 00:28:28,520 Speaker 2: it up because you can do harm with the And 545 00:28:28,560 --> 00:28:30,560 Speaker 2: why has the word escaped me? What is the word 546 00:28:30,600 --> 00:28:31,600 Speaker 2: that guy's dread? 547 00:28:31,720 --> 00:28:32,280 Speaker 10: The two things? 548 00:28:32,320 --> 00:28:36,560 Speaker 11: I think you're thinking about a colonoscopy or we're talking 549 00:28:36,560 --> 00:28:39,920 Speaker 11: about yeah, but that's different. Remember, colonoscopy is looking for 550 00:28:40,000 --> 00:28:42,720 Speaker 11: colon cancer, right, and so we know that the guidelines 551 00:28:42,760 --> 00:28:43,640 Speaker 11: states starting at fifty. 552 00:28:43,680 --> 00:28:44,520 Speaker 10: Some would even say. 553 00:28:44,320 --> 00:28:47,160 Speaker 11: Now earlier you start getting that kolnoscopy, But that's screening 554 00:28:47,160 --> 00:28:50,280 Speaker 11: for colon cancer. I'm screening for something different. I'm screening 555 00:28:50,280 --> 00:28:52,880 Speaker 11: for prostate cancer. And every man between the ages of 556 00:28:52,960 --> 00:28:55,440 Speaker 11: fifty five and seventy should be screened every year for 557 00:28:55,480 --> 00:28:57,800 Speaker 11: prostate cancer. And if you have a high risk, if 558 00:28:57,800 --> 00:28:59,600 Speaker 11: you're African American, if you have a family. 559 00:28:59,320 --> 00:29:01,640 Speaker 10: History like you mentioned, and you should be screened earlier. 560 00:29:01,880 --> 00:29:04,600 Speaker 11: And a family history could be your father had prostate cancer, 561 00:29:04,680 --> 00:29:06,680 Speaker 11: or even a mother or a woman on having a 562 00:29:06,760 --> 00:29:08,960 Speaker 11: history of breast cancer puts you to increased risk for 563 00:29:09,000 --> 00:29:11,880 Speaker 11: prostate cancer. So typically we do a rectal exam with 564 00:29:11,920 --> 00:29:15,000 Speaker 11: the finger and we check a PSA and so that's 565 00:29:15,160 --> 00:29:18,200 Speaker 11: that's important to do that. But for prostate cancer. Your 566 00:29:18,240 --> 00:29:20,800 Speaker 11: colonoscopy is for your colon cancer. 567 00:29:21,360 --> 00:29:24,720 Speaker 2: Why do Blacks have a higher rate? Is that a 568 00:29:24,840 --> 00:29:29,480 Speaker 2: behavioral cultural food stress or is that something like sickle 569 00:29:29,560 --> 00:29:32,960 Speaker 2: cell anemia? Is that is specific to the race? 570 00:29:34,520 --> 00:29:35,600 Speaker 10: Yeah, it could be. So. 571 00:29:35,760 --> 00:29:38,640 Speaker 11: One theory we've seen this before something called the sensitivity 572 00:29:38,680 --> 00:29:41,440 Speaker 11: of the androgen receptor. So we all have testosand receptors, 573 00:29:41,760 --> 00:29:44,960 Speaker 11: and we know that if there is increased sensitivity the receptor, 574 00:29:45,160 --> 00:29:47,040 Speaker 11: it's called the c AG repeat, and we know the 575 00:29:47,080 --> 00:29:50,000 Speaker 11: African Americans have a different SAG repeat than others. It 576 00:29:50,040 --> 00:29:53,440 Speaker 11: could increase their risk for prostate cancer. That's one theory. 577 00:29:54,760 --> 00:29:57,520 Speaker 11: But we do know that certain races like Asians are 578 00:29:57,600 --> 00:30:00,040 Speaker 11: less likely to have prostate cancer, right, So there, what 579 00:30:00,120 --> 00:30:03,400 Speaker 11: is the different propency amongst races to get prostate cancer? 580 00:30:04,040 --> 00:30:09,440 Speaker 2: Interesting? Biggest development in urology in the last ten to 581 00:30:09,480 --> 00:30:11,240 Speaker 2: twenty years that makes you very excited. 582 00:30:12,640 --> 00:30:14,840 Speaker 11: Well, there's so many So I talked about the Traverse trial. 583 00:30:14,920 --> 00:30:18,360 Speaker 11: This was a huge trial, five thousand patients just showing 584 00:30:18,400 --> 00:30:19,880 Speaker 11: the safety of testosterone. 585 00:30:20,360 --> 00:30:21,200 Speaker 10: I think it's a big deal. 586 00:30:21,280 --> 00:30:24,000 Speaker 11: I think our knowledge of testosterone now as a marker 587 00:30:24,040 --> 00:30:24,920 Speaker 11: of overall health. 588 00:30:25,200 --> 00:30:26,320 Speaker 10: Every man over the. 589 00:30:26,240 --> 00:30:29,040 Speaker 11: Age of forty should have a testosteron level checked every 590 00:30:29,080 --> 00:30:31,440 Speaker 11: man every year. And what I get shocked about is 591 00:30:31,440 --> 00:30:33,400 Speaker 11: when you go in for your physical, they check your thyroid, 592 00:30:33,440 --> 00:30:36,720 Speaker 11: they check your humogin aec that is the best marker 593 00:30:36,720 --> 00:30:39,600 Speaker 11: of your overall health, Michael, is your TESTOSTERL level. Not 594 00:30:39,720 --> 00:30:41,280 Speaker 11: only is it a marker of how you are going 595 00:30:41,320 --> 00:30:44,080 Speaker 11: to be your kind medical condition today, but what's going 596 00:30:44,120 --> 00:30:44,680 Speaker 11: to happen to. 597 00:30:44,640 --> 00:30:45,960 Speaker 10: You in the future. 598 00:30:46,640 --> 00:30:51,880 Speaker 11: I said earlier it was for heart attack, bone fracture, diabetes, obesity, 599 00:30:52,080 --> 00:30:55,760 Speaker 11: it's associated with prostate cancer. Lower testosteron levels it's associated 600 00:30:55,800 --> 00:30:56,320 Speaker 11: with depression. 601 00:30:56,440 --> 00:30:56,920 Speaker 10: And I'll tell you this. 602 00:30:57,000 --> 00:30:59,040 Speaker 11: I've been working at the VA Hospital for twenty five 603 00:30:59,120 --> 00:31:02,680 Speaker 11: years with veterans, and these veterans typically will have a 604 00:31:02,720 --> 00:31:05,040 Speaker 11: lot of them become under depression. And I can't tell 605 00:31:05,080 --> 00:31:07,560 Speaker 11: you how few of them ever had a testosteronal level check. 606 00:31:07,960 --> 00:31:12,640 Speaker 11: Low testosterone increases your risk for depression, and testosterone can't 607 00:31:12,640 --> 00:31:15,120 Speaker 11: help with depression, and most of these patients are not 608 00:31:15,120 --> 00:31:16,480 Speaker 11: getting their testotional level check. 609 00:31:16,720 --> 00:31:17,440 Speaker 10: I had a big honor. 610 00:31:17,480 --> 00:31:20,160 Speaker 11: I was invited to go to a special operations command 611 00:31:20,240 --> 00:31:23,240 Speaker 11: in Florida and present to the military on something called 612 00:31:23,320 --> 00:31:24,320 Speaker 11: operator syndrome. 613 00:31:24,800 --> 00:31:25,920 Speaker 10: What is operator syndrome. 614 00:31:25,960 --> 00:31:30,320 Speaker 11: Operator syndrome is when our military when they go train really. 615 00:31:30,040 --> 00:31:32,000 Speaker 10: Hard, and when they're training really hard. 616 00:31:31,880 --> 00:31:35,160 Speaker 11: Doing Hell Week, they feel lousy for several weeks afterwards. 617 00:31:35,440 --> 00:31:36,760 Speaker 10: And what we found is that their. 618 00:31:36,640 --> 00:31:39,920 Speaker 11: Testosterol levels go down significantly and they stay down for 619 00:31:40,000 --> 00:31:42,360 Speaker 11: quite a bit of time. And that's men and women 620 00:31:42,400 --> 00:31:45,680 Speaker 11: in the military, and so they call the operator syndom, 621 00:31:45,680 --> 00:31:47,840 Speaker 11: But the reality is that their te levels go down. 622 00:31:48,080 --> 00:31:50,920 Speaker 11: In my bias is that you know, these men and 623 00:31:50,960 --> 00:31:54,040 Speaker 11: women should have the ability to get their testosteral level 624 00:31:54,120 --> 00:31:57,400 Speaker 11: back just to be in the normal range, because I'll 625 00:31:57,400 --> 00:31:59,280 Speaker 11: give you an example. The normal range is three hundred 626 00:31:59,280 --> 00:32:02,040 Speaker 11: to one thousand, okay, And let's say you have a 627 00:32:02,160 --> 00:32:05,440 Speaker 11: US military at a level of three ten and you 628 00:32:05,480 --> 00:32:08,040 Speaker 11: look at someone who they're fighting against and their level 629 00:32:08,080 --> 00:32:10,000 Speaker 11: is at nine hundred. Who do you think is going 630 00:32:10,040 --> 00:32:12,600 Speaker 11: to have the advantage the nine hundred. And if you 631 00:32:12,600 --> 00:32:15,280 Speaker 11: look at history, the Germans used to give their military 632 00:32:15,480 --> 00:32:18,520 Speaker 11: high doses of testosterone before they went to combat because 633 00:32:18,520 --> 00:32:21,080 Speaker 11: it would increase their mental acuity, it would help them 634 00:32:21,080 --> 00:32:23,960 Speaker 11: with the fighting. And our military if they're at three 635 00:32:24,000 --> 00:32:27,120 Speaker 11: ten or three twenty, they are not allowed to take testosterone, 636 00:32:27,120 --> 00:32:30,920 Speaker 11: which is a big disadvantage to them when they're in combat. 637 00:32:32,200 --> 00:32:35,480 Speaker 2: And what would you like yours to be ideally your 638 00:32:35,600 --> 00:32:36,520 Speaker 2: testosterone level. 639 00:32:37,720 --> 00:32:40,720 Speaker 11: I would the guidelines say you should be between four 640 00:32:40,720 --> 00:32:42,760 Speaker 11: point fifty and six hundred, and I think that's an 641 00:32:42,800 --> 00:32:45,880 Speaker 11: appropriate level. If the levels between three hundred and one 642 00:32:45,920 --> 00:32:48,880 Speaker 11: thousand is a normal range, putting someone at least in 643 00:32:48,960 --> 00:32:52,200 Speaker 11: the middle makes sense. Some patients do better when they're 644 00:32:52,200 --> 00:32:54,480 Speaker 11: a bit high high, but still in the normal range, 645 00:32:54,680 --> 00:32:56,880 Speaker 11: but at least four to fifty to six hundred. But 646 00:32:57,000 --> 00:32:58,880 Speaker 11: you look at all these military personnel there at three 647 00:32:58,880 --> 00:33:00,600 Speaker 11: point thirty three forty eight. And if you look at 648 00:33:00,600 --> 00:33:02,840 Speaker 11: people I take care a lot of professional athletes. They 649 00:33:02,920 --> 00:33:04,840 Speaker 11: come in and their levels are at three point fifty. 650 00:33:05,080 --> 00:33:07,600 Speaker 11: Well they're not allowed to take testos from because band, right, 651 00:33:08,040 --> 00:33:10,880 Speaker 11: but they're at a huge disadvantage when they're on the 652 00:33:10,920 --> 00:33:12,280 Speaker 11: field compared to others. 653 00:33:12,600 --> 00:33:16,280 Speaker 2: You know, Yeah, what your body is producing is giving 654 00:33:16,280 --> 00:33:20,240 Speaker 2: you an advantage or not producing is giving you a disadvantage. 655 00:33:20,360 --> 00:33:21,920 Speaker 2: You know, I would probably have to touch that the 656 00:33:22,000 --> 00:33:24,200 Speaker 2: right time. But a friend of mine went to you, 657 00:33:24,480 --> 00:33:29,800 Speaker 2: his wife went to you with urinary incontinence. He sent 658 00:33:29,840 --> 00:33:31,320 Speaker 2: me a message to talk to you about this, but 659 00:33:31,320 --> 00:33:32,760 Speaker 2: I think we're going to run out of time, and 660 00:33:32,960 --> 00:33:35,600 Speaker 2: that you're using botox to treat that. Is that true? 661 00:33:36,600 --> 00:33:40,400 Speaker 11: Yes, yes, it's phenomenal. It's FDA approved. You be injected 662 00:33:40,400 --> 00:33:42,680 Speaker 11: into the bladder floor and it makes a huge difference 663 00:33:42,960 --> 00:33:46,000 Speaker 11: in quieting the bladder down. It so works so well 664 00:33:46,040 --> 00:33:48,239 Speaker 11: as covered by most insurances as well. But it only 665 00:33:48,320 --> 00:33:49,959 Speaker 11: lasts six months, so you got to do it every 666 00:33:50,000 --> 00:33:50,760 Speaker 11: six months. 667 00:33:51,640 --> 00:33:55,160 Speaker 2: You're the magic man. I love it. If the magic 668 00:33:55,240 --> 00:33:59,360 Speaker 2: man Caric Kae r A as always my friend. 669 00:33:59,400 --> 00:34:03,600 Speaker 10: Thank you, Thank you so much, Michael, really I. 670 00:34:03,560 --> 00:34:05,080 Speaker 2: Wish you could stay two more hours. I got a 671 00:34:05,160 --> 00:34:06,880 Speaker 2: hundred questions from listeners, but I know you've got to 672 00:34:06,920 --> 00:34:07,560 Speaker 2: treat patients.