WEBVTT - Let’s Talk About the Snip: The Truth About Vasectomies

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<v Speaker 1>Let's talk about it.

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<v Speaker 2>Let's talk about the marrow. Let's talk about it. Let's

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<v Speaker 2>talk about the man.

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<v Speaker 3>Hero.

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<v Speaker 2>Welcome to the Man, Welcome back to the Mailroom, guys,

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<v Speaker 2>Doctor Jesse Mills here with my indomitable producer Jordan Runta,

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<v Speaker 2>the Sultan of Sound, roll to my stone in the

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<v Speaker 2>studio again for another episode of the mail Room. It's

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<v Speaker 2>March and March. I don't know how things are going

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<v Speaker 2>in Brooklyn. The poppies popping and the daffodils out. We

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<v Speaker 2>have poppies here. I guess you have daffodils.

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<v Speaker 4>But tell me crosses freezing, my friends.

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<v Speaker 2>No, someday we're gonna have this amazing conversation because I

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<v Speaker 2>feel like, you know, I'm always talking about great it

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<v Speaker 2>is in Santa Monica. But Brooklyn, I mean, it's like

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<v Speaker 2>this New York City. It's like an amazing town. There's

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<v Speaker 2>so much give me, like your top two great thing

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<v Speaker 2>as you did last week, because you're in New York

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<v Speaker 2>City that I probably couldn't do in Los Angeles.

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<v Speaker 4>That's I mean, good pizza, good jazz.

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<v Speaker 2>Okay, other than wear sweater. Oh yeah, since since Chet

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<v Speaker 2>Baker's passing, we got great jazz here. What are you

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<v Speaker 2>talking about? That's true? Okay, yeah, go down the Venice the.

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<v Speaker 5>Blue Notes opening out here.

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<v Speaker 2>I mean yes, but but all right, so you got

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<v Speaker 2>so you go to some a good club, went to Vanguard.

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<v Speaker 2>You know me, I'm old school. Come on, yeah, baby, awesome.

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<v Speaker 2>The pizza thing again, I don't want to talk disparagingly

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<v Speaker 2>of La Pizza, but you're right, it's a lot easier

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<v Speaker 2>to find really good pizza brook and we have our

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<v Speaker 2>spots California Pizza Kitchen. Yeah come ouch ouch. No, they're

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<v Speaker 2>a big sponsor of UCLA Health. Okay, so there's nothing

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<v Speaker 2>wrong as ePK if I donate a lot of money

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<v Speaker 2>to the Department Uerology. So I'm actually a big fan,

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<v Speaker 2>big fan. Okay. Well, so the other thing that happens

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<v Speaker 2>in March is basketball. Great basketball tournaments, Men's tournament, n

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<v Speaker 2>C two a tournament, women's tournament. And so what happens

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<v Speaker 2>during these turns as well? They're crazy. I can't say

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<v Speaker 2>they're mad because it's actually copywritten, but it's they're crazy time.

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<v Speaker 2>And why because there's thirty two games that happen, you know,

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<v Speaker 2>over day. So imagine if you're a huge basketball fan

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<v Speaker 2>and you're thinking I need a really good excuse to

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<v Speaker 2>not do anything. I need to tell my partner, my kids,

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<v Speaker 2>my dog that I can't take them out for the

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<v Speaker 2>next couple of days. But they don't want to buy that. Well,

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<v Speaker 2>so what if it's basketball, just you know, watch a

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<v Speaker 2>couple of games and call it good. But what if

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<v Speaker 2>you had something done, like a surgery, like a procedure

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<v Speaker 2>for example, Jordan, talk to me about this, Right, they're

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<v Speaker 2>surgeries that you have to have, right, I mean, like,

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<v Speaker 2>you can't decide to schedule an apendectomy during during the

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<v Speaker 2>March basketball tournament. Right you can't just say, well, I

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<v Speaker 2>guess you could. You could lie about it. But but

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<v Speaker 2>say I had my appendix out, I can't take out

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<v Speaker 2>the trash for the next two days. But no, no,

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<v Speaker 2>it's actually one of the best times to get a vasectomy,

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<v Speaker 2>which is what we're going to be talking about here

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<v Speaker 2>in the next little bit. I am so so pumped

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<v Speaker 2>to bring on our guest today, doctor j Sandlow, who's

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<v Speaker 2>chair of Urology at Medical College of Wisconsin. I'll do

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<v Speaker 2>a little bit of an introduction, but before I do this,

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<v Speaker 2>I just want to I want to put you on

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<v Speaker 2>the spot for a second Jordan.

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<v Speaker 5>All right, are you ready for this?

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<v Speaker 1>Absolutely?

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<v Speaker 2>You're not nervous.

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<v Speaker 5>Well, I wasn't until you asked me.

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<v Speaker 2>Okay, well that's usually I worked say. Well, I'm going

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<v Speaker 2>to just throw this out at you. So there are

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<v Speaker 2>two forms of permanent birth control that are available to couples. Okay,

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<v Speaker 2>this is a test, this is your medical knowledge test.

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<v Speaker 2>So for a guy, that's a aseectomy. For a woman,

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<v Speaker 2>it's a tubal ligation. So a tubal ligation a dominal procedure.

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<v Speaker 2>They make an incision that go in, often with the scope,

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<v Speaker 2>but there are complications. It requires anesthesia, it requires some

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<v Speaker 2>recovery time. That's a little bit more significant. If a

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<v Speaker 2>sectomy takes it takes me about five minutes. It probably

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<v Speaker 2>talks about doctor Sande little about an hour and a half,

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<v Speaker 2>but we'll talk about that. But it's a very short procedure.

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<v Speaker 2>Usually we do it just a local and it's toned

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<v Speaker 2>through tiny little poke holes. Sometimes we don't even use

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<v Speaker 2>a scalpel at all. So what do you think with

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<v Speaker 2>those parameters, what do you think is more commonly performed

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<v Speaker 2>the United States?

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<v Speaker 1>Jordan?

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<v Speaker 2>Tubal ligation answer A vasectomy answer B.

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<v Speaker 4>I'm sure it's anser a tubal location.

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<v Speaker 2>Right, yeah, yeah, but I don't know, Jay, if you have.

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<v Speaker 5>New numbers on this.

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<v Speaker 2>Yeah, it's exactly right. Yeah, Yeah, there's you know, somewhere

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<v Speaker 2>north of seven eight hundred thousand tubal ligations done every

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<v Speaker 2>year in this country in about four to maybe five

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<v Speaker 2>hundred thousand paths, So it's about a two to one

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<v Speaker 2>ratio somewhere in there of women that are undergoing TUBU,

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<v Speaker 2>which is a way more invasive approach. And we can

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<v Speaker 2>have all kinds of discussions about why that is. Obviously

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<v Speaker 2>the most important one probably is the dog in the hunt.

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<v Speaker 2>That a woman is going to have a much a

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<v Speaker 2>much larger seven and a half to eight pound dog

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<v Speaker 2>in the hunt at the end of pregnancy than a guy.

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<v Speaker 5>But yet it's still there.

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<v Speaker 2>So I'm going to do a formal introduction because Stuck,

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<v Speaker 2>you said, I've known in my literally my entire career.

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<v Speaker 2>In fact, I owe my mentorship. He was my first

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<v Speaker 2>mentor in urology. He was the guy that really got

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<v Speaker 2>me into urology and male fertility specifically. So he is

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<v Speaker 2>currently the chair of Urology at Medical College of Wisconsin,

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<v Speaker 2>but he also, as am I, a fellowship trained surgeon.

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<v Speaker 2>He actually did a very prestigious American Foundation in Neurologic

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<v Speaker 2>Diseases Fellowship, which is now a Urology Care Foundation Fellowship.

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<v Speaker 2>But that was a two year research plus surgical exploration

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<v Speaker 2>into into microsurgery. So the guy is he's vetted. He's

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<v Speaker 2>a true academician, through and through. He spent his entire

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<v Speaker 2>entire career in the academy. Where I got to first

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<v Speaker 2>meet him was when I was a medical student University

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<v Speaker 2>of Iowa and he was about, gosh, a couple of

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<v Speaker 2>years probably into practice by that time, and I was

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<v Speaker 2>a second year of urology. I'm sorry, second year medical student.

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<v Speaker 2>I really knew I wanted to do surgery. I went

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<v Speaker 2>to Eurology interest group. I met Jay and somebody else

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<v Speaker 2>named Dick Williams who's a legend in the field who

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<v Speaker 2>unfortunately lost way too young to lung cancer.

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<v Speaker 5>But he and Jay were.

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<v Speaker 2>At the surgical interest booth. It was sort of like

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<v Speaker 2>speed dating for surgeons. When we knew he wanted to

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<v Speaker 2>do something. I went to neurosurgery. I'm like, I'm not

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<v Speaker 2>those guys.

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<v Speaker 5>I went to ian T.

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<v Speaker 2>I thought, I don't love snot that much, so I'm

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<v Speaker 2>going to walk away from there, and I went to

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<v Speaker 2>these two guys and Dick Williams had a little a

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<v Speaker 2>faucet pin on his lapel like he's He's like, I'm

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<v Speaker 2>just a glorified plumber. And then Jay was there, look

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<v Speaker 2>at like he was. It was like a fraternity rush party.

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<v Speaker 2>He was this tall, athletic, buff, just super good looking guy.

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<v Speaker 2>I'm like, holy crap, like this is the this is

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<v Speaker 2>the fraternity I want to pledge to.

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<v Speaker 5>I want to be a eurologist.

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<v Speaker 2>And then I got to hang out with the residents

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<v Speaker 2>at the time, and it was a visseecondmy reversal, which

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<v Speaker 2>we're going to talk about in the next episode, that

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<v Speaker 2>I was watching Jay do.

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<v Speaker 5>And it wasn't just the skill.

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<v Speaker 2>It wasn't just the way that he was doing this

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<v Speaker 2>incredibly precise surgery with these sutures that are finer than

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<v Speaker 2>human hair that you can barely see without a microscope,

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<v Speaker 2>but he was having so much fun doing it, and

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<v Speaker 2>I thought, Okay, if a guy can be in this

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<v Speaker 2>good shape and seem to have the quality of life

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<v Speaker 2>he has and do what he could do with a

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<v Speaker 2>microscope and make babies where otherwise men and women couldn't

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<v Speaker 2>have babies.

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<v Speaker 5>This is what I gotta do. So that's my intro.

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<v Speaker 2>Jay, I'm grateful to you for bringing me into this

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<v Speaker 2>field when you know, all of about thirty years ago,

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<v Speaker 2>when you were fifteen or so, you were doing surgery

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<v Speaker 2>at that early age. Because you still look like you're

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<v Speaker 2>about to save as what I saw you all those

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<v Speaker 2>years ago.

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<v Speaker 5>So welcome to the mailroom.

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<v Speaker 3>Well, thanks, Jesse. A couple of things you didn't point out.

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<v Speaker 3>One is that it took me eight years to do

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<v Speaker 3>most people doing six. So most people do five years

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<v Speaker 3>of urology residency, one year of fellowship. I did six

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<v Speaker 3>and two. So I was definitely on the you know,

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<v Speaker 3>the slower track. Yes, and uh and uh, you know

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<v Speaker 3>you you sell yourself short. I mean, Jesse was like

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<v Speaker 3>one of the star medical students at University of Iowa.

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<v Speaker 3>We really felt lucky that we conned him or or

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<v Speaker 3>brainwashed him into becoming one of us. And he quickly

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<v Speaker 3>left Iowa to go to greener pastures in Colorado and

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<v Speaker 3>then did his fellowship down in Houston. And now of

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<v Speaker 3>course he's a legend in in La So I will

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<v Speaker 3>tell you it is so gratifying when you see somebody

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<v Speaker 3>that you interacted with early on in their career to

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<v Speaker 3>watch them just flourish and and you know, become this

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<v Speaker 3>monster of of you know, not just in urology, but

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<v Speaker 3>just in as human being.

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<v Speaker 1>So I really appreciate it.

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<v Speaker 3>But you know, I guess we're both captains of our

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<v Speaker 3>of our mutual admiration society.

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<v Speaker 1>So there you go, very happy to be here.

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<v Speaker 2>That's the way it should be. It's it's a wonderful

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<v Speaker 2>community you're part of, and it is. And again that's

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<v Speaker 2>one of the main motivations for doing this podcast, not

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<v Speaker 2>because I don't have enough to do with my day job,

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<v Speaker 2>but really because we get to let the world know, hey,

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<v Speaker 2>what a great field we are, and how happy urologists

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<v Speaker 2>are if you get to if you get the privilege

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<v Speaker 2>and and onnus of seeing one as a patient.

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<v Speaker 5>But also we love to talk, and we love to

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<v Speaker 5>we love we're.

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<v Speaker 2>Very social creatures, and that's what we're going to do today.

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<v Speaker 2>One of the things I left out of your intro

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<v Speaker 2>because I got so excited, and obviously my mom sent

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<v Speaker 2>you those index cards.

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<v Speaker 5>You just read off about it, but.

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<v Speaker 2>I do want to say that you actually wrote the

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<v Speaker 2>AUY guidelines which are American your Logical Association guidelines on vyseectomy.

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<v Speaker 2>So I couldn't think of a better person not to

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<v Speaker 2>mention in our own friendship and mentorship story, to talk

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<v Speaker 2>to the average guy about a vasectomy. And so we're

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<v Speaker 2>going to have sort of a couple of things that

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<v Speaker 2>I'm going to ask you, And I think the best

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<v Speaker 2>thing is, let's start simply tell me who's a candidate

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<v Speaker 2>for a vasectomy?

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<v Speaker 5>What is it?

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<v Speaker 2>Tell me that, Like, pretend I'm a forty two year

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<v Speaker 2>old guy and I'm walking your office. I mean, I'm

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<v Speaker 2>an augmous relationship. I have two beautiful young Dodger fans.

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<v Speaker 2>And sorry about the Brewers by the way, you guys

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<v Speaker 2>what a scrappy team.

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<v Speaker 1>But let me pull that knife.

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<v Speaker 5>Well, you said, two.

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<v Speaker 2>Young Dodgers times like the pre production stops.

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<v Speaker 5>Now.

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<v Speaker 2>We do not need any more at these Dodger fans

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<v Speaker 2>in the world. There's enough already. And my wife is

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<v Speaker 2>forty one, she's still ovulating, and she said, look, we're

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<v Speaker 2>done with kids.

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<v Speaker 1>Yeah, it's your turn.

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<v Speaker 2>How does that console work in your practice? Walk me

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<v Speaker 2>through if I'm in your office.

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<v Speaker 3>You know, obviously most of the patients who come in

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<v Speaker 3>it's a little bit of a self selection. They've already

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<v Speaker 3>done at least enough research to know that of a

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<v Speaker 3>sectomy is something they want to look into. I always

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<v Speaker 3>tell patients that while we consider this a permanent form

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<v Speaker 3>of male sterilization, we don't do anything to make it irreversible,

0:11:29.040 --> 0:11:32.840
<v Speaker 3>and therefore if life changes, we can undo it.

0:11:32.840 --> 0:11:34.080
<v Speaker 1>It's just a much bigger deal.

0:11:34.200 --> 0:11:38.120
<v Speaker 3>So I try to get guys to understand that this

0:11:38.360 --> 0:11:42.120
<v Speaker 3>is by far the best birth control, but you should

0:11:42.200 --> 0:11:45.440
<v Speaker 3>go into it thinking that this is it. You don't

0:11:45.480 --> 0:11:48.560
<v Speaker 3>want to be going back and forth like the like

0:11:48.640 --> 0:11:51.360
<v Speaker 3>the episode from the Office with snip snap, snip snap.

0:11:52.000 --> 0:11:55.880
<v Speaker 2>Yes, good, good reference, and I'm sure you have more

0:11:55.920 --> 0:11:58.320
<v Speaker 2>than one of those stories. And oh yeah, thin too,

0:11:58.400 --> 0:12:00.320
<v Speaker 2>so we'll definitely get it to that.

0:12:00.920 --> 0:12:02.160
<v Speaker 5>So what are the risks?

0:12:02.480 --> 0:12:03.760
<v Speaker 2>I was going to ask you how long it took,

0:12:03.760 --> 0:12:06.480
<v Speaker 2>but already already threw shade upon you. So tell me,

0:12:06.520 --> 0:12:08.720
<v Speaker 2>really what you know? What does it look like? So

0:12:08.760 --> 0:12:11.079
<v Speaker 2>I say, okay, doctor Samlo, you look like the guy

0:12:11.120 --> 0:12:14.240
<v Speaker 2>you wrote. You wrote the handbook, You've trained hundreds of

0:12:14.960 --> 0:12:17.440
<v Speaker 2>residents and fellows to do this procedure, so I want

0:12:17.480 --> 0:12:20.359
<v Speaker 2>you to do it. Tell me what happens next.

0:12:20.400 --> 0:12:24.200
<v Speaker 3>Sure, So typically what I tell guys is it's about

0:12:24.760 --> 0:12:28.079
<v Speaker 3>fifteen minute procedure. We're going to use local anesthesia to

0:12:28.160 --> 0:12:31.880
<v Speaker 3>numb you up. I personally like to make two small holes,

0:12:31.920 --> 0:12:34.800
<v Speaker 3>one on each side of the scrotum. Some people will

0:12:34.800 --> 0:12:38.000
<v Speaker 3>do one right in the middle of the scrotum. Honestly,

0:12:38.040 --> 0:12:41.680
<v Speaker 3>that's dealer's choice. My reasons for doing one on each

0:12:41.760 --> 0:12:45.800
<v Speaker 3>side is that if if you do one in the middle,

0:12:45.840 --> 0:12:47.960
<v Speaker 3>then that second side has to come up to the

0:12:48.080 --> 0:12:51.400
<v Speaker 3>exact same hole, and sometimes the vaz doesn't want to

0:12:51.440 --> 0:12:55.000
<v Speaker 3>move around the same from one side to the other. Also,

0:12:55.760 --> 0:12:58.480
<v Speaker 3>I like to be able to look at the ends

0:12:58.520 --> 0:13:00.480
<v Speaker 3>when I'm done at the end of the case, and

0:13:00.600 --> 0:13:03.440
<v Speaker 3>if you've already done one side, you have to dunk

0:13:03.480 --> 0:13:05.640
<v Speaker 3>it back down into the scrotum, so you can't really

0:13:05.679 --> 0:13:09.320
<v Speaker 3>see if there's anything bleeding or oozing. But it's a

0:13:09.440 --> 0:13:12.640
<v Speaker 3>very straightforward procedure. There's a little pulling, a little tugging,

0:13:13.240 --> 0:13:17.400
<v Speaker 3>and I don't use any stitches because I am making

0:13:17.440 --> 0:13:20.080
<v Speaker 3>such a small hole, So we just put a little

0:13:20.120 --> 0:13:24.480
<v Speaker 3>plastic band aid over each little hole and send you

0:13:24.559 --> 0:13:25.160
<v Speaker 3>on your way.

0:13:25.480 --> 0:13:28.040
<v Speaker 2>So yeah, I do too as well, and I think

0:13:28.280 --> 0:13:31.119
<v Speaker 2>I trained that way even before I did a fellowship

0:13:31.120 --> 0:13:34.520
<v Speaker 2>with doctor Lipschultz, but just I had a community urologist

0:13:34.559 --> 0:13:38.080
<v Speaker 2>in Denver who did a very elegant disseectomy. My reasoning is,

0:13:38.080 --> 0:13:40.200
<v Speaker 2>and I sure you've seen this, is that because you

0:13:40.240 --> 0:13:44.800
<v Speaker 2>said in there too, you always us reconstructive, reproductive doctors

0:13:44.880 --> 0:13:47.440
<v Speaker 2>do things. We're going to take things apart like we'd

0:13:47.440 --> 0:13:50.040
<v Speaker 2>want to put them back together, exactly. And so how

0:13:50.040 --> 0:13:52.040
<v Speaker 2>many times have you gone in to do a reversal

0:13:52.080 --> 0:13:56.080
<v Speaker 2>where you've got a hivasectomy site which is very favorable

0:13:56.080 --> 0:13:58.559
<v Speaker 2>on one side, and then a clip through the epiditymus

0:13:58.640 --> 0:14:01.040
<v Speaker 2>or as low as you possibly can on the other. Yeah,

0:14:01.080 --> 0:14:03.960
<v Speaker 2>And my argument is that right if you're swinging the

0:14:04.000 --> 0:14:06.280
<v Speaker 2>same testicle up through the incision, you're never going to

0:14:06.320 --> 0:14:09.000
<v Speaker 2>get it in that same high site. So that if

0:14:09.000 --> 0:14:10.640
<v Speaker 2>a guy every wants to change his mind, that's it.

0:14:10.720 --> 0:14:13.920
<v Speaker 2>But also concern about hemotoma. But I also like what

0:14:13.960 --> 0:14:16.920
<v Speaker 2>you said, just so we're not throwing our one incision

0:14:17.640 --> 0:14:20.600
<v Speaker 2>urology buddies under the bus, is that it is dealer's choice.

0:14:20.800 --> 0:14:23.080
<v Speaker 2>The goal is to go some place where guys are

0:14:23.560 --> 0:14:25.280
<v Speaker 2>you know that have done so many in the way

0:14:25.320 --> 0:14:27.040
<v Speaker 2>that they're going to do it right for you.

0:14:28.120 --> 0:14:31.320
<v Speaker 3>Yeah, I have seen several patients in my career though

0:14:31.400 --> 0:14:34.840
<v Speaker 3>where because it was done through a midline. I won't

0:14:34.880 --> 0:14:39.000
<v Speaker 3>even say the urologist, the viseectimist caught the same side twice.

0:14:39.440 --> 0:14:43.200
<v Speaker 2>Yes, that's right, I've seen that as well. And then

0:14:43.240 --> 0:14:45.640
<v Speaker 2>that's one of the that's actually one of the questions

0:14:45.640 --> 0:14:47.480
<v Speaker 2>we're going to go. I'm going to go do next

0:14:47.560 --> 0:14:50.400
<v Speaker 2>is what can go wrong with the vasectomy? And actually,

0:14:50.480 --> 0:14:52.320
<v Speaker 2>before I even ask you that, how successful is it?

0:14:52.320 --> 0:14:54.520
<v Speaker 2>So if a guy found that same forty two year

0:14:54.520 --> 0:14:56.160
<v Speaker 2>old guy, I say, great, you know, the wife is

0:14:56.160 --> 0:14:58.280
<v Speaker 2>pulling the goalie, there's no more idd.

0:14:58.240 --> 0:15:01.520
<v Speaker 5>There's no more diaphragm. It's your work.

0:15:01.280 --> 0:15:04.480
<v Speaker 2>Against you know, of eighteen year college fund. What is

0:15:04.520 --> 0:15:07.320
<v Speaker 2>the you know what, what is the success rate of

0:15:07.400 --> 0:15:08.080
<v Speaker 2>this procedure?

0:15:08.280 --> 0:15:12.000
<v Speaker 3>Yeah, so there's actually two different things you have to

0:15:12.040 --> 0:15:14.480
<v Speaker 3>look at. There's an early failure rate where the two

0:15:14.600 --> 0:15:18.600
<v Speaker 3>ends actually will heal back together in the first four

0:15:18.600 --> 0:15:23.120
<v Speaker 3>to six weeks. That's called early recannualization, and that happens

0:15:23.120 --> 0:15:26.680
<v Speaker 3>in about one in five to one in six hundred vaseectomies.

0:15:27.240 --> 0:15:31.440
<v Speaker 3>So I'm all, I'm very you know adamant with my patients.

0:15:31.720 --> 0:15:33.800
<v Speaker 3>We don't even want to check your sement at your

0:15:33.840 --> 0:15:36.840
<v Speaker 3>post posectomy seem analysis till it's been at least eight weeks,

0:15:37.520 --> 0:15:41.160
<v Speaker 3>because there's really good evidence that after eight weeks, the

0:15:41.320 --> 0:15:44.160
<v Speaker 3>likelihood of those two ends coming back together is less

0:15:44.160 --> 0:15:47.840
<v Speaker 3>than one in two thousand and now. That number comes

0:15:47.880 --> 0:15:50.400
<v Speaker 3>from the literature. I'll tell you, at least in my

0:15:50.480 --> 0:15:54.760
<v Speaker 3>own practice, it's even lower than that. I have seen

0:15:55.440 --> 0:15:59.240
<v Speaker 3>on occasion patients who have had what we call these

0:15:59.360 --> 0:16:03.440
<v Speaker 3>late recare analizations years later. To be honest, I haven't

0:16:03.440 --> 0:16:05.760
<v Speaker 3>seen any for my own patients, but I have seen

0:16:05.800 --> 0:16:09.160
<v Speaker 3>it from people who did very good vasectomy, So I

0:16:09.160 --> 0:16:12.320
<v Speaker 3>don't think anything was done wrong. But the body's natural

0:16:12.840 --> 0:16:16.400
<v Speaker 3>reaction to any surgery is to try to heal, and

0:16:16.480 --> 0:16:19.720
<v Speaker 3>we know when we do reversals. Often when you find

0:16:19.800 --> 0:16:22.880
<v Speaker 3>one end of the vas deference, you can find the

0:16:22.920 --> 0:16:25.480
<v Speaker 3>other end just by pulling up on that first end,

0:16:25.880 --> 0:16:28.480
<v Speaker 3>because there'll be a piece of scar tissue connecting the

0:16:28.520 --> 0:16:31.640
<v Speaker 3>two ends, and that scar tissue can have little micro

0:16:31.800 --> 0:16:33.280
<v Speaker 3>channels running through it.

0:16:33.360 --> 0:16:35.480
<v Speaker 1>That's how some of those late failures happen.

0:16:36.280 --> 0:16:39.560
<v Speaker 5>I've seen that. I've seen that in ther yeah.

0:16:39.600 --> 0:16:42.680
<v Speaker 2>I had a guy years ago who actually was coming

0:16:42.720 --> 0:16:44.560
<v Speaker 2>to me for one of the other complications, which i'll

0:16:44.560 --> 0:16:46.880
<v Speaker 2>get your opinion on, in a sect called post vasectomy

0:16:46.920 --> 0:16:50.440
<v Speaker 2>pain syndrome, And it was the strangest case because he

0:16:50.560 --> 0:16:54.320
<v Speaker 2>had excruciating pain and he still had a positive Seaman

0:16:54.360 --> 0:16:57.680
<v Speaker 2>analysis after his second And so I went in. I

0:16:57.720 --> 0:17:00.560
<v Speaker 2>did the right side. I still remember the laity as

0:17:00.600 --> 0:17:04.240
<v Speaker 2>most of us that do these, just yeah, world. In

0:17:04.280 --> 0:17:07.200
<v Speaker 2>my head, right side was fine, just did a simple reversal.

0:17:07.720 --> 0:17:09.520
<v Speaker 2>And on the left side, as I was getting ready

0:17:09.560 --> 0:17:13.320
<v Speaker 2>to do it, I actually saw recannulation and it made sense.

0:17:13.080 --> 0:17:14.959
<v Speaker 5>That he was having persistent votal sperm.

0:17:15.480 --> 0:17:17.879
<v Speaker 2>But that my theory, I don't know, you know, I

0:17:17.880 --> 0:17:19.720
<v Speaker 2>don't there's no way we can prove this, but that

0:17:20.080 --> 0:17:22.040
<v Speaker 2>in some ways he was having kind of this obstructive

0:17:22.080 --> 0:17:24.760
<v Speaker 2>pain because all those little sperm were trying to get

0:17:24.760 --> 0:17:27.800
<v Speaker 2>through this in this little thready channel. But so I

0:17:27.800 --> 0:17:30.359
<v Speaker 2>had to cut through that channel and then sew together

0:17:30.400 --> 0:17:32.399
<v Speaker 2>the pipe, you know, the main pipe, in order to

0:17:33.160 --> 0:17:33.840
<v Speaker 2>reconstruct it.

0:17:33.840 --> 0:17:35.080
<v Speaker 5>But yeah, that's that's real.

0:17:35.160 --> 0:17:38.239
<v Speaker 2>But I think you're saying basically that that you know,

0:17:38.480 --> 0:17:42.040
<v Speaker 2>when you compare that to birth control pills or tubal

0:17:42.160 --> 0:17:46.040
<v Speaker 2>ligation or condoms, you're still looking at something that's you know,

0:17:46.119 --> 0:17:48.320
<v Speaker 2>three or four hundred times more successful.

0:17:48.520 --> 0:17:51.119
<v Speaker 3>That's that's what I always remind guys. So I'll have

0:17:51.160 --> 0:17:53.679
<v Speaker 3>some patients he'll say, God, what in two thousand that

0:17:53.800 --> 0:17:56.639
<v Speaker 3>sounds like a high failure rate, And I'm like, well,

0:17:57.119 --> 0:18:00.000
<v Speaker 3>I guarantee you whatever you're using for birth control, now,

0:18:00.040 --> 0:18:03.639
<v Speaker 3>well this is a lot better. Like that's right, Failure

0:18:03.760 --> 0:18:07.159
<v Speaker 3>rates for tubal igations like one in seven hundred. So,

0:18:07.560 --> 0:18:10.440
<v Speaker 3>as you pointed out, tubules are like a really big

0:18:10.480 --> 0:18:14.679
<v Speaker 3>deal general anesthesia. You're in a woman's belly and you

0:18:14.800 --> 0:18:17.960
<v Speaker 3>still have a three to four time higher rate of

0:18:18.000 --> 0:18:19.560
<v Speaker 3>failure than of aseectomy.

0:18:20.119 --> 0:18:20.840
<v Speaker 5>Yeah, that's right.

0:18:20.880 --> 0:18:23.160
<v Speaker 2>Yeah. I mean I think it's as good a peace

0:18:23.160 --> 0:18:24.960
<v Speaker 2>of mind as we can get when we get that

0:18:24.960 --> 0:18:27.120
<v Speaker 2>that negative seam analysis. And I like how you said

0:18:27.160 --> 0:18:30.119
<v Speaker 2>that at eight weeks, which is also in the guidelines

0:18:30.119 --> 0:18:32.639
<v Speaker 2>that you penned. There are some urologists, I don't know

0:18:32.760 --> 0:18:34.800
<v Speaker 2>if you used to do this too, where they would say,

0:18:35.359 --> 0:18:37.399
<v Speaker 2>you know, you should do about ten to twelve to

0:18:37.480 --> 0:18:40.640
<v Speaker 2>fifteen ejaculations to clean the pipes, And I think that's

0:18:40.720 --> 0:18:44.320
<v Speaker 2>kind of what's the Japanese and European guidelines that what

0:18:44.560 --> 0:18:48.919
<v Speaker 2>they don't even do postasectomy sperm testing because it's so successful.

0:18:49.480 --> 0:18:52.240
<v Speaker 2>The litigation society is a little bit less. There is

0:18:52.240 --> 0:18:54.720
<v Speaker 2>that is that your thought too or you're ahead and

0:18:54.760 --> 0:18:55.960
<v Speaker 2>you're also shaking your head.

0:18:56.080 --> 0:18:58.240
<v Speaker 1>Well there, so there.

0:18:59.160 --> 0:19:01.959
<v Speaker 3>There's a guy up in Canada, Michelle Lebreck, who's actually

0:19:02.440 --> 0:19:05.440
<v Speaker 3>he's a GP he's not a urologist, but he's done

0:19:05.680 --> 0:19:09.120
<v Speaker 3>a zillion vasectomies. He does more in a year than

0:19:09.280 --> 0:19:12.480
<v Speaker 3>you know, most people doing their careers. And he was

0:19:12.520 --> 0:19:16.760
<v Speaker 3>actually on our guidelines panel and he says, to be honest,

0:19:17.080 --> 0:19:21.600
<v Speaker 3>if it wasn't for the fact that no vasectomy is

0:19:21.640 --> 0:19:25.679
<v Speaker 3>ever allowed to fail, we wouldn't do post vasectomy semen

0:19:25.720 --> 0:19:29.040
<v Speaker 3>analyses because the failure rate is so low.

0:19:30.160 --> 0:19:31.280
<v Speaker 1>And it's just.

0:19:31.320 --> 0:19:35.040
<v Speaker 3>That, you know, because because we're doing this procedure on

0:19:35.119 --> 0:19:38.280
<v Speaker 3>a man, it has to be one hundred percent successful,

0:19:38.760 --> 0:19:43.919
<v Speaker 3>like there is no room for error period, and you know,

0:19:44.119 --> 0:19:47.760
<v Speaker 3>if we were willing to accept even the fraction of

0:19:47.800 --> 0:19:50.560
<v Speaker 3>the failures, I mean, think about a woman who's on

0:19:50.640 --> 0:19:55.399
<v Speaker 3>birth control, like oral contraceptives five percent failure rate. Nobody

0:19:55.480 --> 0:19:57.840
<v Speaker 3>bats an eye when someone said they got pregnant, when

0:19:57.840 --> 0:20:00.520
<v Speaker 3>they're on the pill. But if a I has a

0:20:00.560 --> 0:20:03.440
<v Speaker 3>pregnancy and he's had of a sectomy, you would think

0:20:03.480 --> 0:20:06.280
<v Speaker 3>that like, oh my god, the world is coming to

0:20:06.320 --> 0:20:06.920
<v Speaker 3>an end.

0:20:06.880 --> 0:20:08.280
<v Speaker 5>Right, there's another victim there.

0:20:08.720 --> 0:20:13.240
<v Speaker 2>Yeah. Well I used to say, you know, about eight weeks,

0:20:13.560 --> 0:20:16.760
<v Speaker 2>do at least twelve fifteen ejaculations that bring a sample in?

0:20:16.800 --> 0:20:18.200
<v Speaker 2>And I don't know if this is ever happened to

0:20:18.200 --> 0:20:19.840
<v Speaker 2>your career, But then i've you ever had that guy

0:20:19.880 --> 0:20:22.760
<v Speaker 2>that that brought in all fifteen ejaculations in one cup

0:20:22.800 --> 0:20:25.159
<v Speaker 2>and put it on the counter and said, here, it

0:20:25.240 --> 0:20:27.800
<v Speaker 2>is a court of a court of semen for the

0:20:27.880 --> 0:20:30.679
<v Speaker 2>worse to go through. Great, Yeah, what'd you do with that?

0:20:30.720 --> 0:20:32.960
<v Speaker 2>I kept in the refrigerator this whole time? So yeah,

0:20:33.160 --> 0:20:36.280
<v Speaker 2>so I tried to get away from that. Uh that

0:20:36.280 --> 0:20:41.160
<v Speaker 2>that visual for for my nurses at eight ejaculations throw

0:20:41.160 --> 0:20:44.520
<v Speaker 2>them all away please and then come in with that

0:20:45.320 --> 0:20:48.359
<v Speaker 2>with that money shot sample to make sure we're good.

0:20:48.480 --> 0:20:51.480
<v Speaker 2>But but that's great, and so what else can go wrong?

0:20:51.520 --> 0:20:53.399
<v Speaker 2>So tell me, you know, what are the other things?

0:20:53.440 --> 0:20:54.840
<v Speaker 2>Why would a guy not want to do of a

0:20:54.840 --> 0:20:58.720
<v Speaker 2>sectomy other than you know, the fear of a procedure

0:20:58.760 --> 0:20:59.919
<v Speaker 2>and an otherwise healthy.

0:20:59.680 --> 0:21:02.119
<v Speaker 3>Guy yeah, I think you mentioned the one that is

0:21:02.200 --> 0:21:06.359
<v Speaker 3>probably you know, always in the back of our minds,

0:21:06.359 --> 0:21:09.760
<v Speaker 3>and that's post vasectamy pain syndrome. I sort of divided

0:21:09.840 --> 0:21:16.320
<v Speaker 3>into two different types. There's the obstructive. Basically you've got

0:21:16.359 --> 0:21:19.679
<v Speaker 3>a closed system that when they ejaculate, the sperm is

0:21:19.720 --> 0:21:23.320
<v Speaker 3>going into the epidymus, which doesn't have any outlet now

0:21:23.400 --> 0:21:26.920
<v Speaker 3>because the VAZ has been blocked, and so they feel

0:21:27.240 --> 0:21:30.639
<v Speaker 3>like their tescal's going to explode. And then there's the

0:21:30.680 --> 0:21:34.320
<v Speaker 3>more common one, which is what we call neuropathic post

0:21:34.359 --> 0:21:40.399
<v Speaker 3>vasectamy pain, which is basically just pain from scarring of

0:21:40.480 --> 0:21:43.160
<v Speaker 3>nerves along the VAZ deference. Some guys are just more

0:21:43.200 --> 0:21:46.120
<v Speaker 3>sensitive to it. The problem is that there's no way

0:21:46.119 --> 0:21:49.040
<v Speaker 3>to predict those guys ahead of time. There's a guy

0:21:49.080 --> 0:21:52.760
<v Speaker 3>down in Florida, Sidjo Para Quattal, who's done a lot

0:21:52.800 --> 0:21:56.239
<v Speaker 3>of research, some really good stuff, looking at guys who

0:21:56.320 --> 0:22:00.359
<v Speaker 3>have post vasectamy pain after vasectomy and has found that

0:22:01.080 --> 0:22:04.439
<v Speaker 3>those men have a different way of healing than the

0:22:04.520 --> 0:22:07.920
<v Speaker 3>average guy. But you just would never know it. And

0:22:07.960 --> 0:22:12.760
<v Speaker 3>so while true post vasectomy pain is somewhat rare, fortunately

0:22:13.760 --> 0:22:16.240
<v Speaker 3>it is and I don't know about you Jesse, But

0:22:16.280 --> 0:22:18.560
<v Speaker 3>I suspect you're the same way. It's in the back

0:22:18.600 --> 0:22:21.560
<v Speaker 3>of our head with every patient we talk to because

0:22:22.560 --> 0:22:26.439
<v Speaker 3>what I always point out to the residence, vaseectomy is

0:22:26.480 --> 0:22:29.679
<v Speaker 3>one of only two surgeries we do with no direct

0:22:29.720 --> 0:22:33.000
<v Speaker 3>benefit to the person having the surgery. This is a

0:22:33.080 --> 0:22:36.320
<v Speaker 3>donor and ephrectomy. You're no better because you had of

0:22:36.359 --> 0:22:39.920
<v Speaker 3>a sectamy. You're doing this because of your partner, because

0:22:40.000 --> 0:22:42.199
<v Speaker 3>you don't you know, you want to be responsible for

0:22:42.280 --> 0:22:47.199
<v Speaker 3>your own reproductive health. But there's no physical advantage to

0:22:47.280 --> 0:22:48.880
<v Speaker 3>having a vasectomy.

0:22:49.200 --> 0:22:51.480
<v Speaker 2>Right, Actually, that becomes part of my counseling, is that

0:22:51.560 --> 0:22:54.840
<v Speaker 2>say I'm taking a perfectly healthy person and doing a

0:22:54.880 --> 0:22:58.199
<v Speaker 2>surgical procedure on them. Yeah, and you're right, and that

0:22:58.400 --> 0:23:02.200
<v Speaker 2>you know, nothing changes other than one big thing which

0:23:02.920 --> 0:23:06.800
<v Speaker 2>directly benefits you if you're a responsible person, and then

0:23:06.880 --> 0:23:08.879
<v Speaker 2>you couldn't carry less. If you're an irresponsible person, you

0:23:08.880 --> 0:23:10.920
<v Speaker 2>probably wouldn't have the pursuit done in the first place.

0:23:11.000 --> 0:23:13.520
<v Speaker 2>So so right, it can only you can only have

0:23:13.560 --> 0:23:16.920
<v Speaker 2>a complication essentially with that in mind. And I think

0:23:16.960 --> 0:23:19.639
<v Speaker 2>that that counseling is important. But you did bring up

0:23:19.640 --> 0:23:24.280
<v Speaker 2>a point about obstructive versus neuropathic pain, and I think

0:23:24.280 --> 0:23:25.480
<v Speaker 2>this is good for listeners too.

0:23:25.480 --> 0:23:27.359
<v Speaker 5>And I don't know if you found this or not.

0:23:27.440 --> 0:23:29.560
<v Speaker 2>I haven't published this, I don't know if anybody has,

0:23:29.640 --> 0:23:32.560
<v Speaker 2>but but I have noticed and the reversals I do

0:23:32.680 --> 0:23:36.560
<v Speaker 2>for pain, it does tend to be the vasectomy site

0:23:36.720 --> 0:23:39.000
<v Speaker 2>is lower, it's closer to the epiditymus and I don't

0:23:39.000 --> 0:23:41.000
<v Speaker 2>know if that's anybody else has noticed that or not,

0:23:41.000 --> 0:23:44.000
<v Speaker 2>but I always go back to Laplace's law or the

0:23:44.160 --> 0:23:46.159
<v Speaker 2>you know, the lower the volume, the higher the pressure,

0:23:46.200 --> 0:23:49.919
<v Speaker 2>and right there's a period of time where that body

0:23:49.960 --> 0:23:53.800
<v Speaker 2>has to equilibrate that change right in the spermaff not

0:23:54.160 --> 0:23:55.840
<v Speaker 2>having to go anywhere. And is that what sets up

0:23:55.880 --> 0:23:58.919
<v Speaker 2>this obstructive pathology? Which is why I always do my

0:24:00.040 --> 0:24:03.280
<v Speaker 2>sectemies high in the scroadom, which is also why I

0:24:03.359 --> 0:24:06.399
<v Speaker 2>do it through two separate pokecals as opposed to one midline,

0:24:06.400 --> 0:24:08.879
<v Speaker 2>because you can get really high. So you're finding that

0:24:08.960 --> 0:24:11.119
<v Speaker 2>as well. But what I'm trying to do is kind

0:24:11.160 --> 0:24:13.560
<v Speaker 2>of build a playbook for our guys out there to

0:24:13.800 --> 0:24:16.679
<v Speaker 2>you know, what questions should they ask their vseectimists. So

0:24:16.840 --> 0:24:18.639
<v Speaker 2>maybe we'll just jump right into that and say, okay,

0:24:18.640 --> 0:24:21.199
<v Speaker 2>so now I've decided to get the procedure. I'm not

0:24:21.280 --> 0:24:23.320
<v Speaker 2>going to Milwaukee to get this done. I'm not going

0:24:23.320 --> 0:24:25.720
<v Speaker 2>to LA to get this done. So how does a

0:24:25.760 --> 0:24:29.280
<v Speaker 2>guy pick the right viseectimist for the job.

0:24:30.280 --> 0:24:31.480
<v Speaker 1>Well, certainly volume.

0:24:31.640 --> 0:24:35.800
<v Speaker 3>You definitely want somebody who you know does ten to

0:24:35.880 --> 0:24:40.960
<v Speaker 3>twenty to fifty a month, not a year. Yes, you know,

0:24:41.000 --> 0:24:43.520
<v Speaker 3>I can't believe I'm going to say this, but look

0:24:43.600 --> 0:24:47.920
<v Speaker 3>online and look at patient you know, reviews and comments.

0:24:48.600 --> 0:24:52.160
<v Speaker 3>I can't tell you how many patients I get off

0:24:52.240 --> 0:24:57.600
<v Speaker 3>of Reddit and mom's Facebook, because you know, people talk,

0:24:57.840 --> 0:25:00.400
<v Speaker 3>and it's not just when things go bad.

0:25:00.480 --> 0:25:02.160
<v Speaker 1>People talk when things are good.

0:25:02.840 --> 0:25:07.160
<v Speaker 3>And you can find some really good, you know, results

0:25:07.200 --> 0:25:10.800
<v Speaker 3>by by searching those things as well. But I really

0:25:10.840 --> 0:25:13.600
<v Speaker 3>think that volume makes a difference. That the more you do,

0:25:13.640 --> 0:25:16.000
<v Speaker 3>the better you are. And you know, if you think

0:25:16.000 --> 0:25:19.520
<v Speaker 3>about it, if you're not very good, you're not going

0:25:19.600 --> 0:25:21.320
<v Speaker 3>to be doing a lot because people are going to

0:25:21.359 --> 0:25:22.760
<v Speaker 3>talk and say, no, you don't want to go to

0:25:22.800 --> 0:25:23.359
<v Speaker 3>that person.

0:25:23.560 --> 0:25:25.560
<v Speaker 2>That's right. Well, I like how you you brought up

0:25:25.560 --> 0:25:29.320
<v Speaker 2>too in this world of access to care that you

0:25:29.320 --> 0:25:31.680
<v Speaker 2>didn't say you had to be a eurologist. In fact,

0:25:31.680 --> 0:25:33.920
<v Speaker 2>one of our guideline participants is one of the most

0:25:34.240 --> 0:25:37.560
<v Speaker 2>prolific vaseectimists right in the world, and so experience matters

0:25:38.080 --> 0:25:40.760
<v Speaker 2>more than pedigree, and I think that's important too, is well.

0:25:41.359 --> 0:25:43.840
<v Speaker 3>The US is one of the few countries where the

0:25:43.840 --> 0:25:47.080
<v Speaker 3>eurologists do the bulk of the vasectomies. You go to Canada,

0:25:47.200 --> 0:25:49.640
<v Speaker 3>you go to Europe, you go to Australia, they're all

0:25:49.720 --> 0:25:52.160
<v Speaker 3>gps that do them. As a matter of fact, those

0:25:52.720 --> 0:25:54.760
<v Speaker 3>people in those countries will say, don't go to a

0:25:54.920 --> 0:25:58.440
<v Speaker 3>urologist because the only vasectomies they do are under anesthesia.

0:25:58.800 --> 0:26:00.159
<v Speaker 1>You don't know how to do them in the off.

0:26:00.520 --> 0:26:03.919
<v Speaker 2>Yeah, do you train your family medicine docks it at

0:26:04.000 --> 0:26:07.160
<v Speaker 2>MCW or do you do you have training for the primary.

0:26:06.720 --> 0:26:09.080
<v Speaker 1>Care if they request it. In other words, most of

0:26:09.080 --> 0:26:11.600
<v Speaker 1>them don't want to do it. Say who's got interest?

0:26:12.119 --> 0:26:13.280
<v Speaker 1>I'm more than happy to.

0:26:13.480 --> 0:26:15.560
<v Speaker 2>Yeah, that's same here is that we don't have a

0:26:15.600 --> 0:26:18.240
<v Speaker 2>form relationship with family med But every once in a

0:26:18.240 --> 0:26:19.879
<v Speaker 2>while we'll get guys that are interest, especially guys that

0:26:19.920 --> 0:26:23.520
<v Speaker 2>are going into rural California practice. We're somewhere right where

0:26:23.359 --> 0:26:27.160
<v Speaker 2>the access to urology is limited. So so yeah, that's

0:26:27.600 --> 0:26:29.879
<v Speaker 2>that's great. I mean, it's you're getting You're getting it

0:26:29.920 --> 0:26:33.600
<v Speaker 2>out there, so great. What about some of the myths

0:26:33.720 --> 0:26:37.000
<v Speaker 2>with vasectomy. Talk to me about the guy always asked,

0:26:37.200 --> 0:26:39.840
<v Speaker 2>do I still ejaculate? We can do this rapid fire,

0:26:39.880 --> 0:26:40.960
<v Speaker 2>so techt to me, he said.

0:26:40.840 --> 0:26:41.280
<v Speaker 5>So I hear it.

0:26:41.320 --> 0:26:43.480
<v Speaker 2>If I have a vasectomy, I'll never ejaculate again. Is

0:26:43.520 --> 0:26:45.800
<v Speaker 2>that right, doctor Sandlow? No, that's that right.

0:26:45.920 --> 0:26:48.640
<v Speaker 3>Because most of your seamen comes from your prostate, your

0:26:48.640 --> 0:26:52.639
<v Speaker 3>seminal vesicles, which are glands behind your bladder. The amount

0:26:52.640 --> 0:26:55.879
<v Speaker 3>of fluid actually coming from your testicles is really small

0:26:56.000 --> 0:26:59.520
<v Speaker 3>compared to your ejaculate volume. So if you measured it,

0:27:00.000 --> 0:27:02.479
<v Speaker 3>there might be a little bit less, but it's not

0:27:02.840 --> 0:27:04.920
<v Speaker 3>like you're gonna You're not gonna have a big puff

0:27:04.960 --> 0:27:06.240
<v Speaker 3>of air when you ejaculate.

0:27:06.680 --> 0:27:09.159
<v Speaker 2>Right, Yeah, And I tell the patients that you know,

0:27:09.240 --> 0:27:11.680
<v Speaker 2>without a microscope in front of me, I couldn't tell

0:27:11.680 --> 0:27:13.600
<v Speaker 2>the difference between a semen sample from a guy that

0:27:13.880 --> 0:27:16.800
<v Speaker 2>post vasectomy or that's here for other reasons, And so

0:27:16.880 --> 0:27:17.720
<v Speaker 2>that that's important.

0:27:17.720 --> 0:27:19.920
<v Speaker 5>Okay, so we busted that myth.

0:27:20.040 --> 0:27:23.080
<v Speaker 2>What about testostern I've heard that vyseectomies will make my

0:27:23.119 --> 0:27:26.440
<v Speaker 2>testosterone go down because the testicle produces testosterone, need will

0:27:26.480 --> 0:27:28.000
<v Speaker 2>get blocked up in the tubes with a sperm.

0:27:28.080 --> 0:27:29.119
<v Speaker 1>Right wrong.

0:27:29.400 --> 0:27:32.199
<v Speaker 5>So man, where did I go to medical school?

0:27:32.400 --> 0:27:32.640
<v Speaker 2>Yeah?

0:27:32.920 --> 0:27:33.879
<v Speaker 5>University of Iowa.

0:27:34.000 --> 0:27:42.400
<v Speaker 3>Yeah, so your testicles and your your pituitary glen don't

0:27:42.400 --> 0:27:45.879
<v Speaker 3>know you've had a vasectomy. So your tesco's still cranking

0:27:45.880 --> 0:27:49.560
<v Speaker 3>out testosterone, they're still cranking out sperm. The sperm just

0:27:49.600 --> 0:27:51.840
<v Speaker 3>can't go anywhere, so your body just breaks them down

0:27:51.920 --> 0:27:56.720
<v Speaker 3>reabsorbs them. That's why reversals work, because when you re

0:27:56.960 --> 0:28:01.399
<v Speaker 3>establish the connection, everything just keeps chugging along like it

0:28:01.440 --> 0:28:01.880
<v Speaker 3>has been.

0:28:30.359 --> 0:28:31.399
<v Speaker 5>Well, this is great.

0:28:31.800 --> 0:28:34.680
<v Speaker 2>I have a section in all of these podcasts where

0:28:34.920 --> 0:28:37.280
<v Speaker 2>I like to call it, You're probably going to be okay?

0:28:37.520 --> 0:28:39.800
<v Speaker 5>Or am I going to be okay? So let me

0:28:39.880 --> 0:28:40.600
<v Speaker 5>run this by you.

0:28:41.160 --> 0:28:43.720
<v Speaker 2>I just had my vasectomy two days ago, and my

0:28:43.800 --> 0:28:45.640
<v Speaker 2>scrotum looks like a purple grapefruit?

0:28:45.880 --> 0:28:48.000
<v Speaker 5>Am I going to be okay? Doctor Sandlo? What happened?

0:28:48.040 --> 0:28:49.800
<v Speaker 5>And what should I worry about?

0:28:50.560 --> 0:28:54.280
<v Speaker 1>Yeah? So I tell my patients you should have very

0:28:54.320 --> 0:28:58.160
<v Speaker 1>little bruising or swelling after your vasectomy. One.

0:28:58.200 --> 0:29:00.680
<v Speaker 3>I would hope they wouldn't wait two days, But if

0:29:01.040 --> 0:29:02.320
<v Speaker 3>it suddenly happened.

0:29:02.360 --> 0:29:03.640
<v Speaker 1>I would want them to call.

0:29:04.240 --> 0:29:06.720
<v Speaker 3>One of the things we do worry about not very common,

0:29:06.840 --> 0:29:10.440
<v Speaker 3>especially with the type of aseectomies that we do, which

0:29:10.440 --> 0:29:13.560
<v Speaker 3>we call like minimally invasive or no scalpel, is that

0:29:13.600 --> 0:29:14.960
<v Speaker 3>there's not a lot of bleeding.

0:29:15.120 --> 0:29:17.880
<v Speaker 1>So if you suddenly have this.

0:29:17.840 --> 0:29:21.480
<v Speaker 3>Big purple grapefruit down there, you need to be evaluated

0:29:21.480 --> 0:29:24.520
<v Speaker 3>for hematomo, which is a big collection of blood in

0:29:24.560 --> 0:29:27.560
<v Speaker 3>the sack that sometimes.

0:29:27.040 --> 0:29:29.720
<v Speaker 1>Needs to be drained right away. Typically, if we can

0:29:29.760 --> 0:29:32.480
<v Speaker 1>get to them within the first twenty four to thirty

0:29:32.520 --> 0:29:34.240
<v Speaker 1>six hours, it's worth draining.

0:29:34.320 --> 0:29:36.960
<v Speaker 3>But once you get to about three or four days,

0:29:37.000 --> 0:29:39.600
<v Speaker 3>then we just have to let nature run its course

0:29:39.920 --> 0:29:42.040
<v Speaker 3>and let things resolve on its own.

0:29:42.480 --> 0:29:45.239
<v Speaker 2>So I'll probably be okay, but definitely get evaluated. I think.

0:29:45.320 --> 0:29:46.120
<v Speaker 1>Ye, that's for sure.

0:29:46.200 --> 0:29:48.520
<v Speaker 2>That's the message I was looking for. Is any I

0:29:48.520 --> 0:29:50.920
<v Speaker 2>always say it's an open door for whatever I do.

0:29:51.560 --> 0:29:53.880
<v Speaker 2>And the number of times that guys say, you know,

0:29:53.920 --> 0:29:56.280
<v Speaker 2>even with a little scab on there, SCROWEDIM, I don't know,

0:29:56.400 --> 0:29:59.360
<v Speaker 2>is this normal. I'm delighted, you know, as annoyed as

0:29:59.360 --> 0:30:01.120
<v Speaker 2>I can be. Say well, great, let me take a

0:30:01.160 --> 0:30:02.760
<v Speaker 2>look and make sure it's just a little gab.

0:30:03.000 --> 0:30:05.640
<v Speaker 3>We use my chart for a lot of that stuff

0:30:05.680 --> 0:30:08.800
<v Speaker 3>where we'll tell guys, you know what, attach a picture

0:30:08.840 --> 0:30:11.840
<v Speaker 3>to your my chart, and then we can tell you

0:30:11.880 --> 0:30:14.040
<v Speaker 3>whether or not you need to come in. But I

0:30:14.080 --> 0:30:16.680
<v Speaker 3>always tell guys, I'm more than happy to see you

0:30:17.240 --> 0:30:20.600
<v Speaker 3>and reassure you, as opposed to have you stressing for

0:30:20.920 --> 0:30:23.280
<v Speaker 3>days or you know, like, oh my god, what's.

0:30:23.120 --> 0:30:23.680
<v Speaker 1>Going to happen?

0:30:24.080 --> 0:30:25.920
<v Speaker 5>Yeah? How long am I going to.

0:30:25.880 --> 0:30:26.200
<v Speaker 2>Be out for?

0:30:27.360 --> 0:30:29.360
<v Speaker 1>Yeah? It depends what you're getting back into.

0:30:29.440 --> 0:30:29.960
<v Speaker 2>So okay.

0:30:30.160 --> 0:30:32.320
<v Speaker 1>I do a lot of my vasectomies on Fridays.

0:30:32.720 --> 0:30:35.160
<v Speaker 3>My guys who you know work in an office are

0:30:35.320 --> 0:30:38.440
<v Speaker 3>obviously back to work on Monday. To be honest, my

0:30:38.880 --> 0:30:41.560
<v Speaker 3>construction workers go back to work on Monday as well.

0:30:41.640 --> 0:30:44.040
<v Speaker 3>But I do try to tell guys take it easy

0:30:44.080 --> 0:30:47.040
<v Speaker 3>for about five to seven days if possible. I do

0:30:47.160 --> 0:30:50.880
<v Speaker 3>a lot of police officers and firefighters, and I really

0:30:50.920 --> 0:30:55.680
<v Speaker 3>stress to them five to seven days because they can't

0:30:55.720 --> 0:30:58.640
<v Speaker 3>be hesitating when they're doing their job. I mean, if

0:30:58.680 --> 0:31:01.160
<v Speaker 3>I'm walking around like I just got off a horse,

0:31:01.200 --> 0:31:03.719
<v Speaker 3>it's not a big deal. They've got to be able to,

0:31:04.040 --> 0:31:07.720
<v Speaker 3>you know, run at a moment's notice or so those

0:31:07.760 --> 0:31:10.320
<v Speaker 3>guys I do tell that they should take five to

0:31:10.360 --> 0:31:11.440
<v Speaker 3>seven days off.

0:31:11.480 --> 0:31:14.840
<v Speaker 2>And Packers fans two weeks with as rapid as they cheer.

0:31:14.880 --> 0:31:18.400
<v Speaker 2>I'm sure you. Yeah, we see two weeks before you

0:31:18.400 --> 0:31:19.520
<v Speaker 2>get to lambeau Field again.

0:31:19.640 --> 0:31:20.120
<v Speaker 1>Benches.

0:31:20.280 --> 0:31:23.160
<v Speaker 3>The benches at lambeau are all metals, so that's freezing

0:31:23.240 --> 0:31:24.160
<v Speaker 3>cold cool.

0:31:24.560 --> 0:31:27.520
<v Speaker 2>Right, that's why they haven't changed the seating in sixty years.

0:31:27.560 --> 0:31:30.800
<v Speaker 2>It's it's for all your post vosectomy guys. I got ye.

0:31:31.920 --> 0:31:34.320
<v Speaker 3>Just last week I had a guy who said, yeah,

0:31:34.320 --> 0:31:37.400
<v Speaker 3>I'm going to the Packer game this coming Sunday against

0:31:37.440 --> 0:31:38.000
<v Speaker 3>the Bears.

0:31:38.320 --> 0:31:38.880
<v Speaker 1>Can I go?

0:31:38.920 --> 0:31:41.479
<v Speaker 3>And I'm like, absolutely, It'll be just as good as

0:31:41.480 --> 0:31:43.280
<v Speaker 3>if you're sitting at home icing at home.

0:31:43.400 --> 0:31:46.080
<v Speaker 2>It's right, it's a whole sand loo section of lambeau Field.

0:31:47.160 --> 0:31:51.080
<v Speaker 2>Makes sense. Well, this is awesome. I want to ask you,

0:31:51.160 --> 0:31:53.800
<v Speaker 2>like I ask all my guests. You're especially this is

0:31:53.840 --> 0:31:56.200
<v Speaker 2>sadly we don't this is radio, so we don't get

0:31:56.240 --> 0:31:59.640
<v Speaker 2>to see just how amazing you look for your young age.

0:31:59.720 --> 0:32:02.160
<v Speaker 2>But as a men's health specialist, you know what is

0:32:02.200 --> 0:32:02.719
<v Speaker 2>your secret?

0:32:02.720 --> 0:32:03.240
<v Speaker 5>What it give me?

0:32:03.280 --> 0:32:05.200
<v Speaker 2>One or two or three things that you have to

0:32:05.240 --> 0:32:07.880
<v Speaker 2>do every day to be as good as shape so

0:32:07.880 --> 0:32:10.160
<v Speaker 2>that we can empower our guys out there listening.

0:32:10.160 --> 0:32:12.520
<v Speaker 5>Have had to take tips from the experts.

0:32:13.720 --> 0:32:17.120
<v Speaker 3>A lot of exercise, although, as I will openly admit,

0:32:17.320 --> 0:32:21.120
<v Speaker 3>I exercise so I can eat. Some people use food

0:32:21.160 --> 0:32:26.440
<v Speaker 3>to fuel their exercise. I exercise so that I can eat. Honestly,

0:32:26.560 --> 0:32:28.959
<v Speaker 3>I think a lot of it is I'm really lucky.

0:32:29.120 --> 0:32:32.320
<v Speaker 3>I love what I do, which really, you know, stress

0:32:32.400 --> 0:32:36.680
<v Speaker 3>is a huge aging thing, and yeah there's stress at work,

0:32:36.760 --> 0:32:39.400
<v Speaker 3>but I like coming to work, and I have an

0:32:39.440 --> 0:32:44.120
<v Speaker 3>awesome wife who takes care of me. So I'm really fortunate.

0:32:44.160 --> 0:32:45.920
<v Speaker 3>I don't have to come home and then deal with

0:32:45.960 --> 0:32:49.840
<v Speaker 3>a lot of a lot of junk. So I'm fortunate

0:32:50.080 --> 0:32:52.120
<v Speaker 3>that and the fact that I've got this really good

0:32:52.160 --> 0:32:54.240
<v Speaker 3>camera that takes about twenty years off.

0:32:54.440 --> 0:32:55.120
<v Speaker 2>Is that what it is?

0:32:55.200 --> 0:32:55.720
<v Speaker 5>It's working.

0:32:55.880 --> 0:32:58.840
<v Speaker 2>I'm telling you, you don't look at day over seventy,

0:32:58.960 --> 0:33:00.840
<v Speaker 2>I mean a fortunate day of a forty.

0:33:00.920 --> 0:33:02.960
<v Speaker 1>I mean, wow, I definitely feel so.

0:33:03.360 --> 0:33:06.400
<v Speaker 2>Yeah, there are there are days, right, yeah, as our

0:33:06.440 --> 0:33:08.920
<v Speaker 2>recovery isn't as good. Well, actually, I like the you know,

0:33:08.960 --> 0:33:11.080
<v Speaker 2>there's a lot of this that you know, you eat

0:33:11.120 --> 0:33:13.080
<v Speaker 2>to fuel yourself, but but you know, I think we

0:33:13.160 --> 0:33:16.280
<v Speaker 2>do lose that there is something really delicious about eating too,

0:33:16.400 --> 0:33:19.000
<v Speaker 2>so that yeah, I had. I had a roommate at

0:33:19.040 --> 0:33:22.840
<v Speaker 2>UCLA freshman year who was a was a naval academy.

0:33:23.160 --> 0:33:25.080
<v Speaker 2>He was doing graduate school work and he was the

0:33:25.120 --> 0:33:26.600
<v Speaker 2>one that actually taught me at a lift and he

0:33:26.680 --> 0:33:29.960
<v Speaker 2>was enormous, like just so jacked. And I ever told

0:33:29.960 --> 0:33:32.160
<v Speaker 2>me because I came home once and he's eating three

0:33:32.200 --> 0:33:33.920
<v Speaker 2>hot dogs in a row, and I was like, Greg,

0:33:34.280 --> 0:33:35.840
<v Speaker 2>what are you doing? He said, I can eat whatever

0:33:35.880 --> 0:33:37.480
<v Speaker 2>I want because I work out like I work out,

0:33:37.600 --> 0:33:39.840
<v Speaker 2>And I thought, well, okay. He was a little more

0:33:39.840 --> 0:33:42.240
<v Speaker 2>colorful in the language, but the idea is the same

0:33:42.960 --> 0:33:45.520
<v Speaker 2>that that right, I mean, food is fuel, so if

0:33:45.520 --> 0:33:49.200
<v Speaker 2>you're going to burn that fuel, by all means do it.

0:33:49.240 --> 0:33:50.360
<v Speaker 2>So makes sense.

0:33:51.240 --> 0:33:53.760
<v Speaker 5>Well, Jordan, what did I What did I forget? That?

0:33:54.000 --> 0:33:56.080
<v Speaker 2>You know you're the common guy here, You're the voice

0:33:56.120 --> 0:33:58.920
<v Speaker 2>of our audience that you want to know about vaseectomies

0:33:58.960 --> 0:34:00.680
<v Speaker 2>that we may not have covered this half hour.

0:34:00.960 --> 0:34:02.560
<v Speaker 4>First of all, I want to say this is probably

0:34:02.600 --> 0:34:04.120
<v Speaker 4>a bad time to let you know that I get

0:34:04.160 --> 0:34:06.840
<v Speaker 4>a little squeamish talking about blood. This is probably the

0:34:06.840 --> 0:34:07.360
<v Speaker 4>first time.

0:34:08.080 --> 0:34:09.200
<v Speaker 5>That's why you're sitting down.

0:34:09.360 --> 0:34:14.240
<v Speaker 4>Yeah, sitting down and sort of a little cry right now, Yes, exactly,

0:34:14.320 --> 0:34:17.439
<v Speaker 4>rocking back and forth. I was really glad you asked

0:34:17.440 --> 0:34:20.200
<v Speaker 4>about you know, what kind of myths about vasectomies could

0:34:20.200 --> 0:34:22.040
<v Speaker 4>you clear up, because there are a lot out there,

0:34:22.320 --> 0:34:23.720
<v Speaker 4>and I want to ask you a little more about

0:34:23.760 --> 0:34:27.880
<v Speaker 4>I need touched on it a bit about the rumor

0:34:28.480 --> 0:34:32.239
<v Speaker 4>that vasectomy kills your sex drive, which is, you know,

0:34:32.239 --> 0:34:34.279
<v Speaker 4>probably the most prevalent one that that I've heard. I

0:34:34.280 --> 0:34:36.520
<v Speaker 4>just wanted to see if you could shed a little

0:34:36.520 --> 0:34:37.239
<v Speaker 4>more light onto that.

0:34:37.520 --> 0:34:41.000
<v Speaker 3>Yeah, so your sex drive really comes off your testosterone,

0:34:41.440 --> 0:34:44.880
<v Speaker 3>and since testosterone doesn't change, your sex drive doesn't change.

0:34:45.239 --> 0:34:47.880
<v Speaker 3>They've actually done some really good studies that have shown

0:34:48.560 --> 0:34:52.680
<v Speaker 3>that ninety five percent of guys there's no change in

0:34:53.000 --> 0:34:57.200
<v Speaker 3>their sex drive or their in sexual enjoyment. But there's

0:34:57.280 --> 0:35:01.000
<v Speaker 3>a small percentage of men who actually have improvement in

0:35:01.040 --> 0:35:04.080
<v Speaker 3>their sexual and drum because they don't worry about getting

0:35:04.080 --> 0:35:05.040
<v Speaker 3>somebody pregnant.

0:35:05.200 --> 0:35:05.520
<v Speaker 6>Wow.

0:35:06.040 --> 0:35:08.360
<v Speaker 3>Yeah, and so you don't have that worry in the

0:35:08.360 --> 0:35:11.000
<v Speaker 3>back of your head. And so in my mind, and

0:35:11.040 --> 0:35:15.319
<v Speaker 3>I tell this the patients. Part of the benefit of

0:35:15.400 --> 0:35:19.200
<v Speaker 3>a vasectomy is the psychological benefit of not having to worry.

0:35:19.719 --> 0:35:24.120
<v Speaker 3>So I've had guys who their wives are menopausal, they

0:35:24.160 --> 0:35:27.279
<v Speaker 3>can't get pregnant, and they still want to get a vasectomy.

0:35:27.280 --> 0:35:29.080
<v Speaker 3>And after I sort of look at them funny and

0:35:29.120 --> 0:35:32.760
<v Speaker 3>make sure that it's not because they might be stepping out,

0:35:34.080 --> 0:35:38.279
<v Speaker 3>it makes them feel better that they don't have there's

0:35:38.440 --> 0:35:41.680
<v Speaker 3>no concern whatsoever that they're going to get their wife

0:35:41.760 --> 0:35:42.920
<v Speaker 3>or their partner pregnant.

0:35:43.280 --> 0:35:46.040
<v Speaker 2>Yeah. Yeah, there's studies out of Europe years ago too,

0:35:46.200 --> 0:35:49.759
<v Speaker 2>shows that in a partnered relationship, Yeah, the bido of

0:35:49.800 --> 0:35:51.520
<v Speaker 2>the partner goes up. And part of that is I

0:35:51.520 --> 0:35:53.640
<v Speaker 2>think what Jays just said. The other part is that

0:35:53.920 --> 0:35:56.680
<v Speaker 2>we know in women, long term use of world contraceptives

0:35:56.680 --> 0:35:58.759
<v Speaker 2>can have a negative effect on the bido. So if

0:35:58.800 --> 0:36:01.239
<v Speaker 2>you're getting off the pill, then it's it's kind of

0:36:01.280 --> 0:36:03.879
<v Speaker 2>a win win where you know, the responsible man, which

0:36:03.920 --> 0:36:05.800
<v Speaker 2>is the guy that gets a paseectomy in the first place,

0:36:06.280 --> 0:36:07.240
<v Speaker 2>is thinking this is great.

0:36:07.400 --> 0:36:08.160
<v Speaker 5>You know, this is uh.

0:36:08.600 --> 0:36:11.560
<v Speaker 2>And I had a Brazilian patient once it said in

0:36:11.560 --> 0:36:14.200
<v Speaker 2>Brazil want they do viseectings. It says, you're you're closing

0:36:14.200 --> 0:36:17.400
<v Speaker 2>the factory and opening a playground, and so I think, uh,

0:36:17.520 --> 0:36:19.480
<v Speaker 2>I think that makes sense too, right, is that that

0:36:19.840 --> 0:36:22.919
<v Speaker 2>you know that now this is uh, this is recreational

0:36:22.960 --> 0:36:26.879
<v Speaker 2>instead of procreational and uh, and that changes. So that's

0:36:26.920 --> 0:36:28.600
<v Speaker 2>a great it's a great question, Jordan, because we do

0:36:28.640 --> 0:36:31.080
<v Speaker 2>get that a lot. Well awesome. I don't want to

0:36:31.080 --> 0:36:32.840
<v Speaker 2>take any more of your time. We're going to have

0:36:32.880 --> 0:36:36.320
<v Speaker 2>you back very shortly for talk to him all about

0:36:36.360 --> 0:36:39.080
<v Speaker 2>whatever a guy does change his mind. So that's foreshadowing

0:36:39.120 --> 0:36:41.640
<v Speaker 2>for the next episode, was what is a the sectum

0:36:41.719 --> 0:36:44.600
<v Speaker 2>or reversal? Tell you're going to talk us all about

0:36:44.800 --> 0:36:46.839
<v Speaker 2>just options after of as reversal as well.

0:36:46.920 --> 0:36:48.399
<v Speaker 5>So thanks everybody.

0:36:48.040 --> 0:36:49.799
<v Speaker 2>Out there again, Jordan, thanks for stacking it out with

0:36:49.880 --> 0:36:52.640
<v Speaker 2>us again and uh and not passing out. I would

0:36:52.640 --> 0:36:54.080
<v Speaker 2>know have to call nine to one one in Brooklyn

0:36:54.120 --> 0:36:56.360
<v Speaker 2>in the first place. So I'm glad, I'm glad you

0:36:56.400 --> 0:36:58.759
<v Speaker 2>got your color back and uh. And we didn't have

0:36:58.800 --> 0:37:01.040
<v Speaker 2>a medical emergency the last to the last two people

0:37:01.080 --> 0:37:05.840
<v Speaker 2>you wanted a medical emergency or urologists, especially male reproductive specialists,

0:37:05.840 --> 0:37:08.360
<v Speaker 2>because other than putting a catheter in there and interpreting

0:37:08.400 --> 0:37:11.960
<v Speaker 2>a Seaman analysis, we don't have a lot of resuscitative skills.

0:37:11.960 --> 0:37:16.000
<v Speaker 2>So thank goodness you're still with us, all right. Well,

0:37:16.000 --> 0:37:17.040
<v Speaker 2>Thank you everybody.

0:37:25.080 --> 0:37:29.880
<v Speaker 5>Let's talk about it. Let's talk about the Maro.

0:37:33.280 --> 0:37:34.360
<v Speaker 1>Let's talk about it.

0:37:36.400 --> 0:37:44.839
<v Speaker 2>Let's talk about the Maro. Let's talk about it. Let's

0:37:44.880 --> 0:37:51.840
<v Speaker 2>talk about the mail.

0:37:48.880 --> 0:37:52.120
<v Speaker 6>Room with Doctor Jesse Mills was a production of iHeartRadio.

0:37:52.440 --> 0:37:56.600
<v Speaker 6>It was executive produced by Jordan Runtog. It was edited, mixed,

0:37:56.640 --> 0:37:59.440
<v Speaker 6>and mastered by the Heat Fraser, and the theme was

0:37:59.480 --> 0:38:02.640
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0:38:02.840 --> 0:38:06.840
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0:38:07.000 --> 0:38:10.640
<v Speaker 6>check out the iHeartRadio app, Apple Podcasts, or wherever you

0:38:10.680 --> 0:38:15.040
<v Speaker 6>listen to your favorite shows. This program is intended for

0:38:15.200 --> 0:38:19.360
<v Speaker 6>educational and informational purposes only. It is not a substitute

0:38:19.360 --> 0:38:24.280
<v Speaker 6>for professional medical advice, diagnosis, or treatment. Consult your healthcare

0:38:24.320 --> 0:38:26.800
<v Speaker 6>provider for any medical or other related.

0:38:26.480 --> 0:38:29.719
<v Speaker 4>Questions or concerns. The views and discussions aired on this

0:38:29.800 --> 0:38:32.800
<v Speaker 4>podcast are those of doctor Mills and do not represent

0:38:32.880 --> 0:38:36.160
<v Speaker 4>the official positions of UCLA or UCLA Health