Speaker 1: Let's talk about it.
Speaker 2: Let's talk about the marrow. Let's talk about it. Let's
Speaker 2: talk about the man.
Speaker 3: Hero.
Speaker 2: Welcome to the Man, Welcome back to the Mailroom, guys,
Speaker 2: Doctor Jesse Mills here with my indomitable producer Jordan Runta,
Speaker 2: the Sultan of Sound, roll to my stone in the
Speaker 2: studio again for another episode of the mail Room. It's
Speaker 2: March and March. I don't know how things are going
Speaker 2: in Brooklyn. The poppies popping and the daffodils out. We
Speaker 2: have poppies here. I guess you have daffodils.
Speaker 4: But tell me crosses freezing, my friends.
Speaker 2: No, someday we're gonna have this amazing conversation because I
Speaker 2: feel like, you know, I'm always talking about great it
Speaker 2: is in Santa Monica. But Brooklyn, I mean, it's like
Speaker 2: this New York City. It's like an amazing town. There's
Speaker 2: so much give me, like your top two great thing
Speaker 2: as you did last week, because you're in New York
Speaker 2: City that I probably couldn't do in Los Angeles.
Speaker 4: That's I mean, good pizza, good jazz.
Speaker 2: Okay, other than wear sweater. Oh yeah, since since Chet
Speaker 2: Baker's passing, we got great jazz here. What are you
Speaker 2: talking about? That's true? Okay, yeah, go down the Venice the.
Speaker 5: Blue Notes opening out here.
Speaker 2: I mean yes, but but all right, so you got
Speaker 2: so you go to some a good club, went to Vanguard.
Speaker 2: You know me, I'm old school. Come on, yeah, baby, awesome.
Speaker 2: The pizza thing again, I don't want to talk disparagingly
Speaker 2: of La Pizza, but you're right, it's a lot easier
Speaker 2: to find really good pizza brook and we have our
Speaker 2: spots California Pizza Kitchen. Yeah come ouch ouch. No, they're
Speaker 2: a big sponsor of UCLA Health. Okay, so there's nothing
Speaker 2: wrong as ePK if I donate a lot of money
Speaker 2: to the Department Uerology. So I'm actually a big fan,
Speaker 2: big fan. Okay. Well, so the other thing that happens
Speaker 2: in March is basketball. Great basketball tournaments, Men's tournament, n
Speaker 2: C two a tournament, women's tournament. And so what happens
Speaker 2: during these turns as well? They're crazy. I can't say
Speaker 2: they're mad because it's actually copywritten, but it's they're crazy time.
Speaker 2: And why because there's thirty two games that happen, you know,
Speaker 2: over day. So imagine if you're a huge basketball fan
Speaker 2: and you're thinking I need a really good excuse to
Speaker 2: not do anything. I need to tell my partner, my kids,
Speaker 2: my dog that I can't take them out for the
Speaker 2: next couple of days. But they don't want to buy that. Well,
Speaker 2: so what if it's basketball, just you know, watch a
Speaker 2: couple of games and call it good. But what if
Speaker 2: you had something done, like a surgery, like a procedure
Speaker 2: for example, Jordan, talk to me about this, Right, they're
Speaker 2: surgeries that you have to have, right, I mean, like,
Speaker 2: you can't decide to schedule an apendectomy during during the
Speaker 2: March basketball tournament. Right you can't just say, well, I
Speaker 2: guess you could. You could lie about it. But but
Speaker 2: say I had my appendix out, I can't take out
Speaker 2: the trash for the next two days. But no, no,
Speaker 2: it's actually one of the best times to get a vasectomy,
Speaker 2: which is what we're going to be talking about here
Speaker 2: in the next little bit. I am so so pumped
Speaker 2: to bring on our guest today, doctor j Sandlow, who's
Speaker 2: chair of Urology at Medical College of Wisconsin. I'll do
Speaker 2: a little bit of an introduction, but before I do this,
Speaker 2: I just want to I want to put you on
Speaker 2: the spot for a second Jordan.
Speaker 5: All right, are you ready for this?
Speaker 1: Absolutely?
Speaker 2: You're not nervous.
Speaker 5: Well, I wasn't until you asked me.
Speaker 2: Okay, well that's usually I worked say. Well, I'm going
Speaker 2: to just throw this out at you. So there are
Speaker 2: two forms of permanent birth control that are available to couples. Okay,
Speaker 2: this is a test, this is your medical knowledge test.
Speaker 2: So for a guy, that's a aseectomy. For a woman,
Speaker 2: it's a tubal ligation. So a tubal ligation a dominal procedure.
Speaker 2: They make an incision that go in, often with the scope,
Speaker 2: but there are complications. It requires anesthesia, it requires some
Speaker 2: recovery time. That's a little bit more significant. If a
Speaker 2: sectomy takes it takes me about five minutes. It probably
Speaker 2: talks about doctor Sande little about an hour and a half,
Speaker 2: but we'll talk about that. But it's a very short procedure.
Speaker 2: Usually we do it just a local and it's toned
Speaker 2: through tiny little poke holes. Sometimes we don't even use
Speaker 2: a scalpel at all. So what do you think with
Speaker 2: those parameters, what do you think is more commonly performed
Speaker 2: the United States?
Speaker 1: Jordan?
Speaker 2: Tubal ligation answer A vasectomy answer B.
Speaker 4: I'm sure it's anser a tubal location.
Speaker 2: Right, yeah, yeah, but I don't know, Jay, if you have.
Speaker 5: New numbers on this.
Speaker 2: Yeah, it's exactly right. Yeah, Yeah, there's you know, somewhere
Speaker 2: north of seven eight hundred thousand tubal ligations done every
Speaker 2: year in this country in about four to maybe five
Speaker 2: hundred thousand paths, So it's about a two to one
Speaker 2: ratio somewhere in there of women that are undergoing TUBU,
Speaker 2: which is a way more invasive approach. And we can
Speaker 2: have all kinds of discussions about why that is. Obviously
Speaker 2: the most important one probably is the dog in the hunt.
Speaker 2: That a woman is going to have a much a
Speaker 2: much larger seven and a half to eight pound dog
Speaker 2: in the hunt at the end of pregnancy than a guy.
Speaker 5: But yet it's still there.
Speaker 2: So I'm going to do a formal introduction because Stuck,
Speaker 2: you said, I've known in my literally my entire career.
Speaker 2: In fact, I owe my mentorship. He was my first
Speaker 2: mentor in urology. He was the guy that really got
Speaker 2: me into urology and male fertility specifically. So he is
Speaker 2: currently the chair of Urology at Medical College of Wisconsin,
Speaker 2: but he also, as am I, a fellowship trained surgeon.
Speaker 2: He actually did a very prestigious American Foundation in Neurologic
Speaker 2: Diseases Fellowship, which is now a Urology Care Foundation Fellowship.
Speaker 2: But that was a two year research plus surgical exploration
Speaker 2: into into microsurgery. So the guy is he's vetted. He's
Speaker 2: a true academician, through and through. He spent his entire
Speaker 2: entire career in the academy. Where I got to first
Speaker 2: meet him was when I was a medical student University
Speaker 2: of Iowa and he was about, gosh, a couple of
Speaker 2: years probably into practice by that time, and I was
Speaker 2: a second year of urology. I'm sorry, second year medical student.
Speaker 2: I really knew I wanted to do surgery. I went
Speaker 2: to Eurology interest group. I met Jay and somebody else
Speaker 2: named Dick Williams who's a legend in the field who
Speaker 2: unfortunately lost way too young to lung cancer.
Speaker 5: But he and Jay were.
Speaker 2: At the surgical interest booth. It was sort of like
Speaker 2: speed dating for surgeons. When we knew he wanted to
Speaker 2: do something. I went to neurosurgery. I'm like, I'm not
Speaker 2: those guys.
Speaker 5: I went to ian T.
Speaker 2: I thought, I don't love snot that much, so I'm
Speaker 2: going to walk away from there, and I went to
Speaker 2: these two guys and Dick Williams had a little a
Speaker 2: faucet pin on his lapel like he's He's like, I'm
Speaker 2: just a glorified plumber. And then Jay was there, look
Speaker 2: at like he was. It was like a fraternity rush party.
Speaker 2: He was this tall, athletic, buff, just super good looking guy.
Speaker 2: I'm like, holy crap, like this is the this is
Speaker 2: the fraternity I want to pledge to.
Speaker 5: I want to be a eurologist.
Speaker 2: And then I got to hang out with the residents
Speaker 2: at the time, and it was a visseecondmy reversal, which
Speaker 2: we're going to talk about in the next episode, that
Speaker 2: I was watching Jay do.
Speaker 5: And it wasn't just the skill.
Speaker 2: It wasn't just the way that he was doing this
Speaker 2: incredibly precise surgery with these sutures that are finer than
Speaker 2: human hair that you can barely see without a microscope,
Speaker 2: but he was having so much fun doing it, and
Speaker 2: I thought, Okay, if a guy can be in this
Speaker 2: good shape and seem to have the quality of life
Speaker 2: he has and do what he could do with a
Speaker 2: microscope and make babies where otherwise men and women couldn't
Speaker 2: have babies.
Speaker 5: This is what I gotta do. So that's my intro.
Speaker 2: Jay, I'm grateful to you for bringing me into this
Speaker 2: field when you know, all of about thirty years ago,
Speaker 2: when you were fifteen or so, you were doing surgery
Speaker 2: at that early age. Because you still look like you're
Speaker 2: about to save as what I saw you all those
Speaker 2: years ago.
Speaker 5: So welcome to the mailroom.
Speaker 3: Well, thanks, Jesse. A couple of things you didn't point out.
Speaker 3: One is that it took me eight years to do
Speaker 3: most people doing six. So most people do five years
Speaker 3: of urology residency, one year of fellowship. I did six
Speaker 3: and two. So I was definitely on the you know,
Speaker 3: the slower track. Yes, and uh and uh, you know
Speaker 3: you you sell yourself short. I mean, Jesse was like
Speaker 3: one of the star medical students at University of Iowa.
Speaker 3: We really felt lucky that we conned him or or
Speaker 3: brainwashed him into becoming one of us. And he quickly
Speaker 3: left Iowa to go to greener pastures in Colorado and
Speaker 3: then did his fellowship down in Houston. And now of
Speaker 3: course he's a legend in in La So I will
Speaker 3: tell you it is so gratifying when you see somebody
Speaker 3: that you interacted with early on in their career to
Speaker 3: watch them just flourish and and you know, become this
Speaker 3: monster of of you know, not just in urology, but
Speaker 3: just in as human being.
Speaker 1: So I really appreciate it.
Speaker 3: But you know, I guess we're both captains of our
Speaker 3: of our mutual admiration society.
Speaker 1: So there you go, very happy to be here.
Speaker 2: That's the way it should be. It's it's a wonderful
Speaker 2: community you're part of, and it is. And again that's
Speaker 2: one of the main motivations for doing this podcast, not
Speaker 2: because I don't have enough to do with my day job,
Speaker 2: but really because we get to let the world know, hey,
Speaker 2: what a great field we are, and how happy urologists
Speaker 2: are if you get to if you get the privilege
Speaker 2: and and onnus of seeing one as a patient.
Speaker 5: But also we love to talk, and we love to
Speaker 5: we love we're.
Speaker 2: Very social creatures, and that's what we're going to do today.
Speaker 2: One of the things I left out of your intro
Speaker 2: because I got so excited, and obviously my mom sent
Speaker 2: you those index cards.
Speaker 5: You just read off about it, but.
Speaker 2: I do want to say that you actually wrote the
Speaker 2: AUY guidelines which are American your Logical Association guidelines on vyseectomy.
Speaker 2: So I couldn't think of a better person not to
Speaker 2: mention in our own friendship and mentorship story, to talk
Speaker 2: to the average guy about a vasectomy. And so we're
Speaker 2: going to have sort of a couple of things that
Speaker 2: I'm going to ask you, And I think the best
Speaker 2: thing is, let's start simply tell me who's a candidate
Speaker 2: for a vasectomy?
Speaker 5: What is it?
Speaker 2: Tell me that, Like, pretend I'm a forty two year
Speaker 2: old guy and I'm walking your office. I mean, I'm
Speaker 2: an augmous relationship. I have two beautiful young Dodger fans.
Speaker 2: And sorry about the Brewers by the way, you guys
Speaker 2: what a scrappy team.
Speaker 1: But let me pull that knife.
Speaker 5: Well, you said, two.
Speaker 2: Young Dodgers times like the pre production stops.
Speaker 5: Now.
Speaker 2: We do not need any more at these Dodger fans
Speaker 2: in the world. There's enough already. And my wife is
Speaker 2: forty one, she's still ovulating, and she said, look, we're
Speaker 2: done with kids.
Speaker 1: Yeah, it's your turn.
Speaker 2: How does that console work in your practice? Walk me
Speaker 2: through if I'm in your office.
Speaker 3: You know, obviously most of the patients who come in
Speaker 3: it's a little bit of a self selection. They've already
Speaker 3: done at least enough research to know that of a
Speaker 3: sectomy is something they want to look into. I always
Speaker 3: tell patients that while we consider this a permanent form
Speaker 3: of male sterilization, we don't do anything to make it irreversible,
Speaker 3: and therefore if life changes, we can undo it.
Speaker 1: It's just a much bigger deal.
Speaker 3: So I try to get guys to understand that this
Speaker 3: is by far the best birth control, but you should
Speaker 3: go into it thinking that this is it. You don't
Speaker 3: want to be going back and forth like the like
Speaker 3: the episode from the Office with snip snap, snip snap.
Speaker 2: Yes, good, good reference, and I'm sure you have more
Speaker 2: than one of those stories. And oh yeah, thin too,
Speaker 2: so we'll definitely get it to that.
Speaker 5: So what are the risks?
Speaker 2: I was going to ask you how long it took,
Speaker 2: but already already threw shade upon you. So tell me,
Speaker 2: really what you know? What does it look like? So
Speaker 2: I say, okay, doctor Samlo, you look like the guy
Speaker 2: you wrote. You wrote the handbook, You've trained hundreds of
Speaker 2: residents and fellows to do this procedure, so I want
Speaker 2: you to do it. Tell me what happens next.
Speaker 3: Sure, So typically what I tell guys is it's about
Speaker 3: fifteen minute procedure. We're going to use local anesthesia to
Speaker 3: numb you up. I personally like to make two small holes,
Speaker 3: one on each side of the scrotum. Some people will
Speaker 3: do one right in the middle of the scrotum. Honestly,
Speaker 3: that's dealer's choice. My reasons for doing one on each
Speaker 3: side is that if if you do one in the middle,
Speaker 3: then that second side has to come up to the
Speaker 3: exact same hole, and sometimes the vaz doesn't want to
Speaker 3: move around the same from one side to the other. Also,
Speaker 3: I like to be able to look at the ends
Speaker 3: when I'm done at the end of the case, and
Speaker 3: if you've already done one side, you have to dunk
Speaker 3: it back down into the scrotum, so you can't really
Speaker 3: see if there's anything bleeding or oozing. But it's a
Speaker 3: very straightforward procedure. There's a little pulling, a little tugging,
Speaker 3: and I don't use any stitches because I am making
Speaker 3: such a small hole, So we just put a little
Speaker 3: plastic band aid over each little hole and send you
Speaker 3: on your way.
Speaker 2: So yeah, I do too as well, and I think
Speaker 2: I trained that way even before I did a fellowship
Speaker 2: with doctor Lipschultz, but just I had a community urologist
Speaker 2: in Denver who did a very elegant disseectomy. My reasoning is,
Speaker 2: and I sure you've seen this, is that because you
Speaker 2: said in there too, you always us reconstructive, reproductive doctors
Speaker 2: do things. We're going to take things apart like we'd
Speaker 2: want to put them back together, exactly. And so how
Speaker 2: many times have you gone in to do a reversal
Speaker 2: where you've got a hivasectomy site which is very favorable
Speaker 2: on one side, and then a clip through the epiditymus
Speaker 2: or as low as you possibly can on the other. Yeah,
Speaker 2: And my argument is that right if you're swinging the
Speaker 2: same testicle up through the incision, you're never going to
Speaker 2: get it in that same high site. So that if
Speaker 2: a guy every wants to change his mind, that's it.
Speaker 2: But also concern about hemotoma. But I also like what
Speaker 2: you said, just so we're not throwing our one incision
Speaker 2: urology buddies under the bus, is that it is dealer's choice.
Speaker 2: The goal is to go some place where guys are
Speaker 2: you know that have done so many in the way
Speaker 2: that they're going to do it right for you.
Speaker 3: Yeah, I have seen several patients in my career though
Speaker 3: where because it was done through a midline. I won't
Speaker 3: even say the urologist, the viseectimist caught the same side twice.
Speaker 2: Yes, that's right, I've seen that as well. And then
Speaker 2: that's one of the that's actually one of the questions
Speaker 2: we're going to go. I'm going to go do next
Speaker 2: is what can go wrong with the vasectomy? And actually,
Speaker 2: before I even ask you that, how successful is it?
Speaker 2: So if a guy found that same forty two year
Speaker 2: old guy, I say, great, you know, the wife is
Speaker 2: pulling the goalie, there's no more idd.
Speaker 5: There's no more diaphragm. It's your work.
Speaker 2: Against you know, of eighteen year college fund. What is
Speaker 2: the you know what, what is the success rate of
Speaker 2: this procedure?
Speaker 3: Yeah, so there's actually two different things you have to
Speaker 3: look at. There's an early failure rate where the two
Speaker 3: ends actually will heal back together in the first four
Speaker 3: to six weeks. That's called early recannualization, and that happens
Speaker 3: in about one in five to one in six hundred vaseectomies.
Speaker 3: So I'm all, I'm very you know adamant with my patients.
Speaker 3: We don't even want to check your sement at your
Speaker 3: post posectomy seem analysis till it's been at least eight weeks,
Speaker 3: because there's really good evidence that after eight weeks, the
Speaker 3: likelihood of those two ends coming back together is less
Speaker 3: than one in two thousand and now. That number comes
Speaker 3: from the literature. I'll tell you, at least in my
Speaker 3: own practice, it's even lower than that. I have seen
Speaker 3: on occasion patients who have had what we call these
Speaker 3: late recare analizations years later. To be honest, I haven't
Speaker 3: seen any for my own patients, but I have seen
Speaker 3: it from people who did very good vasectomy, So I
Speaker 3: don't think anything was done wrong. But the body's natural
Speaker 3: reaction to any surgery is to try to heal, and
Speaker 3: we know when we do reversals. Often when you find
Speaker 3: one end of the vas deference, you can find the
Speaker 3: other end just by pulling up on that first end,
Speaker 3: because there'll be a piece of scar tissue connecting the
Speaker 3: two ends, and that scar tissue can have little micro
Speaker 3: channels running through it.
Speaker 1: That's how some of those late failures happen.
Speaker 5: I've seen that. I've seen that in ther yeah.
Speaker 2: I had a guy years ago who actually was coming
Speaker 2: to me for one of the other complications, which i'll
Speaker 2: get your opinion on, in a sect called post vasectomy
Speaker 2: pain syndrome, And it was the strangest case because he
Speaker 2: had excruciating pain and he still had a positive Seaman
Speaker 2: analysis after his second And so I went in. I
Speaker 2: did the right side. I still remember the laity as
Speaker 2: most of us that do these, just yeah, world. In
Speaker 2: my head, right side was fine, just did a simple reversal.
Speaker 2: And on the left side, as I was getting ready
Speaker 2: to do it, I actually saw recannulation and it made sense.
Speaker 5: That he was having persistent votal sperm.
Speaker 2: But that my theory, I don't know, you know, I
Speaker 2: don't there's no way we can prove this, but that
Speaker 2: in some ways he was having kind of this obstructive
Speaker 2: pain because all those little sperm were trying to get
Speaker 2: through this in this little thready channel. But so I
Speaker 2: had to cut through that channel and then sew together
Speaker 2: the pipe, you know, the main pipe, in order to
Speaker 2: reconstruct it.
Speaker 5: But yeah, that's that's real.
Speaker 2: But I think you're saying basically that that you know,
Speaker 2: when you compare that to birth control pills or tubal
Speaker 2: ligation or condoms, you're still looking at something that's you know,
Speaker 2: three or four hundred times more successful.
Speaker 3: That's that's what I always remind guys. So I'll have
Speaker 3: some patients he'll say, God, what in two thousand that
Speaker 3: sounds like a high failure rate, And I'm like, well,
Speaker 3: I guarantee you whatever you're using for birth control, now,
Speaker 3: well this is a lot better. Like that's right, Failure
Speaker 3: rates for tubal igations like one in seven hundred. So,
Speaker 3: as you pointed out, tubules are like a really big
Speaker 3: deal general anesthesia. You're in a woman's belly and you
Speaker 3: still have a three to four time higher rate of
Speaker 3: failure than of aseectomy.
Speaker 5: Yeah, that's right.
Speaker 2: Yeah. I mean I think it's as good a peace
Speaker 2: of mind as we can get when we get that
Speaker 2: that negative seam analysis. And I like how you said
Speaker 2: that at eight weeks, which is also in the guidelines
Speaker 2: that you penned. There are some urologists, I don't know
Speaker 2: if you used to do this too, where they would say,
Speaker 2: you know, you should do about ten to twelve to
Speaker 2: fifteen ejaculations to clean the pipes, And I think that's
Speaker 2: kind of what's the Japanese and European guidelines that what
Speaker 2: they don't even do postasectomy sperm testing because it's so successful.
Speaker 2: The litigation society is a little bit less. There is
Speaker 2: that is that your thought too or you're ahead and
Speaker 2: you're also shaking your head.
Speaker 1: Well there, so there.
Speaker 3: There's a guy up in Canada, Michelle Lebreck, who's actually
Speaker 3: he's a GP he's not a urologist, but he's done
Speaker 3: a zillion vasectomies. He does more in a year than
Speaker 3: you know, most people doing their careers. And he was
Speaker 3: actually on our guidelines panel and he says, to be honest,
Speaker 3: if it wasn't for the fact that no vasectomy is
Speaker 3: ever allowed to fail, we wouldn't do post vasectomy semen
Speaker 3: analyses because the failure rate is so low.
Speaker 1: And it's just.
Speaker 3: That, you know, because because we're doing this procedure on
Speaker 3: a man, it has to be one hundred percent successful,
Speaker 3: like there is no room for error period, and you know,
Speaker 3: if we were willing to accept even the fraction of
Speaker 3: the failures, I mean, think about a woman who's on
Speaker 3: birth control, like oral contraceptives five percent failure rate. Nobody
Speaker 3: bats an eye when someone said they got pregnant, when
Speaker 3: they're on the pill. But if a I has a
Speaker 3: pregnancy and he's had of a sectomy, you would think
Speaker 3: that like, oh my god, the world is coming to
Speaker 3: an end.
Speaker 5: Right, there's another victim there.
Speaker 2: Yeah. Well I used to say, you know, about eight weeks,
Speaker 2: do at least twelve fifteen ejaculations that bring a sample in?
Speaker 2: And I don't know if this is ever happened to
Speaker 2: your career, But then i've you ever had that guy
Speaker 2: that that brought in all fifteen ejaculations in one cup
Speaker 2: and put it on the counter and said, here, it
Speaker 2: is a court of a court of semen for the
Speaker 2: worse to go through. Great, Yeah, what'd you do with that?
Speaker 2: I kept in the refrigerator this whole time? So yeah,
Speaker 2: so I tried to get away from that. Uh that
Speaker 2: that visual for for my nurses at eight ejaculations throw
Speaker 2: them all away please and then come in with that
Speaker 2: with that money shot sample to make sure we're good.
Speaker 2: But but that's great, and so what else can go wrong?
Speaker 2: So tell me, you know, what are the other things?
Speaker 2: Why would a guy not want to do of a
Speaker 2: sectomy other than you know, the fear of a procedure
Speaker 2: and an otherwise healthy.
Speaker 3: Guy yeah, I think you mentioned the one that is
Speaker 3: probably you know, always in the back of our minds,
Speaker 3: and that's post vasectamy pain syndrome. I sort of divided
Speaker 3: into two different types. There's the obstructive. Basically you've got
Speaker 3: a closed system that when they ejaculate, the sperm is
Speaker 3: going into the epidymus, which doesn't have any outlet now
Speaker 3: because the VAZ has been blocked, and so they feel
Speaker 3: like their tescal's going to explode. And then there's the
Speaker 3: more common one, which is what we call neuropathic post
Speaker 3: vasectamy pain, which is basically just pain from scarring of
Speaker 3: nerves along the VAZ deference. Some guys are just more
Speaker 3: sensitive to it. The problem is that there's no way
Speaker 3: to predict those guys ahead of time. There's a guy
Speaker 3: down in Florida, Sidjo Para Quattal, who's done a lot
Speaker 3: of research, some really good stuff, looking at guys who
Speaker 3: have post vasectamy pain after vasectomy and has found that
Speaker 3: those men have a different way of healing than the
Speaker 3: average guy. But you just would never know it. And
Speaker 3: so while true post vasectomy pain is somewhat rare, fortunately
Speaker 3: it is and I don't know about you Jesse, But
Speaker 3: I suspect you're the same way. It's in the back
Speaker 3: of our head with every patient we talk to because
Speaker 3: what I always point out to the residence, vaseectomy is
Speaker 3: one of only two surgeries we do with no direct
Speaker 3: benefit to the person having the surgery. This is a
Speaker 3: donor and ephrectomy. You're no better because you had of
Speaker 3: a sectamy. You're doing this because of your partner, because
Speaker 3: you don't you know, you want to be responsible for
Speaker 3: your own reproductive health. But there's no physical advantage to
Speaker 3: having a vasectomy.
Speaker 2: Right, Actually, that becomes part of my counseling, is that
Speaker 2: say I'm taking a perfectly healthy person and doing a
Speaker 2: surgical procedure on them. Yeah, and you're right, and that
Speaker 2: you know, nothing changes other than one big thing which
Speaker 2: directly benefits you if you're a responsible person, and then
Speaker 2: you couldn't carry less. If you're an irresponsible person, you
Speaker 2: probably wouldn't have the pursuit done in the first place.
Speaker 2: So so right, it can only you can only have
Speaker 2: a complication essentially with that in mind. And I think
Speaker 2: that that counseling is important. But you did bring up
Speaker 2: a point about obstructive versus neuropathic pain, and I think
Speaker 2: this is good for listeners too.
Speaker 5: And I don't know if you found this or not.
Speaker 2: I haven't published this, I don't know if anybody has,
Speaker 2: but but I have noticed and the reversals I do
Speaker 2: for pain, it does tend to be the vasectomy site
Speaker 2: is lower, it's closer to the epiditymus and I don't
Speaker 2: know if that's anybody else has noticed that or not,
Speaker 2: but I always go back to Laplace's law or the
Speaker 2: you know, the lower the volume, the higher the pressure,
Speaker 2: and right there's a period of time where that body
Speaker 2: has to equilibrate that change right in the spermaff not
Speaker 2: having to go anywhere. And is that what sets up
Speaker 2: this obstructive pathology? Which is why I always do my
Speaker 2: sectemies high in the scroadom, which is also why I
Speaker 2: do it through two separate pokecals as opposed to one midline,
Speaker 2: because you can get really high. So you're finding that
Speaker 2: as well. But what I'm trying to do is kind
Speaker 2: of build a playbook for our guys out there to
Speaker 2: you know, what questions should they ask their vseectimists. So
Speaker 2: maybe we'll just jump right into that and say, okay,
Speaker 2: so now I've decided to get the procedure. I'm not
Speaker 2: going to Milwaukee to get this done. I'm not going
Speaker 2: to LA to get this done. So how does a
Speaker 2: guy pick the right viseectimist for the job.
Speaker 1: Well, certainly volume.
Speaker 3: You definitely want somebody who you know does ten to
Speaker 3: twenty to fifty a month, not a year. Yes, you know,
Speaker 3: I can't believe I'm going to say this, but look
Speaker 3: online and look at patient you know, reviews and comments.
Speaker 3: I can't tell you how many patients I get off
Speaker 3: of Reddit and mom's Facebook, because you know, people talk,
Speaker 3: and it's not just when things go bad.
Speaker 1: People talk when things are good.
Speaker 3: And you can find some really good, you know, results
Speaker 3: by by searching those things as well. But I really
Speaker 3: think that volume makes a difference. That the more you do,
Speaker 3: the better you are. And you know, if you think
Speaker 3: about it, if you're not very good, you're not going
Speaker 3: to be doing a lot because people are going to
Speaker 3: talk and say, no, you don't want to go to
Speaker 3: that person.
Speaker 2: That's right. Well, I like how you you brought up
Speaker 2: too in this world of access to care that you
Speaker 2: didn't say you had to be a eurologist. In fact,
Speaker 2: one of our guideline participants is one of the most
Speaker 2: prolific vaseectimists right in the world, and so experience matters
Speaker 2: more than pedigree, and I think that's important too, is well.
Speaker 3: The US is one of the few countries where the
Speaker 3: eurologists do the bulk of the vasectomies. You go to Canada,
Speaker 3: you go to Europe, you go to Australia, they're all
Speaker 3: gps that do them. As a matter of fact, those
Speaker 3: people in those countries will say, don't go to a
Speaker 3: urologist because the only vasectomies they do are under anesthesia.
Speaker 1: You don't know how to do them in the off.
Speaker 2: Yeah, do you train your family medicine docks it at
Speaker 2: MCW or do you do you have training for the primary.
Speaker 1: Care if they request it. In other words, most of
Speaker 1: them don't want to do it. Say who's got interest?
Speaker 1: I'm more than happy to.
Speaker 2: Yeah, that's same here is that we don't have a
Speaker 2: form relationship with family med But every once in a
Speaker 2: while we'll get guys that are interest, especially guys that
Speaker 2: are going into rural California practice. We're somewhere right where
Speaker 2: the access to urology is limited. So so yeah, that's
Speaker 2: that's great. I mean, it's you're getting You're getting it
Speaker 2: out there, so great. What about some of the myths
Speaker 2: with vasectomy. Talk to me about the guy always asked,
Speaker 2: do I still ejaculate? We can do this rapid fire,
Speaker 2: so techt to me, he said.
Speaker 5: So I hear it.
Speaker 2: If I have a vasectomy, I'll never ejaculate again. Is
Speaker 2: that right, doctor Sandlow? No, that's that right.
Speaker 3: Because most of your seamen comes from your prostate, your
Speaker 3: seminal vesicles, which are glands behind your bladder. The amount
Speaker 3: of fluid actually coming from your testicles is really small
Speaker 3: compared to your ejaculate volume. So if you measured it,
Speaker 3: there might be a little bit less, but it's not
Speaker 3: like you're gonna You're not gonna have a big puff
Speaker 3: of air when you ejaculate.
Speaker 2: Right, Yeah, And I tell the patients that you know,
Speaker 2: without a microscope in front of me, I couldn't tell
Speaker 2: the difference between a semen sample from a guy that
Speaker 2: post vasectomy or that's here for other reasons, And so
Speaker 2: that that's important.
Speaker 5: Okay, so we busted that myth.
Speaker 2: What about testostern I've heard that vyseectomies will make my
Speaker 2: testosterone go down because the testicle produces testosterone, need will
Speaker 2: get blocked up in the tubes with a sperm.
Speaker 1: Right wrong.
Speaker 5: So man, where did I go to medical school?
Speaker 2: Yeah?
Speaker 5: University of Iowa.
Speaker 3: Yeah, so your testicles and your your pituitary glen don't
Speaker 3: know you've had a vasectomy. So your tesco's still cranking
Speaker 3: out testosterone, they're still cranking out sperm. The sperm just
Speaker 3: can't go anywhere, so your body just breaks them down
Speaker 3: reabsorbs them. That's why reversals work, because when you re
Speaker 3: establish the connection, everything just keeps chugging along like it
Speaker 3: has been.
Speaker 5: Well, this is great.
Speaker 2: I have a section in all of these podcasts where
Speaker 2: I like to call it, You're probably going to be okay?
Speaker 5: Or am I going to be okay? So let me
Speaker 5: run this by you.
Speaker 2: I just had my vasectomy two days ago, and my
Speaker 2: scrotum looks like a purple grapefruit?
Speaker 5: Am I going to be okay? Doctor Sandlo? What happened?
Speaker 5: And what should I worry about?
Speaker 1: Yeah? So I tell my patients you should have very
Speaker 1: little bruising or swelling after your vasectomy. One.
Speaker 3: I would hope they wouldn't wait two days, But if
Speaker 3: it suddenly happened.
Speaker 1: I would want them to call.
Speaker 3: One of the things we do worry about not very common,
Speaker 3: especially with the type of aseectomies that we do, which
Speaker 3: we call like minimally invasive or no scalpel, is that
Speaker 3: there's not a lot of bleeding.
Speaker 1: So if you suddenly have this.
Speaker 3: Big purple grapefruit down there, you need to be evaluated
Speaker 3: for hematomo, which is a big collection of blood in
Speaker 3: the sack that sometimes.
Speaker 1: Needs to be drained right away. Typically, if we can
Speaker 1: get to them within the first twenty four to thirty
Speaker 1: six hours, it's worth draining.
Speaker 3: But once you get to about three or four days,
Speaker 3: then we just have to let nature run its course
Speaker 3: and let things resolve on its own.
Speaker 2: So I'll probably be okay, but definitely get evaluated. I think.
Speaker 1: Ye, that's for sure.
Speaker 2: That's the message I was looking for. Is any I
Speaker 2: always say it's an open door for whatever I do.
Speaker 2: And the number of times that guys say, you know,
Speaker 2: even with a little scab on there, SCROWEDIM, I don't know,
Speaker 2: is this normal. I'm delighted, you know, as annoyed as
Speaker 2: I can be. Say well, great, let me take a
Speaker 2: look and make sure it's just a little gab.
Speaker 3: We use my chart for a lot of that stuff
Speaker 3: where we'll tell guys, you know what, attach a picture
Speaker 3: to your my chart, and then we can tell you
Speaker 3: whether or not you need to come in. But I
Speaker 3: always tell guys, I'm more than happy to see you
Speaker 3: and reassure you, as opposed to have you stressing for
Speaker 3: days or you know, like, oh my god, what's.
Speaker 1: Going to happen?
Speaker 5: Yeah? How long am I going to.
Speaker 2: Be out for?
Speaker 1: Yeah? It depends what you're getting back into.
Speaker 2: So okay.
Speaker 1: I do a lot of my vasectomies on Fridays.
Speaker 3: My guys who you know work in an office are
Speaker 3: obviously back to work on Monday. To be honest, my
Speaker 3: construction workers go back to work on Monday as well.
Speaker 3: But I do try to tell guys take it easy
Speaker 3: for about five to seven days if possible. I do
Speaker 3: a lot of police officers and firefighters, and I really
Speaker 3: stress to them five to seven days because they can't
Speaker 3: be hesitating when they're doing their job. I mean, if
Speaker 3: I'm walking around like I just got off a horse,
Speaker 3: it's not a big deal. They've got to be able to,
Speaker 3: you know, run at a moment's notice or so those
Speaker 3: guys I do tell that they should take five to
Speaker 3: seven days off.
Speaker 2: And Packers fans two weeks with as rapid as they cheer.
Speaker 2: I'm sure you. Yeah, we see two weeks before you
Speaker 2: get to lambeau Field again.
Speaker 1: Benches.
Speaker 3: The benches at lambeau are all metals, so that's freezing
Speaker 3: cold cool.
Speaker 2: Right, that's why they haven't changed the seating in sixty years.
Speaker 2: It's it's for all your post vosectomy guys. I got ye.
Speaker 3: Just last week I had a guy who said, yeah,
Speaker 3: I'm going to the Packer game this coming Sunday against
Speaker 3: the Bears.
Speaker 1: Can I go?
Speaker 3: And I'm like, absolutely, It'll be just as good as
Speaker 3: if you're sitting at home icing at home.
Speaker 2: It's right, it's a whole sand loo section of lambeau Field.
Speaker 2: Makes sense. Well, this is awesome. I want to ask you,
Speaker 2: like I ask all my guests. You're especially this is
Speaker 2: sadly we don't this is radio, so we don't get
Speaker 2: to see just how amazing you look for your young age.
Speaker 2: But as a men's health specialist, you know what is
Speaker 2: your secret?
Speaker 5: What it give me?
Speaker 2: One or two or three things that you have to
Speaker 2: do every day to be as good as shape so
Speaker 2: that we can empower our guys out there listening.
Speaker 5: Have had to take tips from the experts.
Speaker 3: A lot of exercise, although, as I will openly admit,
Speaker 3: I exercise so I can eat. Some people use food
Speaker 3: to fuel their exercise. I exercise so that I can eat. Honestly,
Speaker 3: I think a lot of it is I'm really lucky.
Speaker 3: I love what I do, which really, you know, stress
Speaker 3: is a huge aging thing, and yeah there's stress at work,
Speaker 3: but I like coming to work, and I have an
Speaker 3: awesome wife who takes care of me. So I'm really fortunate.
Speaker 3: I don't have to come home and then deal with
Speaker 3: a lot of a lot of junk. So I'm fortunate
Speaker 3: that and the fact that I've got this really good
Speaker 3: camera that takes about twenty years off.
Speaker 2: Is that what it is?
Speaker 5: It's working.
Speaker 2: I'm telling you, you don't look at day over seventy,
Speaker 2: I mean a fortunate day of a forty.
Speaker 1: I mean, wow, I definitely feel so.
Speaker 2: Yeah, there are there are days, right, yeah, as our
Speaker 2: recovery isn't as good. Well, actually, I like the you know,
Speaker 2: there's a lot of this that you know, you eat
Speaker 2: to fuel yourself, but but you know, I think we
Speaker 2: do lose that there is something really delicious about eating too,
Speaker 2: so that yeah, I had. I had a roommate at
Speaker 2: UCLA freshman year who was a was a naval academy.
Speaker 2: He was doing graduate school work and he was the
Speaker 2: one that actually taught me at a lift and he
Speaker 2: was enormous, like just so jacked. And I ever told
Speaker 2: me because I came home once and he's eating three
Speaker 2: hot dogs in a row, and I was like, Greg,
Speaker 2: what are you doing? He said, I can eat whatever
Speaker 2: I want because I work out like I work out,
Speaker 2: And I thought, well, okay. He was a little more
Speaker 2: colorful in the language, but the idea is the same
Speaker 2: that that right, I mean, food is fuel, so if
Speaker 2: you're going to burn that fuel, by all means do it.
Speaker 2: So makes sense.
Speaker 5: Well, Jordan, what did I What did I forget? That?
Speaker 2: You know you're the common guy here, You're the voice
Speaker 2: of our audience that you want to know about vaseectomies
Speaker 2: that we may not have covered this half hour.
Speaker 4: First of all, I want to say this is probably
Speaker 4: a bad time to let you know that I get
Speaker 4: a little squeamish talking about blood. This is probably the
Speaker 4: first time.
Speaker 5: That's why you're sitting down.
Speaker 4: Yeah, sitting down and sort of a little cry right now, Yes, exactly,
Speaker 4: rocking back and forth. I was really glad you asked
Speaker 4: about you know, what kind of myths about vasectomies could
Speaker 4: you clear up, because there are a lot out there,
Speaker 4: and I want to ask you a little more about
Speaker 4: I need touched on it a bit about the rumor
Speaker 4: that vasectomy kills your sex drive, which is, you know,
Speaker 4: probably the most prevalent one that that I've heard. I
Speaker 4: just wanted to see if you could shed a little
Speaker 4: more light onto that.
Speaker 3: Yeah, so your sex drive really comes off your testosterone,
Speaker 3: and since testosterone doesn't change, your sex drive doesn't change.
Speaker 3: They've actually done some really good studies that have shown
Speaker 3: that ninety five percent of guys there's no change in
Speaker 3: their sex drive or their in sexual enjoyment. But there's
Speaker 3: a small percentage of men who actually have improvement in
Speaker 3: their sexual and drum because they don't worry about getting
Speaker 3: somebody pregnant.
Speaker 6: Wow.
Speaker 3: Yeah, and so you don't have that worry in the
Speaker 3: back of your head. And so in my mind, and
Speaker 3: I tell this the patients. Part of the benefit of
Speaker 3: a vasectomy is the psychological benefit of not having to worry.
Speaker 3: So I've had guys who their wives are menopausal, they
Speaker 3: can't get pregnant, and they still want to get a vasectomy.
Speaker 3: And after I sort of look at them funny and
Speaker 3: make sure that it's not because they might be stepping out,
Speaker 3: it makes them feel better that they don't have there's
Speaker 3: no concern whatsoever that they're going to get their wife
Speaker 3: or their partner pregnant.
Speaker 2: Yeah. Yeah, there's studies out of Europe years ago too,
Speaker 2: shows that in a partnered relationship, Yeah, the bido of
Speaker 2: the partner goes up. And part of that is I
Speaker 2: think what Jays just said. The other part is that
Speaker 2: we know in women, long term use of world contraceptives
Speaker 2: can have a negative effect on the bido. So if
Speaker 2: you're getting off the pill, then it's it's kind of
Speaker 2: a win win where you know, the responsible man, which
Speaker 2: is the guy that gets a paseectomy in the first place,
Speaker 2: is thinking this is great.
Speaker 5: You know, this is uh.
Speaker 2: And I had a Brazilian patient once it said in
Speaker 2: Brazil want they do viseectings. It says, you're you're closing
Speaker 2: the factory and opening a playground, and so I think, uh,
Speaker 2: I think that makes sense too, right, is that that
Speaker 2: you know that now this is uh, this is recreational
Speaker 2: instead of procreational and uh, and that changes. So that's
Speaker 2: a great it's a great question, Jordan, because we do
Speaker 2: get that a lot. Well awesome. I don't want to
Speaker 2: take any more of your time. We're going to have
Speaker 2: you back very shortly for talk to him all about
Speaker 2: whatever a guy does change his mind. So that's foreshadowing
Speaker 2: for the next episode, was what is a the sectum
Speaker 2: or reversal? Tell you're going to talk us all about
Speaker 2: just options after of as reversal as well.
Speaker 5: So thanks everybody.
Speaker 2: Out there again, Jordan, thanks for stacking it out with
Speaker 2: us again and uh and not passing out. I would
Speaker 2: know have to call nine to one one in Brooklyn
Speaker 2: in the first place. So I'm glad, I'm glad you
Speaker 2: got your color back and uh. And we didn't have
Speaker 2: a medical emergency the last to the last two people
Speaker 2: you wanted a medical emergency or urologists, especially male reproductive specialists,
Speaker 2: because other than putting a catheter in there and interpreting
Speaker 2: a Seaman analysis, we don't have a lot of resuscitative skills.
Speaker 2: So thank goodness you're still with us, all right. Well,
Speaker 2: Thank you everybody.
Speaker 5: Let's talk about it. Let's talk about the Maro.
Speaker 1: Let's talk about it.
Speaker 2: Let's talk about the Maro. Let's talk about it. Let's
Speaker 2: talk about the mail.
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