Your Penis Has Changed: Finding a New Normal After Peyronie’s Disease

26:06So walk me through, walk me through what you counsel guys on your success rates with Zyaflex. And also, I think I can't emphasize enough because this is something we get a lot from insurance companies in and just in general in the medical community is that this is a drug, but it's actually, as you said, a medical scalpel. So you have to have that drug in very qualified hands to do a good job. So there's a level of certification we have to go through called REMS certification to be able to even inject the drug. And then training, like your fellowship, you actually train people to do this on a basis when they're out in the community.

26:45So, so yeah, I mean, fire away. Talk to me about results, unpack a little bit more of, of what we just talked about there. Yeah. So like you said, I mean, the people who are administering Zyaflex have some certification, right? So even to get Zyaflex at your hospital, that hospital has to have certification. You as a provider have to have certification. So if you're seeing someone who is offering this treatment, they have gone through some training and approval by the manufacturer. So that's, you know, that's a good thing. That's the way we keep people safe. I usually like to quote the impressed trials when I talk to patients about success rates.

27:24So I usually say that in the trials, the average improvement was about 35%. So that's not 35 degrees, but the 35%, which means like you mentioned, for a guy who has 70 degrees of curvature, he may recognize a 30 degree improvement. And that's really, really significant going from 70 to 40. So we do know from another study that the best outcomes for men undergoing Zyaflex treatments come from men with great erections and actually more severe curvature. So they tend to do a little bit better. I also say that, you know, treatments are inherently going to be on a bell curve where some guys just don't really respond very well.

28:08Many are going to be kind of at that average median. And then some may have really robust improvements, like 80%. And so I think we want to capture everybody. And I really counsel men as they go through the series. I know we haven't really kind of described the treatment with Zyaflex, but it's essentially to boil it down, it's about eight shots over a six month period. And I check in with them for every single cycle to see how are you doing? Are you seeing improvements? And should we keep proceeding? And it's very rare for me to see a guy want to stop early. Because they do, we know that there are typically sequential improvements.

28:55So each cycle tends to give a little bit more and more benefit. So So I usually want to encourage them to continue because we do see continued improvement. But I want to make sure it's the right treatment for them. And if they're not getting any benefit, we can always stop. But 35 % is average, but they may do better. Again, guys with better erections are probably going to do better. Yeah, I can't believe I'm going to go on record as saying this. But a couple of years ago, a few of our biggest insurance carriers started to mandate something which was not on label. In fact, I rallied against it, which was that we had to have every two injections, we had to have a check-in with the patient, a separate office visit to monitor their progress.

29:44And in the old days and in other insurance companies that don't mandate that for us to continue coverage, I just would ask them how they're doing right before we gave them another shot. And it's interesting when I, and most of the time we're able to do it with video visits and, you know, we're able to document kind of verbal improvement in curvature and just show that we're on the right track. But I get so many questions and really it's a value added little visit, you know, that we can see how they're doing in between. And again, I rallied against it because you're busy, I'm busy. You know, we see thousands of people a year.

30:17And I thought, geez, here's another guy. The label says we're supposed to get eight injections before we reassess. And now I got to do it every two. And you multiply that by the number of Xiflix I do. And then all of a sudden, I got hundreds, literally hundreds of new office visits every month that I have to get through. But it actually is kind of cool. I mean, these guys, it's, you know, the difference between talking to, this sounds very crass, but a clothed man about his erections versus a guy that's ready for another shot changes the dynamic a lot. Shocker, but I'm glad you brought that up.

30:49So how do you, do you do the same thing? Do you do, I mean, you know, we have a lot of the same insurance carriers in Washington as in California. So I'm sure it's, you know, some of it you're seeing too. But talk to me about what that visit looks like for our guys. And I'm really glad you also brought up this is a sequential series of injections. Yeah. So usually ours is kind of rolled into the same visit. So they have their cycles are two shots within a few days of each other, four weeks where they are recommended to have no sex. You know, this is a medical, serious medical treatment. So they need to have a little bit of restrictions, just like a surgery, two weeks of reprieve.

31:32And then they go back into their next cycle of two more shots. So the entire series of eight shots takes about six months. and we roll that sort of check-in into each of the first injection in each cycle. So they come in at the six-week mark for their second cycle and we're having that check-in before we prep the medication. So there's no pressure to sort of proceed because we don't have anything, you know, ready for them yet. They give us the thumbs up and then we get it going. So talk to me also about modeling in terms of what you do in the office. is maybe explain what modeling is. Jordan has an idea of a penis model that is not what we're talking about here.

32:13So that I know what you're thinking, Jordan. I know, I know you, but talk about penile modeling, not runway, not Milan here. And also talk about how guys should be doing this at home. What are the adjunct procedures that you recommend for success with this intralesional therapy? Yeah, so penile modeling is very well described by the manufacturer of Zyaflex. So there are stretches that men do in length, and then stretches that they do to bend opposite the curvature. There's some that they do with an erection, some they do mostly flaccid. And that is just aiming, you know, to, while we have destabilized this plaque or loosen the plaque, we want to kind of put stretch over it to encourage the straightening.

33:02And so the way our clinic works is they come in for their first cycle. They come in two days after the second shot and they receive modeling training from one of our PAs. So our physician assistant, um, they then do that at home. I really encourage them to do this because it's their way of putting skin in the game to optimize the treatment. And then after that, in subsequent cycles, we don't do additional training. It's, you know, it's pretty self-explanatory. It's, you know, several minutes a day, but it's not an onerous task. I do talk to them about using penile traction. So this is a stretching tool that can be added to Zyaflex.

33:45And this, there's sort of one option on the market that was developed by a urologist, one of our colleagues, Dr. Trost, who developed this penile traction device, second generation that allows stretching in length, but also bending opposite the curvature. So that is an adjunctive tool men can use to really add more to the modeling. So it's hard to hold your penis for 30 minutes in a bent position, but this device allows that. And some of the research from our field has shown additional benefits on top of the Zyaflex alone. There are some downsides to trying traction, which is mostly just that it's uncomfortable to wear this device.

34:30But I think it does add benefit if a guy can tolerate it and tolerate the out-of-pocket expense for it. Yeah, that's right. About$600 these days. The only warning I put on traction, I'm a little bit agnostic. I think for guys that are very compliant, I got to ask, you know, for my guys with young kids in the house where, you know, it's hard to walk around with this medieval device that looks like an erector set. Just to give you an idea in your mind, Jordan, imagine these steel cylinders or steel pillars that then connect to the base of the penis as well as another little clamp that comes out towards the head or the crone of the penis.

35:07And it's these rods that then you can put in additional spacers every half centimeter or so as you're stretching the penis. And again, the other incentive to this is that you may regain some length with it. But it is, you got to put, as you said, a lot of skin or penis in the game for sure to be able to do it, but can be effective. My word of warning that we've seen a few times, and I think Professor Trost has also commented on this, is that you really want to make sure you don't have so much swelling or bruising or skin blistering, which can be some of the side effects we're going to talk about here in a second with Xyflex, where you can get tissue breakdown.

35:45because the clamp at the head of the penis, if you have any bruising in that area and you have really, you know, the penis, the skin of the penis is about the same thickness as the skin of the eyelid. So it doesn't take much to cause bruising or even blistering of the skin. So make sure that your skin is intact. If you're listening, you're in the middle of Zyflex and you run out and buy a traction device, that's our only kind of, be careful until that skin is fully healed. But yeah, so then talk to me about what could go wrong with Zyflex. What are the things you worry about with your patients or what are your common concerns that they've come to you with?

36:18So it's so interesting to see my patients after their first cycle when they may see swelling and bruising, and this is the first time they see it, and it can be shocking. And then the fourth cycle, where they've seen that this happens, it goes away, and they're just so much more comfortable with that kind of just reaction, and they know it's sort of a side effect of the treatment. So that's just to say that swelling and bruising are expected. I say that about 100 % of men experience bruising at some point in the treatment cycles. It can be like a little pinpoint bruise. It can look like a tiger stripe or it can look pretty dramatic, like a big purple penis.

37:05Jesse, you have categorized these and sort of codified a hematoma staging scale that is really helpful to sort of share with patients that this is, you know, there can be a range of outcomes. But I tell them that this is expected and it will go away on its own. I say that blood blisters can happen. Again, those heal on their own. They can get swelling. sometimes, you know, in men that bruising and swelling can go up onto the pubic bone. And, you know, I wouldn't be surprised to see that. So hopefully I try to allay some of those concerns. But our nurses are always available to answer questions about this and to review pictures.

37:47So we offer just, you know, really a lot of support through the treatment cycles. I say that this enzyme is very powerful. And part of that sort of power means that it can weaken those strong connective tissue that hold the blood for an erection. And if that weakens enough, that can cause a tear. And that's called a penile fracture. Penile fracture can look very, you know, especially dramatic. So big purple penis, we mostly treat this with just observation and just allow it to resolve on its own. And so I think patients are really, you know, feel a lot of, they feel well supported and just knowing that this will go away and it doesn't need, you know, some crazy surgery to help repair it.

38:44Yeah. I described that that's about one in a thousand. So especially if they follow our instructions of no sex for four weeks after injections, that should be a really rare outcome. But again, it is something that typically goes away on its own. There are some more rare sort of side effects, like being allergic to the medication. I've never seen that in my practice. I don't know if Jesse, you've ever had any of that experience. I have not. Yeah. You know, these are the things that are kind of on the label for us to describe when we talk about the medication. But those are really, I mean, that's the most common side effect is just local sort of tissue injury because this is such a really advanced, powerful enzyme.

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41:30Call 1-800-545-5979 or visit zepbounds.lily.com. Hey, I'm Hoda Kotb, host of the podcast Joy 101 with Hoda Kotb. Okay, if you know me, you know this. I'm always searching for inspiration, for support, and useful tools to help maximize joy. So this podcast lets us uncover all of that together. We're going to have these meaningful conversations with the world's most fascinating people, like when actress Olivia Munn shared how she overcame fierce health challenges that she never saw coming. I've gone through breast cancer and then helped my mother through breast cancer, and that was more difficult.

42:11There's a lot of people who understand postpartum depression. I was not prepared for postpartum anxiety. Olympic champ Shawn Johnson revealed why she had no choice but to be a gymnast. There was something about gymnastics that was intoxicating to me. It's given me a belief that we all have one of those treasures inside of us. We just have to find it. Listen to Joy 101 with Hoda Kotb on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

42:41My first guest is Paris Hilton, Shakira, Luke and Yerin, Samira and Gracie. I'm so excited. On a bouncy bed. You have surprises. Many surprises. Welcome to Sweet 305, where the group chat comes to life. What up, ****? It's like a way to say, Hi, friend. Hi, best friend. Hi, sister. What up? Look, I've never talked to anyone. Except with my children. My children know. Yes. Sé mi amante. Uf. Punch. Qué increíble. Ya, la telenovela. You're the only person I know that loves a yellow starburst. It's lemonade. No hay alguien que te falta, como que tú dices, me gustaría colaborar con esta persona. This is Sweet 305.

43:29Listen to Sweet 305 with Lele Pons as part of my Cultura Podcast Network on the iHeartRadio app, Apple Podcast, or wherever you get your podcasts.

43:44yeah i think i think that sums it up well the one thing that that we've also described that came out post-talk was the uh was back pain you know there's this strange low back pain it's about in at least in our series that we published a few years ago it's about five percent of guys but it's actually lower than that if you look at it's an accumulated effect and so it's rare in In fact, I think maybe a 0 % chance of a guy getting back pain with his first or second injections, but guys that need eight, and then sometimes, you know, about 20 % of my population, and I'll ask you about what your experience with what we call multiple rounders is, but a 20 % or so of my men potentially will need some fraction of another series.

44:26If they got 40 % better, they're not quite ready for surgery. They may not need it, but the back pain incidence goes up pretty significantly after those first eight injections. And so that's something that we counsel, guys, it's self-limiting, just like you were saying with the other issues that we see, the bruising, even a small corporal rupture. There was this old, you know, in our general surgery days, there was this classic book called Principles of Surgery. And one of the chapters talks about wound healing. And this is something that I always talk with patients about is that the natural tissue, the reason that surgeons are lucky and better than our auto mechanics is that we're both mechanics, we're both plumbers in a way, but, you know, PVC doesn't heal on its own.

45:12You know, radiator tubing doesn't heal on its own. But if we have a three millimeter rent in a tunica albigenia, which is what you're talking about is a penile fracture, a corporal rupture, our body heals at about a millimeter a day circumferentially. And so in three days, even a small rent, which is usually what we find when we do imaging on corporal ruptures after Xyflex, will heal without us doing anything. And that's the beauty of being a surgeon is we have this wonderful biological machine called the human body that cuts us a lot of slack, much more than a manifold in a 78 BMW or a 72 Volvo.

45:49Is that right? Is that what you have, Jordan? 72-volt or 1800, yeah. See, there you go. Yeah, our penises are easier to fix than the 72-volt. Glad I don't have to work on that. Exactly right, yeah. So good. So I think that is a reasonably good assessment of the kind of the fair and balanced risks and benefits. So then how do you set your expectations for Xyflex? You alluded to it a little bit with the impressed trials, but I want to get back to something you said a little bit earlier and maybe just give me at least some kind of back of the envelope data on the number of men that you do Xiflex on that then need something else.

46:32How does that work? If some guy is listening right now, he had eight rounds or eight cycles, eight injections somewhere else, and he's thinking, I may need to book a trip to Seattle to see Professor Heeman. And who are the guys or what do you do adjunctively if Zyaflex doesn't fully work? And how often does that happen? Yeah. I mean, so I would say that those guys in whom we have finished eight cycles of Zyaflex and they may still have bothersome curvature, I usually like to get the objective data that we talked about earlier with the penile Doppler ultrasound. So I do that penile duplex. I reestablish degree of curvature, you know, what that scar tissue looks like using an ultrasound to determine maybe it is calcified.

47:21Maybe that's why you're not seeing a treatment response, especially for guys who aren't seeing any response. I think if guys are seeing sequential response and they really like the treatment and they want to proceed with more, I'm more than happy to offer continued cycles as long as their insurance will approve it. I think we live in kind of a really interesting era of medicine where we don't always make the treatment decisions. And we don't maybe even often make the treatment decisions. It's insurance companies that can dictate whether or not this is something they're going to be approved for.

47:59And that's an unfortunate reality that we live in as healthcare providers. So in terms of the percentage of men that need further therapy, that's a great question. I really can't pinpoint my own sort of percentage, but I would say maybe 15 to 20 % go on to receive more than four cycles or some kind of surgical intervention after treating with the initial eight injections. I'm curious about your rates. You do more Ziaplex than I do. Yeah. Yeah, so we have a little bit of data. And you just reminded me, we shared a patient, which is a pretty good story, I'll say here in a sec. But the, yeah, I mean, so we looked at our studies somewhere around 2019, 2020, and I think it may be in Journal of Sexual Medicine.

48:51I can't remember where it finally ended up or IJIR. But essentially, you know, when I quote success, certainly I talk about the IMPRESS trial because that's kind of what's written. But I also think you did a really good job of setting the expectation of, hey, you could be, you could get zero or you could get 80 % or even 100 % better. And we really don't know. We did this huge linear regression analysis a few years ago that came up with a complete null hypothesis. In other words, we could not find who the ideal candidate was for Xyflex, excluding guys that had just pure calcified bony plaque that could only really be addressed with surgery.

49:28We knew that. So I didn't look at those guys. But we looked at diabetes. We looked at age. We looked at at how long they'd had the plaque, all of this stuff. And essentially, it was still rolling the dice and seeing how a guy did. But in that big series where we looked at everybody, including ventral curves, what we found was about 80 % of guys had satisfactory treatments. We kind of pushed away angulation because I published a lot about angulation, which really bothers me on a soapbox for advocacy anyway. Because if a guy comes in with a 29-degree curvature, I either have to say it's 30 or not treat him because the insurance companies won't pay for anything less than 30 because that's the label.

50:09So that's a whole nother advocacy discussion we could have. But for that, just getting rid of angulation and just saying, hey, are you happy? Like if you went from 70 to 40 and you could not have penetrative sex and now you can have penetrative sex and your partner is happy with your 40 degree curvature, that's a win. You know, I don't have to prove that I can take a guy with a 70 degree curvature and make him 10 or zero and say I'm the best Xiaflex guy ever. I don't, you know, again, that's not my deal. My deal is to make a guy happy and make his partner or partners happy with how things have turned out.

50:41So if you look at that, 80 % of guys pretty happy with one round of Xiaflex. And then for the number of guys that either needed additional cycles, that number was somewhat smaller as we were talking about around 20%. But in terms of just looking at all over, if you look at guys after even two cycles or two rounds, so 16 injections, which is usually what happened for my surgical candidates, it's uncommon if I see any improvement in guys after just one round that I won't offer another round if I can get it covered, as you said. But the number is about 7 % of guys would need surgery post-Zyaflex.

51:18But that doesn't mean that they were cured. It just means that they were satisfied enough that they were, they were done with that therapy. But yeah, I, so I, I mean, I'll give you one of your semi-year guys. So we had a guy a few years ago who split his time between LA and Seattle. And he was, he summered up in the, uh, in San Juan islands. God bless that guy. What a great place to summer. It's not bad. Yeah. Right. It's Santa Monica most of the year. And then San Juan's in the summer. He did something right. But, but I had, I think we did one round. went from 60 to 40, but I didn't know that.

51:52I said, Hey Mark, could you do me a solid? You did his ultrasound penile duplex, just like you said you do for your guys that you're thinking second rounds on and essentially teed him up. So the next time he was in LA, we took that 40, placated him. So a little bit less of an aggressive surgery. And we'll, we'll talk about that in the upcoming episode, but the application was very successful. And he essentially went from 60 to zero with a little bit of Zyaflex, a little bit of surgery and a great outcome. And I think that's really important because there's a lot of, not a controversy, but a lot of debate at our national meetings about really high-level urologists in sexual medicine that either believe that this drug is doing something, is effective.

52:33Yes, it's expensive. A whole other discussion on advocacy. But others that just say, you know, it doesn't work well enough, so we should either just observe or operate. And I think, you know, looking at it as a staging procedure is not a failure necessarily, but as a priming procedure, you know, again, we use cancer terminology a lot, almost as a debulking to say, let's take a guy that would need a massive surgery and bring him back down to where it's not quite so, you know, so massive and they do well. So I'm glad. Yeah, we're pretty simpatico on that. Absolutely. You kind of alluded to this concept that a guy who goes from 70 to 40 may be really satisfied, but someone who presents with 20 degrees of curvature, it may be really distressing.

53:19And so we see that all the time. That's in the literature. This understanding that the degree of curvature doesn't really predict the amount of distress. And so I think that's where we kind of the art of what we do is in tailoring treatment and talking to men. And, you know, one of my research residents who's coming to UCLA for fellowship next year did a really lovely study on men going through Peyronie's disease treatments, their experience and what's important to them. And it's really not all about the degree of curvature. It's about so much more than that. The emotions that are involved, the body confidence, the relationship.

54:01It's really an interesting condition because it really affects so much more than just, you know, the penis itself. And so our treatments, you know, have to be tailored. That's the bottom line.

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55:10Or some adults with overweight who also have weight-related medical problems to lose excess body weight and keep the weight off. ZepBound is approved as a 2.5, 5, 7.5, 10, 12.5, or 15 milligram injection. ZepBound contains terzepatide and should not be used with other terzepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if ZepBound is safe and effective for use in children. Don't share needles or pens or reuse needles. Don't take if allergic to it. Or if you or someone in your family had medullary thyroid cancer or if you've had multiple endocrine neoplasia syndrome type 2.

55:47Tell your doctor if you get a lump or swelling in your neck. Stop ZEPBound and call your doctor if you have severe stomach pain or a serious allergic reaction. Severe side effects may include inflamed pancreas or gallbladder problems. Tell your doctor if you experience vision changes before scheduled procedures with anesthesia. If you're nursing, pregnant, plan to be, or taking birth control pills. Taking ZEPBound with a sulfonylurea or insulin may cause low blood sugar. Side effects include nausea, diarrhea, and vomiting, which can cause dehydration and worsen kidney problems. Talk to your doctor.

56:19Call 1-800-545-5979 or visit zepbounce.lily.com. Hey, I'm Hoda Kotb, host of the podcast Joy 101 with Hoda Kotb. Okay, if you know me, you know this. I'm always searching for inspiration, for support, and useful tools to help maximize joy. So this podcast lets us uncover all of that together. We're going to have these meaningful conversations with the world's most fascinating people. Like when actress Olivia Munn shared how she overcame fierce health challenges that she never saw coming. I've gone through breast cancer and then helped my mother through breast cancer. And that was more difficult.

57:00There's a lot of people who understand postpartum depression. I was not prepared for postpartum anxiety. Olympic champ Shawn Johnson revealed why she had no choice but to be a gymnast. There was something about gymnastics that was intoxicating to me. It's given me a belief that we all have one of those treasures inside of us. We just have to find it. Listen to Joy 101 with Hoda Kotb on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

57:30My first guest is Paris Hilton. Shakira. Luke and Yerin. Samira and Gracie. I'm so excited. On a bouncy bed. You have surprises. I have many surprises. Welcome to Sweet 305, where the group chat comes to life. What up, ****? It's like a way to say, Hello, friend. Hello, best friend. Hello, sister. What up, ****? Look, I've never talked to anyone. Except with my children. My children know. Yes. Be my love. Oh, f***. That's incredible. The movie is already done. You're the only person I know that loves a yellow starburst. It's lemonade. No hay alguien que te falta, como que tú dices, me gustaría colaborar con esta persona.

58:15This is Sweet 305. Listen to Sweet 305 with Lele Pons as part of my Cultura Podcast Network on the iHeartRadio app, Apple Podcast, or wherever you get your podcasts.

58:33Wow, you just, you know, you segwayed perfectly into this section of our show we call You're Probably Gonna Be Okay. And so, yeah, I couldn't have done it better. And so we do have this section every episode where we talk to our guests about, you know, a case presentation or something where a guy may have something similar to what we're talking about. And you got to walk through either one day we're going to have somebody that is not going to be okay. And that's okay too, because, you know, there's not all sunshine and rainbows in medicine or Peyronie's disease. But here's a guy, 35 years old, single.

59:05He developed Peyronie's spontaneously. So it could have been that business trip. No trauma that he remembers. He's three months in. He's noticing a 30-degree curvature and is devastated. He's wrecked by that 30-degree curvature. Can't imagine actually being sexually active at this point. He's a total shut-in. And I know you're going to see two or three guys this week that have this condition. And he hates how his penis looks. I mean, he perseverates on it. He can't focus at work. It's every other thought and is a rumination on why his penis curved 30 degrees. And he's also noticing penile shortening.

59:39So tell me, is this guy going to be okay? What are you going to do for him? How do you support the mental health aspect? Which, again, we had that paper out a few years ago in the Journal of Urology with my colleagues from Karolinska in Sweden, just looking at the mental health toll of Peroni's disease is devastating for these guys. And it's something that a lot of physicians either joke about, it's kind of jokes on late night TV, Saturday night live, and as much fun as I have in life and on the show, this is, yeah, this is one that's hard to tell jokes about. So is this 35-year-old guy going to be okay, Professor Heeman?

1:00:10What are you going to do for him? Yeah, I mean, I think that the most important thing for this guy is just is first reassurance and education. And I really like to just start by giving the background, you know, because they read all kinds of things on the internet and I want to give them the real scoop on what's going on. So I really like to educate patients. It's kind of part of my role as an educator of our trainees. And I really see myself as an educator of our patients. And I do think that laying the groundwork of evidence-based information is really helpful and can just get guys in the right mind state.

1:00:52I would really reassure him that he's in the right place. So a lot of guys have seen other urologists. They feel like they don't know what the diagnosis is. They have been told by another urologist that this isn't treatable, which is not uncommon for me to hear. And so I want to reassure him that he is in the right place and that you're seeing someone who's an expert and we have excellent treatment options. Yeah. I think it's, you know, so that's really the basis of the first sort of counseling session. I want to understand more about, you know, obviously his condition, but his mental state. it's, I like to, we kind of joke that we do a lot of psychourology, um, because these are patients who are like you mentioned, totally distraught.

1:01:39Um, and you know, we have to team up with our, our partners in sex therapy sometimes for, for guys, or just in general, you know, therapists who can help with some of the coping around this. But I do think that getting guys on a really solid treatment pathway, giving them the right information and just seeing them through, having good support from our nurses is really helpful to sort of take away some of that worry. So it's not all about just the medical treatments. It's also about the care of the whole person. Yeah, I love it. No, that's great. You brought up yet another incredible pearl in that, which is the internet can be a scary place for Peyronie's.

1:02:20And another, one of the other things we do a lot on the show is try to separate fact from fiction and myths. And there are so many topical creams. There's so many supplements out there for Peyronie's. I was the victim of a deep fake on the internet for me, somebody that looked just like me selling Peyronie supplements. It was terrible. I had to go through a lot to get it off of YouTube. But yeah, I mean, there is nothing out there. Don't see a Peyronie specialist because we are going to walk you through what does work and what doesn't and the rest of it can just kind of waste your time and screw you up even more.

1:02:54So, all right, I got to do this because I know you've probably got to get to the operating room, but every episode, I also have to ask my specialist in men's health, what do you do every day? What is your non-negotiable to make you be present for your patients and your family? And just talk to me through what makes Mara Mara every day? What do you need? Yeah, that's a great question. It is ever changing. So I have an 18 month old daughter, and it's just the delight of my life to have a kid. And just to watch her grow and, you know, see her being a hilarious individual at age 18 months. So that's really sort of rejuvenating to me.

1:03:40I'm a big, I know you're big into exercise and so am I. It's of course harder as, you know, a fairly new parent. Um, but exercise is so important. It's so good for our mental health, for our physical health. So getting outside, I've been running more again, um, did a few 10 K's in the past couple months and lifting weights. And so that's, you know, spending time with my husband and my daughter is really kind of the crux of what makes me happy these days. That's beautiful. And it keeps going. Yeah. I mean, my 21-year-old son destroyed me at the gym yesterday. So he somehow thinks like he remembers dad when he was 30, not 55.

1:04:22And so he somehow thinks that I can still keep up with him. So you have that to look forward to teaching your girl a lifetime of fitness and health. Jordan, what did we miss? Professor Heeman is here in the house, in the mailroom. She delivered expertly, as I knew she would. And we had such a good conversation. But you haven't been too queasy. You've been a little quiet. Yeah, you're doing good. Jordan used to pass out when we talked about anything medical. So I'm glad that you said. I think surgical. Surgical, yeah, that's right. Yeah, so when you talked about penile fractures, he was still staying upright.

1:04:55I don't think he has a brace behind him yet. Pillows all around the floor, just in case, though. in case I do that. Smart. Smart. I mean, I'm just really glad you touched on the mental health piece because that was something that me didn't bring up over the last few episodes. I mean, do you recommend that your patients see a mental health professional that kind of help coach them through this? Like, I mean, I know, you know, it's a traumatic event, man, I imagine. Yeah. I mean, I think it depends on the patient. I think some absolutely may need that support. If, you know, I'm perceiving, I don't do any like mental health screening questionnaires.

1:05:32In the 15 minutes I have to see a urology patient, it's a little bit beyond my scope. But I think that some absolutely I would recommend. I think men who have partners with them have, you know, a unique support system, which is wonderful. But that support system may also need a little bit of help. And, you know, I do talk about this with couples as, as, you know, a new normal that they may experience with their intimacy after Peyronie's treatments. It's a new normal, just like after, you know, your spouse had your children and went through breastfeeding that changes the body and changes your relationship a little bit.

1:06:11And so there are new dynamics at play. We have great sort of lists of supportive therapists and, you know, sex counselors that we can offer just at a moment's notice. So it's not uncommon for me to sort of put that in my little after visit summary for patients to access if I think it's important for them. Yeah, another freaking brilliant analogy. That's great. Yeah, so you'll never, you'll get your penis back, but it may not be the same one as before you had this. That's freaking brilliant, as always. I remind that to a lot of patients because, you know, I just, you know, really, um, it's hard for some men to sort of wrap their brain around the penis changing.

1:06:51And I liken it to, you know, our ears get bigger as we get older, certain parts of our body get saggier, stiffer, crunchier, and the penis does change too. So, um, not uncommon for, for men to experience that, but it still can be a little bit jarring. So, um, important to recognize. It is. And with docs like you and me hanging around, we get to have those penises raging against the dying of the light. So it's what we do. Well, thank you. Thank you so much, Mara. I hope you have the rest of a fantastic day. And again, thanks for all your wisdom sharing it with our listeners on the mailroom. And Long Transit, some Stevie Ray Strat.

1:07:30Let's get out of here. I Heart Radio, thanks so much. And we'll see you all next time. Thanks for the invitation. That was awesome. Thank you so much. thank you yeah thanks jesse this is great yeah it'll be good yeah so we'll we'll probably put this up in the next couple of weeks we're you know we're kind of getting through uh some of our june stuff and so yeah we'll uh we'll let you know when it airs but um and then yeah we can you know promote it on your socials whatever you want uh from your perspective we'll blow you up but thank you so much it was great yeah thanks i'm glad we can get this on the books right away and happy to check in with you arash is ready oh i know i know that guy is a guy's a warrior.

1:08:09Yeah. So Jordan Rush was who she mentioned. He came, he was my second year medical student mentee. And he just walked into my clinic one day and said, I really want to do urology and men's health as a second year medical student. So now, however many years later, that would be seven, eight, 10, something like that. He's coming back to do the fellowship after Mara trained him in his surgical residency. So continuity care. The well is deep. The well is deep. All right. Well, I'm going to go do some penile placations and complex IPPs. So I'm going to get out of here. All right. Bye, you guys. See you, Jordan.

1:08:45Talk to you later.

1:09:05Let's talk about it in the mailroom Let's talk about it Let's talk about it in the mailroom The Mailroom with Dr. Jesse Mills was a production of iHeartRadio. It was executive produced by Jordan Runtog. It was edited, mixed, and mastered by Bahid Frazier. And the theme was provided by Long Transit. If you like what you heard, please subscribe and leave a review. For more podcasts from iHeartRadio, check out the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows. This program is intended for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.

1:09:52Consult your health care provider for any medical or other related questions or concerns. The views and discussions aired on this podcast are those of Dr. Mills and do not represent the official positions of UCLA or UCLA Health.

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