Speaker 1: Let's talk about it. Let's talk about the man hero.
Speaker 2: Welcome to the man Well, hell yeah, welcome back to
Speaker 2: the mail room.
Speaker 3: Me and Jordan Renta.
Speaker 2: I know that's not grammatically correct, hanging out and talking
Speaker 2: about all things men's health. Do you ever get a
Speaker 2: song just stuck in your head where you just can't
Speaker 2: get it out of men?
Speaker 3: I know this is a thing. Does this happened to
Speaker 3: you at all?
Speaker 4: Jordan's all the time as a former music journalist. This
Speaker 4: is definitely it's a hazard.
Speaker 2: Right, You just realize I got a little ditty there's
Speaker 2: a thing. Yeah, and me too as well. And sometimes
Speaker 2: they're good songs. And I don't want to mess anybody
Speaker 2: up because I think what I'm gonna say is a
Speaker 2: good song. So I don't want it to get in
Speaker 2: anybody's head in a way that they can't get it
Speaker 2: out and they're gonna curse me. But you remember this
Speaker 2: song by Nana in the eighties, the ninety nine Red Balloons.
Speaker 2: Oh yeah, you annoying, annoying? Yeah, And it's like you
Speaker 2: and I toy shop with a bag of balloons or
Speaker 2: the money we've got I don't know why, but that's
Speaker 2: such a little it's not even pentameter. Itau's but such
Speaker 2: a great little ditty. It's just that I can't get
Speaker 2: that out of my head. And and that song. I
Speaker 2: don't know if you know, because you were a little
Speaker 2: bit younger than I, but that came out in the
Speaker 2: sort of the very height of the Cold War, and
Speaker 2: it's basically about nuclear destruction and mutually assured destruction and
Speaker 2: war games with Matthew Broderick, and you know, messed me.
Speaker 2: That kept me up at night the day after that
Speaker 2: apocalyptic movie that came out on TV that was I
Speaker 2: guess supposed to scare us into uh into submission.
Speaker 3: Well, that kept me up at night. But do you
Speaker 3: know what else keeps me up at night? What's that?
Speaker 2: Well, I mean the worry about patients that have to
Speaker 2: get up to pee at times. I mean it's terrible
Speaker 2: getting up at night. Nocturnal urine agency. What I did
Speaker 2: there that was so smooth.
Speaker 4: As long as you need the erna's like atting you.
Speaker 3: Up in the middle of the night, That's that's right.
Speaker 2: I mean, I'm a man of a certain age, but
Speaker 2: but I know, how often is okay? And how often
Speaker 2: is not okay when I should seek medical help? And
Speaker 2: I think that's going to be somewhere in there. You're
Speaker 2: gonna find a title and you're gonna make this clean
Speaker 2: and squeaky and ready for prime time. But but we're
Speaker 2: going to talk about yeah, just you know, when is
Speaker 2: your nation normal? In other words, like everybody got a
Speaker 2: pe uh, and when is it something that you should
Speaker 2: find a doctor for? And So what I thought we'd
Speaker 2: do today, if you're game for this, is I thought
Speaker 2: I would be your human AI medical source where you're
Speaker 2: going to ask the questions that that you're going to
Speaker 2: put into your search engine. And then instead of having
Speaker 2: somebody comb the literature and the popular media and then
Speaker 2: give you a sucact answer, now I'm gonna give you, you know,
Speaker 2: an actual human physician response from a board certified urologist.
Speaker 2: So I am your doctor Mills GPT, at your service.
Speaker 4: All right, Well, I have done a little bit of
Speaker 4: research academically, but also physically. I've got my giant thing
Speaker 4: of iceed coffee and my leader of water right here.
Speaker 2: That's amazing. Yeah, so you're you're priming your kidneys for
Speaker 2: what they do best. We hope I love it well,
Speaker 2: So yeah, so let me let me give a guy
Speaker 2: a little bit of an understanding of how the whole
Speaker 2: process works. And it's a pretty amazing process. I mean
Speaker 2: it starts in the brain with a bunch of hormones
Speaker 2: that regulate the fluid.
Speaker 3: Balance in our entire system.
Speaker 2: And so basically, the kidneys are pretty amazing organs and
Speaker 2: we probably should dedicate in a whole episode to them
Speaker 2: because they keep the blood in acid base balance, so
Speaker 2: they have this perfect pH. I can tell you my
Speaker 2: thoughts on alkaline water because I don't think we have
Speaker 2: any sponsors of alkaline water. But spoiler alert doesn't really work.
Speaker 2: If you need alkaline water, it means your kidneys aren't
Speaker 2: doing their job. Because that's a beautiful thing about our
Speaker 2: kidneys is you can drink vinegar, which has a pH
Speaker 2: of two, and you could drink well, I wouldn't recommend
Speaker 2: it regularly, but you could drink baking soda, which has
Speaker 2: a much higher pH and still end up with a nice,
Speaker 2: verily well balanced urine that tends to be a little
Speaker 2: bit on the acidic side. So that's the first thing
Speaker 2: the kidneys do. But they also process fluid. You already
Speaker 2: have a question. I'm looking at you, so I do.
Speaker 3: This is me being a word.
Speaker 4: If you need alkaline water, it means your kidney's are
Speaker 4: doing their job. Conversely, if you drink a lot of
Speaker 4: alkaline water, does that have a harmful effect?
Speaker 3: I love it.
Speaker 2: No. And by the way, yeah, if you have if
Speaker 2: you have acid demi or an excess of acid in
Speaker 2: your bloodstream, drinking alkaline water is not gonna do anything.
Speaker 2: It doesn't work that way. An acid base balance is
Speaker 2: controlled both by our lungs, our respiratory system, and then
Speaker 2: also our kidneys. So no, The bottom line is that
Speaker 2: you can drink things, and you can eat things with
Speaker 2: an incredibly low pH or an incredibly high pH, and
Speaker 2: the kidneys have an amazing way of exchanging hydrogen ions
Speaker 2: across a very complex system within the meat or what
Speaker 2: we call the prank of of the kidneys to balance it.
Speaker 2: So by the time it gets to the bladder, your
Speaker 2: urinary pH is somewhere on a normal level between five
Speaker 2: point five, which is acidic up to it really doesn't
Speaker 2: get much above basic of seven point five because most
Speaker 2: of us carry an excess acid base or acid in
Speaker 2: our in our baseline diet, so In other words, if
Speaker 2: you eat kind of a normal American diet full of
Speaker 2: meat and protein, that tends to be a cidic and
Speaker 2: so you have to kind of get rid of that acid.
Speaker 3: And the way you do that is through the kidneys.
Speaker 2: Eventually, if you drink, if you have a very vegetarian diet,
Speaker 2: then actually that's one way that you can alkalinize your urine.
Speaker 2: We're gonna have an episode on kidney stones too, where
Speaker 2: we talk about how important it is to manage acid
Speaker 2: base balance. I'll bring in one of my expert guests
Speaker 2: and friends and colleagues for that sometime in the future.
Speaker 2: But the bottom line is that that you know, drink
Speaker 2: water and it doesn't have to be it doesn't have
Speaker 2: to be alkalin and the health benefits have never been
Speaker 2: shown in any clinical trials. To do anything other than
Speaker 2: I'll spend a lot of money and look cool at
Speaker 2: the gym, which again is totally fine, and you should
Speaker 2: do that, and I promise I won't I won't alkaline
Speaker 2: water shame you because you're doing what makes you feel good,
Speaker 2: and that's that's what.
Speaker 3: This is all about.
Speaker 5: Brother, I have another water based question.
Speaker 4: I'm so sorry, man, this is fine no, no, no,
Speaker 4: none of these are ones that I prep but I'm
Speaker 4: addicted to seltzer water.
Speaker 5: I'm a New Yorker. It's kind of one of the
Speaker 5: things that we do.
Speaker 4: And I have heard mixed reports on what whether or
Speaker 4: not seltzer water is completely fine same as regular water or.
Speaker 3: The right a CO two.
Speaker 4: It could be bad for you either I've heard, either
Speaker 4: internally or for the teeth.
Speaker 5: Teeth.
Speaker 4: Yeah, yeah, do you have any thoughts on that?
Speaker 3: Yeah, I mean it's kind of the same thing.
Speaker 2: And I love the whole teeth thing because you know,
Speaker 2: unless you're gargling it or switching it around, then then
Speaker 2: the amount of contact time your teeth has with anything,
Speaker 2: whether it's coffee or wine or seltzer water, it's probably
Speaker 2: not going to do that much. And so really the
Speaker 2: teeth should be pretty well excluded. It's a thing that
Speaker 2: I hear, you know, from some dentist all the time.
Speaker 2: Another Dannis say, Now, there's no absolutely no data to
Speaker 2: show that seltzer water erodes.
Speaker 3: You're enamel.
Speaker 2: It's acidic, sure, CO two, but again, your your body's
Speaker 2: able to handle that, and and it's probably better for
Speaker 2: you than say sugar sodas that that I have so
Speaker 2: much sugar in the that it is really going to
Speaker 2: be what hurts you. Though those also have seltzer water,
Speaker 2: they just also have sugar. So so no, I mean,
Speaker 2: I remember years ago people would pour coke onto car
Speaker 2: hoods and say, look how bad soda is for you
Speaker 2: because it erodes car enamel, Like, well, you're right, you know,
Speaker 2: reason why is that your car doesn't have kidneys. If
Speaker 2: your car had a kidney, it would say, hey, I'm
Speaker 2: going to look at this and I'm going to dialyze
Speaker 2: this off and.
Speaker 3: You're gonna be fine.
Speaker 2: So yeah, yeah, So so that that's the deal. So drink,
Speaker 2: drink whatever you want within reason, and celtzer water is
Speaker 2: probably a lot healthier for you than than sugar, sodas
Speaker 2: and other such things.
Speaker 3: So I'm cool with that. Totally cool with that. All right.
Speaker 3: So then you make urine and it stores in the bladder.
Speaker 2: So now we're just going to completely bypass hours of
Speaker 2: renal physiology and say your bladder is basically a storage
Speaker 2: muscle and that's really important because in a guy, and
Speaker 2: that's what really going to focus on today. Although a
Speaker 2: lot of this you can translate to women minus the prostate,
Speaker 2: which is really what we're building up to here. But
Speaker 2: the bladder is simply a muscle that it starts very
Speaker 2: small when it's when it's decompressed. In other words, that
Speaker 2: after you pee, it shrivels down to this tiny, little,
Speaker 2: maybe fist size organ that that's hollow in the middle.
Speaker 2: It just kind of collapses in on itself and waits
Speaker 2: for you to make more urine.
Speaker 3: And so as.
Speaker 2: We look at the pathology of urination, we break it
Speaker 2: down into two phases. We break it into storage problems,
Speaker 2: and then we break it down into elimination problems. And
Speaker 2: a storage problem means there's something wrong with a bladder
Speaker 2: where it doesn't it can't fill enough. And you hear
Speaker 2: this all the time, I have a shy bladder, or
Speaker 2: ever since I was you know, twelve, people made fun
Speaker 2: of me because I had to pee all the time.
Speaker 2: Some of that could be pathologic and that they truly
Speaker 2: have a storage problem where their bladder just never developed
Speaker 2: to the point where it can capacitate what we would consider.
Speaker 3: A normal amount of urine.
Speaker 2: And again there's really there's not really a set define
Speaker 2: urologic baseline for what is normal. But in general, most
Speaker 2: bladders should hold about two hundred and fifty mili liters,
Speaker 2: so a little bit, you know, less than a twelve
Speaker 2: ounce can of soda, So that's a about normal before
Speaker 2: you say you should go pee. Some bladders can hold
Speaker 2: leaders literally leaders of viurine before they have to go pee.
Speaker 3: That becomes pathologic.
Speaker 2: So somewhere between a can of soda and a leader
Speaker 2: of soda is where normal bladder capacitation should be for
Speaker 2: an adult. So that's a storage issue. If somebody is
Speaker 2: not able to expand the bladder muscle because there's something pathologic,
Speaker 2: either neurologically wrong or muscularly wrong, then that's a storage issue.
Speaker 2: And those people are going to present mostly with what
Speaker 2: we call frequency and urgency symptoms where they're peeing all
Speaker 2: the time and like they got to go, and there's
Speaker 2: a there's a classic classic diagnostic indicator we call the
Speaker 2: key in the door symptom when basically, if your brain,
Speaker 2: and this is where the brain takes over, knows that
Speaker 2: there's going to be a urinal around somewhere, then you
Speaker 2: have this little socially appropriate signal like, oh, it's go
Speaker 2: time and I got to pee. For older guys, this
Speaker 2: is one of those things where you will know exactly
Speaker 2: where every bathroom is in public places. If you're in
Speaker 2: the mall, you know, oh, it's on the first story
Speaker 2: in that department store behind shoes, and you almost have
Speaker 2: bladder maps that you've worked out, and God help you
Speaker 2: if it's closed for cleaning, right because you have that
Speaker 2: key in the door that I know, I'm aout right
Speaker 2: open the door and there's going to be urinal on
Speaker 2: the other side, and I got a peek. So those
Speaker 2: are mostly storage problems or frequency urgency, irritative voiding symptoms.
Speaker 2: That's the number one issue of what we look at.
Speaker 2: The second is voiding or elimination, where then you can
Speaker 2: have problems with when you actually start the flow of
Speaker 2: ur and it doesn't come out so well. And that's
Speaker 2: also what we call obstructive symptoms. So a little side
Speaker 2: note for bladder and prostate anatomy is that. And we've
Speaker 2: talked about prostate and a whole other series with prostate cancer,
Speaker 2: and so the side note here is that basically the
Speaker 2: prostate does two things to guys as we get older.
Speaker 2: It either gets bigger causes obstructive urinary symptoms, or it
Speaker 2: gets cancer. And that's about it other than still being
Speaker 2: an organ that makes semen and therefore.
Speaker 3: Part of sexual pleasure.
Speaker 2: So if you have the symptoms of where yeah, doc,
Speaker 2: I can hold my ear and just fine. I don't
Speaker 2: have frequency and urgency, but when I do find a
Speaker 2: good place to pee and I let her.
Speaker 3: Rip, it just trickles out.
Speaker 2: That means that you have a force differential between what's
Speaker 2: going on in the bladder where the bladder muscles contracting,
Speaker 2: but yet it's hitting what we call an obstructive process.
Speaker 2: And there's two kinds of obstructions. There's a fixed obstruction
Speaker 2: where it doesn't move at all, and then there's a
Speaker 2: more variable obstruction, which is the prostate land itself. So
Speaker 2: best definition, and this is something we don't see very
Speaker 2: much anymore. But the most common fixed obstruction and a
Speaker 2: guy is a urethral stricture. So urethral strictures were the
Speaker 2: bane of early urologists. Existence is because the most common
Speaker 2: cause of urethral stricture is really, up until the nineteen
Speaker 2: forties was on area and gonerhea was such an endemic
Speaker 2: condition globally than so many guys suffered from it women too. Obviously,
Speaker 2: it didn't affect the urethra as much in women, and
Speaker 2: it was.
Speaker 3: It was really the.
Speaker 2: Cause of a lot of medical innovations, which again I'm
Speaker 2: glad you're sitting down for, and I don't want to
Speaker 2: ruin your summer vacation with talking about these tools of
Speaker 2: the devil, as we say, but there are all kinds
Speaker 2: of strictural dilators that they really do look like torture
Speaker 2: devices of pewter made steel made straws basically that you
Speaker 2: grind into the urethra, which is as you know, since
Speaker 2: right there in heavy real estate, right in the penis
Speaker 2: to get that structure open so guys could bee. It
Speaker 2: was miserable and miserable and people would die from it
Speaker 2: there die from infections, they died from kidney failure, and
Speaker 2: so it was really a bad deal. And in fact,
Speaker 2: really the only treatment for that was to bypass that
Speaker 2: stricture surgically and do what's called a perineal urythrostomy, where
Speaker 2: again it would put a guy up in a frog
Speaker 2: leg position, get four of his best friends to hold
Speaker 2: him down, get him just absolutely shit face drunk, and
Speaker 2: then take a hot metal rod and stick it right
Speaker 2: behind the testicles through the paraneum into the bladder, and
Speaker 2: then just let it drain.
Speaker 3: And that was the that was what we made up.
Speaker 2: Then we called that term dorsal lithotomy because you were
Speaker 2: up on your back with your legs up in the air,
Speaker 2: kind of like a pelvic exam, and it was to
Speaker 2: get the stones out of the bladder, which can happen
Speaker 2: to the guys that have chronic emptying issues, and they
Speaker 2: would die if they didn't get it, and the unfortunately
Speaker 2: a lot of times they would die.
Speaker 3: If they did get that procedure.
Speaker 2: So it was a huge, huge issue in eighteenth century,
Speaker 2: all the way back to the times of Galen and
Speaker 2: Hippocrates actually that eurethral obstruction and death from bladderstones from
Speaker 2: urethral and prostate destruction was a thing. So we come
Speaker 2: a long way. But that's a fixed obstruction. So getting
Speaker 2: back to the prostate, as I said, it's not necessarily
Speaker 2: a fixed obstruction because the prostate is a muscle and
Speaker 2: a gland. And the best way that we look at
Speaker 2: at prostate as we age is that it almost everybody,
Speaker 2: it gets bigger, and it gets bigger and bigger as
Speaker 2: we age, and there are ways to treat it, which
Speaker 2: we had talked about episodes ago with doctor Wayne Brisbane
Speaker 2: in one of the most common ways is to shrink
Speaker 2: it through a hormone medication called detastoride or finasteride, And
Speaker 2: we talked about and a multiple.
Speaker 3: Episodes because a lot of side effects, a lot of
Speaker 3: benefits to.
Speaker 2: Those drugs, but the bottom line is that shrinks that glands.
Speaker 2: It's not fixed anymore, and it allows better emptying of
Speaker 2: the bladder because you've relieved some of that obstruction. The
Speaker 2: most common medication we use for BPH benign prosthetic hyperplasia,
Speaker 2: is something called an alpha blocker, and an alpha blocker
Speaker 2: just hits the muscle receptors in the prostate to open
Speaker 2: it up temporarily, and so you have to take that
Speaker 2: every day essentially forever, in order to keep that muscle
Speaker 2: relaxed so you can pee better.
Speaker 3: That's the non fit construction.
Speaker 2: But that's the thing that most people when a guy
Speaker 2: comes into the dock and says, hey, I'm getting up
Speaker 2: at night to pee one time, two times, four times,
Speaker 2: they say, Oh, it's probably your prostate. And if you
Speaker 2: don't ask the question, if your doctor doesn't ask the
Speaker 2: question about whether this is what we think of storage issue,
Speaker 2: meaning it may be a bladder problem or whether this
Speaker 2: is an outlet issue, meaning an obstructive or a avoiding problem.
Speaker 2: Then a lot of guys come in and they're on
Speaker 2: medications that don't work because they're treating a prostate issue,
Speaker 2: and in fact, a lot of guys have storage problems
Speaker 2: and they have a lot of intrinsic bladder issues frequency
Speaker 2: urgency that aren't really looked at. So that's the kind
Speaker 2: of the easy bladder physiology prosta physiology one O one.
Speaker 2: But the wheels come off in a lot of different ways.
Speaker 2: And one of the ways they come off is that
Speaker 2: if a bladder is chronically blocked over time from an
Speaker 2: enlarged prostate, then it can have problems with storage and
Speaker 2: it can either cause frequency and urgency because because the
Speaker 2: bladder is a muscle and the prostate, if it enlarges,
Speaker 2: causes a higher pressure or what we call an outflow pressure.
Speaker 2: It gets to the point where the bladder has to
Speaker 2: keep working out, it has to keep stronger and stronger,
Speaker 2: and at some point the bladder can wear out. And
Speaker 2: so that's why getting your prostate looked at and making
Speaker 2: sure that it's not getting too big and causing that
Speaker 2: obstruction is so important. Because there are guys that can
Speaker 2: end up with what we call an in stage bladder,
Speaker 2: and this is one of these warning signs that we
Speaker 2: worry about in medicine where you and it's happened actually
Speaker 2: twice in the last week to patients of mind that
Speaker 2: I was seeing for other issues that had been kind
Speaker 2: of doing just fine. They both ended up on a
Speaker 2: long plane ride to Europe. One was in London, one
Speaker 2: was in Paris and called the office saying, Hey, I
Speaker 2: can't pee, I'm in an er here and I need
Speaker 2: a catheter. And that's because they got out of their
Speaker 2: normal urinary habits and they weren't maybe getting up on
Speaker 2: a twelve hour flight to pee. And then some of them,
Speaker 2: you know, if you take a sleeping medicine to help
Speaker 2: you get across the Atlantic, that can make it worse.
Speaker 2: And then all of a sudden, you know, you need
Speaker 2: a cafe in order to avoid No. Thankfully, for the
Speaker 2: guys that I still see there, they don't have an
Speaker 2: in stage bladder. They're they're fine because we caught it early.
Speaker 2: But there are guys that ignore it to the point
Speaker 2: where even if we do do something to their prostate
Speaker 2: open it up. Either surgically, which again we're gonna have
Speaker 2: an amazing episode on or medically that bladder can just
Speaker 2: give out, and then those guys are gonna need to
Speaker 2: figure out how to drain their bladder with a catheter
Speaker 2: really for you know, potentially the rest of their lives.
Speaker 2: So so again a big, a big thing that that
Speaker 2: urination is normal, which is I'm sure one of the
Speaker 2: questions you're gonna ask me. Uh, you know, you should
Speaker 2: be peeing every few hours during there in the daytime
Speaker 2: and at night. You should be able to sleep through
Speaker 2: the night, you know, well into your fifties without getting up.
Speaker 2: We do have in our diagnostic codes actually where we
Speaker 2: where we try to say, here's a guy, he's coming
Speaker 2: in for nocturia, which is the fancy name for getting
Speaker 2: up a night to pee. If it is greater than once,
Speaker 2: then there's a separate code for that, and so so
Speaker 2: I guess that's normal. But again, if a guy's like Doc,
Speaker 2: I get at once, I can't get back to sleep,
Speaker 2: you know, then we have to start looking at sleep
Speaker 2: disorders as well as you know, at looking at the prostate.
Speaker 2: And still we're going to try to address the eurologic
Speaker 2: issues before we look at some of the other things
Speaker 2: that can get you up at night a lot to pee,
Speaker 2: Like diabetes is still one of the things that man
Speaker 2: that's a medicare as a disease. It gets involved in
Speaker 2: all parts of urology. But some guys pee so frequently
Speaker 2: because the sugar causes you to make more really poorly
Speaker 2: concentrated urine, and you got to pee all the time,
Speaker 2: you know, because you have diabetes. So you got to
Speaker 2: get that checked out. And then heart issues as we
Speaker 2: get older. The other amazing thing sometimes is a urologist
Speaker 2: that I get to diagnose is early stage heart failure
Speaker 2: because they come to me maybe they just they don't
Speaker 2: even see their primary doc, and like, oh, I got
Speaker 2: to see a urologists because I'm getting up a night
Speaker 2: to pee and I look at their ankles and they're
Speaker 2: they're not ankles anymore. They're cankles and they're these big, fat,
Speaker 2: swollen lower extremities. That means that they're not mobilized and
Speaker 2: they're fluid well during the day because they're up and
Speaker 2: walking and gravity is not being kind to them to
Speaker 2: get that fluid mobilize in the minute day live flat.
Speaker 2: Their heart doesn't have to work as hard, kidneys don't
Speaker 2: have to work as hard, and all of that fluid
Speaker 2: they make during the day that their heart isn't metabolizing
Speaker 2: ends up in their legs and then eventually gets to
Speaker 2: their kidney. Then all a sudden, they're getting up three
Speaker 2: or four times at night to pee. So we got
Speaker 2: to make sure they're cardiovascular systems okay as well.
Speaker 3: And there's a list of.
Speaker 2: Other things, but those are really the big the big
Speaker 2: things that I see eurologically on a day to day basis.
Speaker 3: So that's your lecture.
Speaker 2: We did it, and I don't know about eighteen minutes
Speaker 2: or less with some questions, but now, yeah, I want
Speaker 2: to be your engine. I want to be your search engine.
Speaker 2: Type in something and see what computer Jesse, doctor Jesse
Speaker 2: can do for you.
Speaker 4: Well, I hadn't written this one down, but just listening
Speaker 4: to you, I thought of it. We keep hearing and
Speaker 4: I believe we touched a little bit on this in
Speaker 4: the episode with Doctor Brisbane. The episodes, I should say,
Speaker 4: the Procett episodes. We need them, but we keep hearing
Speaker 4: about how you know you prostate and largest as you age?
Speaker 3: Why is that?
Speaker 4: Can you touch a little bit about why that happens?
Speaker 2: Yeah, yeah, I mean I made the sad joke about
Speaker 2: the fact that it's you know that unfortunately our penis
Speaker 2: doesn't get bigger as we age, but our prostate does,
Speaker 2: and it's under the same hormonal control something called DHD
Speaker 2: or dihydrotestesterone, and and the receptors in our hair follicle
Speaker 2: for DHD and the receptors in our prostate for some reason,
Speaker 2: don't shut down as we age. If anything, they kind
Speaker 2: of ramp up, which is why the older we get,
Speaker 2: the thinner our hair gets, and the older we get,
Speaker 2: the larger prostate gets. But they do shut down in
Speaker 2: the penis somewhere, you know, post puberty, where all of
Speaker 2: a sudden that doesn't start growing, which I think is
Speaker 2: a good thing up to a certain extent, as you
Speaker 2: can imagine how fraud that would be.
Speaker 3: A thing's just getting bigger and bigger and bigger.
Speaker 2: And all of a sudden you have kind of a
Speaker 2: jack and the beanstalk phenomenon going on.
Speaker 3: You'd be careful what you wish for, right, But the.
Speaker 2: Truth is it is all hormonally mediated, Jordan, and we
Speaker 2: don't know exactly why it's important to keep those DHD
Speaker 2: receptors on as we age. Really no known understanding of
Speaker 2: that except for that, thankfully, we do have medications that
Speaker 2: can block that, albeit with side effects, but that is
Speaker 2: still considered A first line agent is blocking those receptors
Speaker 2: so that the testosterone that gets converted into the DHD
Speaker 2: and therefore the prostate growth, the magic dust that makes
Speaker 2: the prostate grow, you know, can stop turning off and
Speaker 2: then actually it does involute or it does actually shrink
Speaker 2: the prostate, which is pretty cool.
Speaker 6: Man.
Speaker 3: That was a pretty amazing discovery thirty odd years ago.
Speaker 4: I mean, I keep thinking back what you're saying earlier
Speaker 4: about the key of the door phenomenon, which is something
Speaker 4: you know, all of a forty five minute commute or something,
Speaker 4: and I'll be completely fine until I'm walking up the stairs.
Speaker 5: It's in my apartment, that's right.
Speaker 3: Yeah, commuters have this thing.
Speaker 2: I mean, I when I ask the guys and I
Speaker 2: screened them, you know, about their urinary symptoms, I say, well,
Speaker 2: you know, how fuen are you driving? And you know,
Speaker 2: LA is famous for our freeways and famous for our
Speaker 2: congested freeways.
Speaker 3: On the west side of town where I live.
Speaker 2: In practice, it's the four oh five, which is obviously
Speaker 2: made it into Saturday Night Live lore is how to
Speaker 2: avoid the four oh five at certain times a day, Right,
Speaker 2: I take the ten to the one ten.
Speaker 3: The four oh five sign is also.
Speaker 2: A very hyper local way of saying, well, you know,
Speaker 2: when do you get that urge to pull off the
Speaker 2: four five because you just can't.
Speaker 3: Hold it anymore?
Speaker 2: Or have you ever pulled off and just you know,
Speaker 2: found an old gatorade bottle or something and just let
Speaker 2: her rip into that, and the guys will say, oh, yeah,
Speaker 2: that's happened, you know.
Speaker 3: And that to me is pathologic.
Speaker 2: Urgency, and to the point where there are guys that
Speaker 2: actually don't leave their their house or take surface treats
Speaker 2: because they don't want to get caught on the four
Speaker 2: oh five and or whatever.
Speaker 3: Your local event of the four h five is the
Speaker 3: l I E.
Speaker 2: And so I think that, I mean, it wasn't good
Speaker 2: for Harry Chapin, it's not good for the commuter.
Speaker 3: Sometimes it's too soon.
Speaker 4: Yeah said, that's a deep cut music lord reference.
Speaker 3: Yeah, when you're coming home down no time soon?
Speaker 5: Oh god, I've last some taxi later for him.
Speaker 2: Oh god, man. We could go on and on. So
Speaker 2: uh yeah, but but that's it. You know that that's
Speaker 2: the Those are the signs that you're you're in trouble,
Speaker 2: and so those are pathological in themselves. But also, I mean,
Speaker 2: I have to say as we get older, and we
Speaker 2: talked a lot about frail tea, and we talked a
Speaker 2: lot about the importance of testosterone and men as we age,
Speaker 2: and we had that whole episode of Admiral Christine talking
Speaker 2: about the ports of testosterone and frail tea, which means,
Speaker 2: you know, when your muscles get weak and your bones
Speaker 2: get weak and you get a little unstable, that can
Speaker 2: kill you urologically as well. I mean, if you the
Speaker 2: number of guys that end up in the emergency room
Speaker 2: because they get up at night and they stub their
Speaker 2: toe and they fall over and they break a hip
Speaker 2: or they break a back or something like that is
Speaker 2: not zero. And once you break a bone and you're
Speaker 2: older and you're kind of frail, it did. It's a
Speaker 2: kind of a time clock in terms of the number
Speaker 2: of guys that recover, the number of guys that need
Speaker 2: long term rehabilitation, and then the number of people that
Speaker 2: I can actually die from complications from hip spine fracture.
Speaker 2: And so it does become more than a euro logic
Speaker 2: issue getting up at night to pee. So some of
Speaker 2: the pointers, especially for our guys or older guys out there, is, yes,
Speaker 2: make sure you have a little night light in your
Speaker 2: bathroom so it doesn't affect your sleep. But give yourself
Speaker 2: a little runway so that you know how to get
Speaker 2: to the restroom at night. Make sure that you don't
Speaker 2: have your clothes or your dog or something on the
Speaker 2: floor between you and the night room, and that you
Speaker 2: have a clear pathway, because that's the worst thing in
Speaker 2: the world. And I'll tell you one other crazy little
Speaker 2: pearl is that that the most common medicines that we
Speaker 2: prescribe for men to to help them pee is what
Speaker 2: I said. It is the alpha blockers, and there's non
Speaker 2: specific and there's specific alpha blockers, and then the specific
Speaker 2: alpha blockers or things like tam Saloson, who is kind
Speaker 2: of the most common solodosins, another one elf fuses And
Speaker 2: actually that's all three of them, not trying to show
Speaker 2: off or anything, and they all are a little bit
Speaker 2: less guilty of causing what we call orthostatic hypotension, where
Speaker 2: when you get up too fast, it can make you
Speaker 2: a little woozy, and you can fall. The non selective ones,
Speaker 2: which are old, old, old school, they all have a
Speaker 2: much higher rate of that where you know, can you
Speaker 2: imagine if your doctor gives you a drug says, hey,
Speaker 2: I want you to pee better, I want you to
Speaker 2: sleep through the night, and oh yeah. One of the
Speaker 2: side effects is it can make you kind of dizzy
Speaker 2: and make you kind of unstable when you first get
Speaker 2: up and in the middle of the night. The first
Speaker 2: time you're on it, you're like, oh, this is great.
Speaker 2: I only got up once tonight, not four times. But
Speaker 2: that one time you get up, you get dizzy, you
Speaker 2: fall over, you hit your head, you break your hip.
Speaker 2: You know, unfortunately that doctor didn't do you any good.
Speaker 2: And so it becomes its own side of fact. That is,
Speaker 2: you know that you're trying to you're treating something, but
Speaker 2: you could cause an entire additional pathologic process with that.
Speaker 2: So no free lunch, man, no free lunch in the
Speaker 2: pharmaceutical industry.
Speaker 4: Now this is kind of a broad question, but what
Speaker 4: are some everyday factors that can worsen urinary symptoms? Caffeine,
Speaker 4: alcohol consumption, any histamines, decongestion, Oh man, holding it too long,
Speaker 4: I mean, are there any things that you really want
Speaker 4: to give a general PSA about the warm people of Hell?
Speaker 3: Yeah. In fact, it was actually funny.
Speaker 2: The guy one of my one of my guys I
Speaker 2: was telling you about that I just saw again for
Speaker 2: totally different eurologic history, peronies of all things that we
Speaker 2: just talked about. He was a guy that got that
Speaker 2: got stuck somewhere between New York and Paris with with
Speaker 2: urinary retention. And it was I said, well, you dude,
Speaker 2: anything different, you know, I mean, we knew he had
Speaker 2: some prostate enlargement issues other than the whole plane ride.
Speaker 2: He said, no, I I this is the craziest little meta,
Speaker 2: whole you know, doctor house moment. But he changed underarm
Speaker 2: deodorant because he went to like a long acting when
Speaker 2: he's like, I'm going to be in Paris is going
Speaker 2: to be hot.
Speaker 3: So we went to this new deodorant and that.
Speaker 2: Set off allergies and cause all this rhinitis and stuff.
Speaker 2: He knows, and so he doubled his allergy medications to
Speaker 2: combat the deordorant that he changed to. So we could
Speaker 2: go to Paris and not stink up on Lemitroux with
Speaker 2: you know, with one hundred degree weather paris Is and
Speaker 2: that was probably enough to put him over the edge
Speaker 2: that in a long time flight. But yeah, antihistamines and
Speaker 2: especially the cold medication pseudofedrin, they're actually what we call
Speaker 2: alpha agonists, so they work exactly opposite of the alpha
Speaker 2: blockers we just talked about, tam solos and solidos and alfusis,
Speaker 2: and they can cause the muscles and the prostate to
Speaker 2: contract to basically cause those two big oak doors that
Speaker 2: the prostate act on your bladder to slam shut, and
Speaker 2: they work exactly opposite what happens in the nasal urban it.
Speaker 2: So you take those to open up the nasal turbatants
Speaker 2: and let more airflow in, and by letting more flow
Speaker 2: in the nose, the same receptors cause that prostate to
Speaker 2: contract to the point where it's harder to peete. And
Speaker 2: antihistamines have a little bit less of but still a
Speaker 2: known side effect of that, they can actually cause the
Speaker 2: bladder to have what we call an anti or a
Speaker 2: colinergic effect, where basically the bladder muscle doesn't contract as much,
Speaker 2: so you don't get that push you need. And so
Speaker 2: if you combine that with a little extra prostate tissue
Speaker 2: that causes a little extra outlet obstruction and the bladder's
Speaker 2: not working as hard. That can cause yourn air retention
Speaker 2: as well. So it's kind of nutty. It's really amazing
Speaker 2: how quickly the cascade can set off.
Speaker 3: Caffeine.
Speaker 2: Yeah, it can definitely increase temporarily you need to pee.
Speaker 3: Now.
Speaker 2: Caffeine in general has a half life of about six
Speaker 2: hours and for most people, and so so definitely, you know,
Speaker 2: you don't want to be drinking coffee too late in
Speaker 2: the day for both obviously the reasons you know, can
Speaker 2: affect your sleep, but it can cause you to pee
Speaker 2: a lot more frequently. In alcohol has that same it
Speaker 2: has that same hormone effect of or diuretic hormone effect
Speaker 2: of causing you to want to pee a little bit more,
Speaker 2: and so more than.
Speaker 3: Just the volume of alcohol.
Speaker 2: Now, you know, if you're drinking beer not whiskey, you know,
Speaker 2: one ounce to twelve ounces, then obviously there's going to
Speaker 2: be some volume effect of drinking a dilute source of alcohol.
Speaker 2: So so both of those very well known effect and
Speaker 2: so yeah, I mean again it's the same thing. You know,
Speaker 2: you want to limit your alcohol intake before bed is
Speaker 2: not good for your sleep. It messes up your sleep cycles,
Speaker 2: doctor Shgari told us a long time ago on our podcast.
Speaker 2: And it also can mess up your urinary habits just
Speaker 2: because it causes so much more urine to be made.
Speaker 3: So those are two things.
Speaker 2: And in general, yeah, the whole idea of sleep hygiene
Speaker 2: is important, meaning that if you have a problem getting
Speaker 2: up at night to pee, then trying to limit your
Speaker 2: fluid intake right before bed is important. And there's no
Speaker 2: good rule of thumb, but you know, generally, if you can,
Speaker 2: if you can really hold even if you have to
Speaker 2: take medicines right before bed, just a little sip of water.
Speaker 2: But if you can give yourself a couple of hours,
Speaker 2: you know, so you go to bed at ten, Yeah,
Speaker 2: just take that last slip of sip of water around eight.
Speaker 2: It's amazing how little things like that actually can help.
Speaker 2: And and then if that doesn't, then again go in
Speaker 2: and see your dog, because there there could be something
Speaker 2: else going on that that she could help you with.
Speaker 3: If you if you have sort of a good global.
Speaker 2: Perspective about what's going on, making sure you don't have diabetes,
Speaker 2: making sure your heart's ticking away just fine, and then
Speaker 2: getting into your logic sources.
Speaker 4: Now you talked earlier about incomplete voiding I think is
Speaker 4: the polite term.
Speaker 2: Yes, or incomplete emptying. Yeah, yeah, actually both. That could
Speaker 2: be front side backside of guest boat. So yeah, we'll
Speaker 2: start with the front side.
Speaker 4: What are some sort of hazards of that. What happens
Speaker 4: when you're in repeatedly remains in the bladder. Can that
Speaker 4: damage the ladder, the kidneys, increase risk of infection?
Speaker 3: Yeah?
Speaker 2: Yeah, So so that that's sort of we got back
Speaker 2: to what I got on that prehistoric almost tangent about
Speaker 2: Galen and Hippocrates, but the right I mean, so the
Speaker 2: most common thing that happens is that the bladder if
Speaker 2: it doesn't empty every time you pee. So say that
Speaker 2: you have two hundred and fifty milimeters in your bladder
Speaker 2: and every time you go you get down to fifty.
Speaker 2: That's pretty good, you know. That's what we call a
Speaker 2: post void residual of fifty mili laters. We don't get
Speaker 2: worried about it. But if that fifty turns into one hundred,
Speaker 2: at that hundred turns into two hundred, then two things
Speaker 2: are starting to happen. One is your bladder is insidiously
Speaker 2: capacitating more to the point where instead of getting that
Speaker 2: urge to pee when you have a can of soda
Speaker 2: in there so that you know, three hundred milli liters
Speaker 2: or so, then you will all of a sudden say, hey,
Speaker 2: you know what, my bladder's getting stronger. That's a good thing.
Speaker 2: I can hold it better. The most common professions I
Speaker 2: worry about are you know, Buckingham power guards or I mean,
Speaker 2: I don't know, but I imagine they stay standard, They
Speaker 2: stay straight for what eight hours at a time, you know,
Speaker 2: unless they have a catheter or a diaper.
Speaker 3: You know.
Speaker 2: I worry about those guys. Military policemen in our armed
Speaker 2: services generally, you know, just police detectives on stakeouts, firefighters,
Speaker 2: people that can't have immediate access to to restrooms because
Speaker 2: of occupational hazards. I mean, there's a term of almost
Speaker 2: respect and a thought of the of the term nurses
Speaker 2: bladder in veteran nurses where they're like, I can hold
Speaker 2: it for a whole shift, you know, that's almost like, yeah,
Speaker 2: I'm stronger than the other nurses.
Speaker 3: I like, no, you're not.
Speaker 2: That's really bad for you, Like, it's great that you're
Speaker 2: so dedicated to your patients or surgeons that do twelve
Speaker 2: hour cases. I mean there's sometimes we're scrubbed in for
Speaker 2: twelve hours without a break. You know, if you do
Speaker 2: that once a week and then the rest of the
Speaker 2: time you're you know, you're actually living a relatively normal
Speaker 2: urinary existence. Okay, you can get away with it, but
Speaker 2: other than that, it's not cool, you know, to not
Speaker 2: void on the regular. But so that's one thing is
Speaker 2: your bladder can go into what we call myotonic failure,
Speaker 2: where it capacitates to the point where those muscle fibers
Speaker 2: are so far apart that they can't contract. And I
Speaker 2: always use the analogy that if you try to do
Speaker 2: a bicep curl with your arms straight out, it's really
Speaker 2: really hard because your fibers are already at their most extended,
Speaker 2: and so any amount of weight is going to be
Speaker 2: tough to pull in.
Speaker 3: But if you pull that.
Speaker 2: Bicep closer into your closer into your body and you're
Speaker 2: at about ninety degrees instead of one to eighty am
Speaker 2: and then you can curl for days.
Speaker 3: Well, it's the same thing.
Speaker 2: If your bladder is so extended, then it's hard for
Speaker 2: those muscles to actually form the cross links they need
Speaker 2: to do their job, which is to contract and push
Speaker 2: urine out, and so that's myogenic failure. The second thing
Speaker 2: is that that concentrated urine will start to accumulate solids
Speaker 2: that normally you pee out calcium, magnesium or the two
Speaker 2: big ones, phosphate, oxalate, all of these things that can
Speaker 2: form bladder stones, and you will get a chemistry environment
Speaker 2: within the bladder where you will have more of the
Speaker 2: dissolved material than the bladder, the urinary or the water
Speaker 2: that is in the bladder, and that material will form
Speaker 2: into stones. And sometimes bladderstones can be as big as
Speaker 2: your bladder. They can completely cause the bladder to have
Speaker 2: no storage capacity and you're making the new urine that's
Speaker 2: coming in is just going to be surrounded as a
Speaker 2: shell around this giant, fist sized stone, and that's where
Speaker 2: you can get in trouble, and those stones can become infected.
Speaker 2: So yeah, basically those are the three horsemen of the
Speaker 2: bladder apocalypse, which is myotonic failure. Bladderstones and infection and
Speaker 2: myotonic and all three of those things can lead to
Speaker 2: the fourth horsemen, which will kill you and as renal
Speaker 2: failure and so.
Speaker 3: One of the ways that if your bladder.
Speaker 2: Has that myotonic failure, those pressures will get transmitted up
Speaker 2: to the kidney and the kidney doesn't really love high
Speaker 2: pressure systems, and high pressure systems it will cause me
Speaker 2: either from blood pressure problems, which is one of the
Speaker 2: biggest causes of need for dialysis, and can you failures
Speaker 2: high blood pressure. High bladder pressure also can kill the
Speaker 2: kidney and lead you to renal failure. And that's you know,
Speaker 2: that's ridiculous in this day and age. Unfortunately, it still
Speaker 2: happens with guys that have poor access to medical care
Speaker 2: that they can get to the point where they go
Speaker 2: into renal failure from bladder obstruction. But you know, I've
Speaker 2: seen it multiple times in my career. And again I'm
Speaker 2: not avoiding specialist anymore. Really, even though I'm a urologist,
Speaker 2: my career is so specialized, and yet I still see
Speaker 2: it on call. I still see it, and some of
Speaker 2: my guys are seeing that are coming for me for
Speaker 2: other things and so so yeah, that's a huge PSA
Speaker 2: right there. So yeah, you gotta go on the regular man.
Speaker 4: I imagine that's something we'll touch more on on the
Speaker 4: kidney stones episode too.
Speaker 2: M m, yeah, stones are fascinating, fascinating things that can
Speaker 2: happen in our bodies. We're like oysters, except for they're
Speaker 2: not quite as pretty when we pop out at pearl.
Speaker 4: But probably more expensive in the long run.
Speaker 2: Wow, well put, yes, thanks to the American healthcare system.
Speaker 5: Yes, my last question before we wrap up.
Speaker 4: I know on an earlier episode you very beautifully discussed
Speaker 4: the physiological ballet that occurs when men climax. I wanted
Speaker 4: to ask you a similar question for when we suddenly
Speaker 4: feel the urge to urinate. What is actually happening? What
Speaker 4: is the tipping point in the bladder?
Speaker 2: I love that actually, and there's a little bit of
Speaker 2: a correlation between in guys, between climax and urination, so
Speaker 2: we'll hit it.
Speaker 3: So, So there is this, this.
Speaker 2: Is cool part of the brain called the central pontine
Speaker 2: Pictorian complex. And I didn't even practice that. I just
Speaker 2: let her rip the first time since I took my
Speaker 2: boards twenty years ago.
Speaker 3: I came out all right.
Speaker 2: But that is that your urinary trigger where it sends
Speaker 2: a signal, it's probably pressure and hormonally based to the
Speaker 2: prefrontal cortex, which is the part of our brain that
Speaker 2: controls volitional behavior. And that's what potty training is right there,
Speaker 2: is that you get an internal signal and if you're
Speaker 2: party trained, then you know, you just let her rip
Speaker 2: in the diity, right, and then mom and dad clean
Speaker 2: it up. And that happens until you know, however old
Speaker 2: we are two three, and then that prefrontal cortex takes
Speaker 2: over to the point where then you understand people are
Speaker 2: telling you that this is a socially appropriate time to urinate.
Speaker 2: And it happens at all mammals, right, especially you know,
Speaker 2: house trained mammals. So we do the same thing with
Speaker 2: our animals. We developed that prefrontal cortex to say, yeah,
Speaker 2: you can't pee on the floor. We got to get
Speaker 2: you outside. And eventually that socially appropriate trigger happens in
Speaker 2: mammals as well, I mean in non human mammals. And
Speaker 2: so that's the first part is the brain says, hey, dude,
Speaker 2: it's time to go.
Speaker 3: So then you say, cool, I'm going to go.
Speaker 2: And then because I am potty trained, I'm going to unzip,
Speaker 2: pull down, take off my jog shorts, whatever I got on.
Speaker 2: That's blocking the socially appropriate flow of this golden liquid.
Speaker 2: And I'm gonna stand over the toilet, and then the
Speaker 2: relaxation phase happens. And so the first thing that should
Speaker 2: happen is your prefrontal cortec controls what we call your
Speaker 2: external urinary sphincter, which sits and guys just on the
Speaker 2: other side of the prostate. And when you let that
Speaker 2: skeletal muscle rip, which is down deep in the pelvis
Speaker 2: in the kind of the very back part of the
Speaker 2: front of the urethram, if that makes sense, at also
Speaker 2: right right there in front of the prostate, that says, okay, cool,
Speaker 2: I'm going to let this sphincter open, and then you
Speaker 2: start to get that the trucer contraction in the bladder,
Speaker 2: and the muscle just goes and if you have no blockages,
Speaker 2: no strictures, and no big prostate, then it just empties
Speaker 2: all the way to the point where the urine is
Speaker 2: fully empty, and that that sphincter you don't have to
Speaker 2: really think about it. We'll just kind of close on
Speaker 2: its own, because you know, you're potty trained. So that's
Speaker 2: the the urinary process in a in a nutshell.
Speaker 4: I really didn't consider the neurological or I guess I
Speaker 4: should have more or even just the psychological component urination
Speaker 4: too well.
Speaker 2: Right, and there is because a lot of times, I
Speaker 2: mean you know, there are there are pediatric problems that
Speaker 2: that called dysfunctional avoiding where some people will ignore that signal.
Speaker 2: But it's also kind of the same as you know
Speaker 2: as my truck drivers, my Buckingham Palace guards, of which
Speaker 2: I've seen zero in my practice, but obviously you know,
Speaker 2: don't spend a lot of time over there, but they
Speaker 2: they can figure out how to potty train to the
Speaker 2: point where they ignore that signal. And instead of that
Speaker 2: what we call first urge where you're like, you know
Speaker 2: what I got to and guess what, there's a restroom
Speaker 2: right here. I'm gonna let her rip to you get
Speaker 2: that first urge when you're on the four or five
Speaker 2: and you're in an hour's worth of traffic, you're like,
Speaker 2: you know what, I get a pee? I can't, so
Speaker 2: I'm gonna ignore that urge. And then you know, an
Speaker 2: hour later, you pull off and you find the nearest
Speaker 2: in and out and you go get a double double end.
Speaker 2: You let her rip, and then you get back in
Speaker 2: your car and you get back on the four or
Speaker 2: five and you're stuck in the traffic for another hour
Speaker 2: to the next in and out or wherever you want
Speaker 2: to stop. And in Buckingham Palace, you know you do
Speaker 2: that at two hours you think I just started my shift.
Speaker 2: I got six more hours of this, and you just
Speaker 2: let her ignore and you ignore and you ignore, so
Speaker 2: you can actually override to the point where you can
Speaker 2: go into your near retention and get to that myotonic
Speaker 2: failure part because you ignore that. So it's not really
Speaker 2: a psychology as much as it's.
Speaker 3: A trained behavior for sure.
Speaker 2: Back when I was in training, and I don't even
Speaker 2: know if I guess they have the switch these days,
Speaker 2: but we used to have a term called Nintendo bladder
Speaker 2: where kids were so fixed on playing their games that
Speaker 2: they absolutely would not pee until either they'd wet themselves
Speaker 2: or they'd get such bladder pain that they couldn't be
Speaker 2: because they had ignored that urge. You know that they
Speaker 2: learned so well when they were three and now they're
Speaker 2: seven or eight or twelve that that they wouldn't they
Speaker 2: wouldn't stop their game long enough to pee. So so yeah,
Speaker 2: there's a lot of conditioned responses in the urinary process
Speaker 2: that cause it. There's bashful voiding too, or stage fright
Speaker 2: as we call it. Where you're you know, you're at
Speaker 2: Dodger Stadium, you're at the Yankees game, you're at the
Speaker 2: World Cup and you're lined up for the trough and
Speaker 2: there's all these guys around you just let her rip
Speaker 2: and you're like, I don't have the way that translates
Speaker 2: audio wise, But that was me wincing and trying to
Speaker 2: pee and couldn't and and that happens too, you know
Speaker 2: where you can have bashful bladder And that's real.
Speaker 3: Wow, that is I never considered that aspect of all this.
Speaker 5: That's so fascinating.
Speaker 2: I mean, it's a PhD worth of information in forty minutes.
Speaker 2: This is what we do here.
Speaker 4: No, the p how do you spell a P E
Speaker 4: E HD?
Speaker 3: Dude, you're the one with the jokes.
Speaker 5: Sorry.
Speaker 3: I love this right to Jordan. I love this side
Speaker 3: of No, we're good. You know that was a primer.
Speaker 2: Maybe, you know, with audience feedback, we'll revisit this in
Speaker 2: a lot more detail, because I think we touched on
Speaker 2: a lot of things. But yeah, I think these are
Speaker 2: super important little tidbits that guy should know that. Yeah,
Speaker 2: you know, go on the regular, make it happen. If
Speaker 2: you're getting up too much at night to pee, go
Speaker 2: see somebody. Probably reasonable to start with your primary care doc,
Speaker 2: just for them to do the work up to make
Speaker 2: sure it's not something more systemic than just a urinary
Speaker 2: issue or just the fact that you know you're not
Speaker 2: thirty anymore. But then, but make sure you have at
Speaker 2: least an idea of who your good friendly neighborhood urologist is.
Speaker 2: To just take that diagnostic cascade home.
Speaker 3: That's it.
Speaker 4: And if you're in the LA area and you need
Speaker 4: to find a friendly neighborhood urologist, that's it.
Speaker 3: I think we know a guy.
Speaker 2: I know a guy. That's another whole tagline. Well, dude,
Speaker 2: that was fun. Thanks for hanging out with me. And
Speaker 2: a special shout out to Jordan. He really is literally
Speaker 2: calling in and we're doing this from his summer vacation.
Speaker 2: So God bless you, your dedication to the audience, to
Speaker 2: iHeart and all that you do. Man, I got no jokes.
Speaker 2: There are just there's nothing but love and admiration.
Speaker 5: Right back at you.
Speaker 4: You every day are helping men, saving lives. My admiration
Speaker 4: is tenfold towards you. Thank you.
Speaker 2: Oh, come on, we can go on forever, all right,
Speaker 2: Long Transit, get us out of here and we'll see
Speaker 2: you soon.
Speaker 1: Let's talk about it. Let's talk about the Maro. Let's
Speaker 1: talk about it. Let's talk about him, a ma hero.
Speaker 1: Let's talk about it. Let's talk about it.
Speaker 2: The Man.
Speaker 6: The mail Room with Doctor Jesse Mills was a production
Speaker 6: of iHeartRadio. It was executive produced by Jordan Runtog. It
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