Alright, let's take another one. I have a patient that says,
"I underwent a prostatectomy procedure three weeks ago. Overall, I'm doing well. Is there
anything I can do to reduce the chances of experiencing problems with erectile dysfunction?"
And this question, I am amazed that urologists are not putting men routinely on penile injections
right after surgery. The studies are very clear that men have better recovery if they
don't go through these long downtimes without getting erections, and have you
seen the same thing Dr. Moyad with this, you know, people get surgery and they get kind of
kicked to the sidelines and the doctors aren't aggressive about getting them on shots right away?
I mean, I don't — I guess what I don't understand, again, we come from two totally different
worlds in terms of my public health world, your oncology world, I just don't understand not
having that conversation about rehabilitation before the actual procedure. This idea
that you have to talk about the rules of the game after the game has already started. What
if I did that as a kid? They said let me — can you imagine, okay, we're going to play checkers;
here's my move, now let me teach you how to play. That makes no sense.
It doesn't, and yet I see it over and over.
You see it a lot. The penile rehab discussion has to happen before the treatment. What's this
going to look like? And what's this going to look like if it doesn't go well or if it goes well?
You know, you're talking about nerve trauma, right? Name another place in medicine where nerve
trauma has occurred or will occur and there's not talk of rehabilitation regardless of the method?
Right.
So can I do this shout out? I don't know why I'm doing this because I'm doing this at home.
You and I are big fans of this, "Saving Your Sex Life" from Mulhall.
Yep.
Right.
Good book.
Right, so now I don't know how to hold up a book on the internet.
This is by John Mulhall who's at Sloan-Kettering;
he's one of the top, would you say, top three or four or five experts in the world on rehab?
Definitely.
People should read the book. I don't get a penny for for pushing that book,
and it walks you through—there's
many experts—but it walks you through the discussion of rehab and all your rehab options.
You know, it just occurred to me Mark that the reason that this doesn't come up — can
you imagine if you're telling someone, "Okay we're gonna do a radical prostatectomy, you're
gonna have a catheter for a few days, you'll have, you know, leaky urine for a week or two,
and if everything goes good we'll be real happy and then hopefully erections come back someday."
But the proper education would have been, "By the way, we're gonna give shots in your penis
three times a week for several months after the operation to give you optimal recovery."
All of a sudden radical prostatectomy doesn't sound so good anymore, so I think that's why
this whole conversation gets dropped to the side of the road and it doesn't come up.
I think it should be a mandatory discussion to go through the spectrums of what it means to
do penile rehabilitation. John Mulhall found in a study from Sloan-Kettering that the healthier
men were when they were treated, the more likely they were to get to where they wanted to go in
terms of rehab. Okay, so lifestyle matters; that's a good thing, but you know, there's the injection,
right? There's the vacuum erection device, the VED you know, you can do that. There are the —
In my opinion, I'm not convinced that the vacuum device which doesn't sound
is quite as disgusting as giving yourself a shot
is going to work as good because you want to have the muscles contract. The vacuum erection
device brings blood flow into the penis which is a good thing, but it doesn't cause those muscles
that clamp down on the blood flow to activate. I'm concerned, I'm concerned without the shots we're
not going to get the type of muscular activation that'll lead to long-term better recovery rates.
You want best intervention for best outcome is what you want.