Benign prostatic hyperplasia / sex after heart attack / COVR medical
From the studios of the mayo clinic news network. This is mayo clinic. Radio exploring the latest developments in health and medicine and what they mean to you. Welcome everyone to mayo clinic radio. I'm dr tom shy. And i'm tracy mcrae for men. Over the age of fifty problems with the prostate are common. The prostate gland tends to grow larger as you get older which can cause a number of health issues on. Today's program will highlight prostate health during men's health month and learn more from mayo clinic expert. I also do. Surgical mission work in haiti where it's different the same disease. Bph minner died so in. The united states is more of a disease of convenience and other parts of the world is more of a disease that can be lethal also on the program sex after a heart attack and a startup company making a product to help surgical patients stay covered up. That's this week's program up next. June is men's health month finely. Oh god the purpose of men's health month is to raise awareness of preventable health problems and to encourage early detection and treatment for men and boys. Now that's a really good idea. Here are some facts from the cdc that you may not know okay. Women are a hundred percent more likely to visit the doctor for annual examinations and preventive services than are men. Does that surprise you. Not a bad probably not now in one thousand nine hundred twenty women lived on average one year longer than men but now men on average die almost five years earlier than women and what happened. No comment no comment from me. It's not an exaggeration to say that on average men live sicker and die younger than american women. Men need help. We live sicker and die young. Men's health month. You're running us in studio to talk about one of many men's health issues. The prostate gland is dr. Mitch humphries from mayo clinic in arizona. Welcome back to the program but you so much for having me. It's great to be back. Doctrine may trump for. He's always good to have you on the program. Welcome to rochester. So what advice would a world class urologists have for. American men so one of the things that i would tell men. Is that a lot of times as men get older. They find that they're not pena's well mostly because they said well it's just age. I'm just not seen as well so this is normal. My dad did it. my grandfather did it. I get old. You know my going to the bathroom with my grandson. He's done in two minutes. And i'm still standing there five minutes later and so they equate that as the normal process of age. It's not really the normal process of aging what it signifying the prostate gets bigger causes obstruction. One of the slow year as maybe that first symptom that most men detected that they also get up more at night to your night. There are several reasons for that. One of the most important ones is a lot of time. Men get knocked sharia and it's just means getting up more at night to the bathroom and the reason for that is sometimes especially in men that may have other health problems like sleep apnea. You wouldn't think of sleep apnea causing problems with urination. That's where you kinda hold your breath at night when you sleep but when you snore and you sleep. That right. Side of the heart gets dilated. And then what happens. The heart sends a message to your kidneys and says this person's got too much fluid on board. You need to make more urine and get the urine out in so men. Get up. More at night to urinate. They don't get as good night rest and it's indicative of what's going on with their heart and harkin gets stretched and it can cause problems so what i would tell men the take home message from that is. Don't you urinate system. It may be kind of your early warning system that something's going on that you need to fix whether it's in your lower urinate track with your prostate or it could be reflective of your heart and how your sleeping and other things so it's important to pay attention so we needed a prostate gland to reproduce one time. Don't need it anymore. it's a useless. Oregon. but why does it get bigger. As many so the prostate is just a glenn. And it's one of those glands that's responsive to hormones so the more the prostate is exposed the testosterone your over your life the more it will grow. Basically the prostate takes testosterone and it converts it into di hydro epi testosterone. Which is a fancy way of. Just how it handles the hormone to grow as it grows. It gets bigger in the size itself doesn't really mean much except where that size impacts the urinate channel so if it gets bigger on the outside that's a problem but if it gets bigger on the inside to include that urinate channel. That's a problem. I like to describe. The prostate is an orange and orange. Peel the outer part of the orange. That's where prostate cancer grows in the media. The orangemen p through the middle of the me that orange like ping through a donut hole and if that donut hole gets smaller and smaller because the prostates getting bigger. That creates some of the urinary problems that they have. There are certain men who are more likely to develop a bph benign prostatic hypertrophy enlargement of the prostate than others. Is that a desert run in families. There's certainly a family Risk with it so it definitely runs in families There's also a bunch of theories about certain environmental exposure certain lifestyle things of things that you eat or ingest or be exposed to in your career but usually it does run in families of a part of it is men are just living longer and we may be sicker and dine younger. But we're living longer than we were back when we Emerged from the oceans so based on that the prostate gets bigger over time and it certainly does cause problems. The other thing that we're seeing now is prospects are getting bigger because as a first symptom of those urinary symptoms primary care. Physicians and men's health providers are providing medications. Which is an easy answer to help. Alleviate the symptoms that doesn't always shrink the prostate so the symptoms may be getting better but the prostate keeps growing bigger and bigger. I wanna go back to something you said. Initially when we got started in that you thought well. My dad took him longer to go to the bathroom. My grandpa are you telling me that men really do have these conversations with the other men in their lives to find out that. Oh it's normal. What's happening Taking longer to go to the bathroom is a normal part of aging. Are that surprised me when you said that. I really thought this would be something. That men would be kind of suffering on their own and wouldn't talk to other people about it just like most things separate any doctor any other topics that we talk about. That's one of the problems for men yet. And i think that they do suffer. But what you gotta look at us. The bathroom situation for men is totally different. We all have urinals so when you go to a restaurant or if you go to a sports event or if you go to an airport and you're urinating next to somebody else you know who takes longer to urinate. And so it it elevates what they're seeing in terms of their life. I find that the most men have this conversation from what i hear on the golf course so all about how many times after. Go to the bathroom before the turn mr golfer. We're not in a stall guy next door is doing that makes that makes great point so then you see that it is changing and then do they come and see you or are they just talking amongst each other. Yeah this sucks to get old. So it's it's actually really interesting. We did a study looking at trends and surgical treatment of bph. And what we did is we took all the men that had had. Bph and we tracked where they're from For a specialized procedure. We do for bph. And i thought well all these patients that i'm operating on there's certain physicians that just keep sending them in over and over but when we looked at it it was a viral spread. That just made the country. Just kinda start turning red. Were they when we first started doing this procedure back over a decade ago about sixty five percent of my patients came from arizona now in two thousand eighteen only about twenty two percent of my patients come from arizona. The rest come from all over the country and all over the world for this procedure. We do for bph and my largest referral sources patient sending patients and that's unique in a disease right so usually it's physician sending patients in referring the men but this procedure is a little bit specialize in. It's the patients in one man may have one surgical treatment. One man may have other surgical treatment and other and then they're all peeing on the golf course. They're all talking about it and they're like i wanna pee like he did. I want to be able to write my name in the snow again or the sand depending on where you're from engulfing the snow golfing in the wrong spot minnesota goal before we talk about Treatment options and in particular the one that you specialize in i want to ask you about What happens if this goes untreated. Arthur some potential complications. If you either get medication or surgery yeah so. So what's interesting is. There are certain complications who say surgery. Absolutely isn't necessarily. We can't urinate anymore. Your kidneys can start to fail. Because they can't get the urine out anymore. You start to get infections. He started to get stones and your bladder from the signs of not being able to get those get the urine out in the united states the real death mortality of pretty much a historical disease because patients seek treatment before they get to that stage in its treated with medication of the referred on. I also do. Surgical mission work in haiti where it's different the same disease. Bph men are dying because their prostates get so big and they can't be So they get a catheter but they don't have the resources to get more than one catholic so they die from infection or they can't pee in the kidney. Start to fail. And they don't have access to dialysis so in the united states. It's more of a disease of convenience and other more austere parts of the world. It's more of a disease that can be lethal all right before we talk about Treatment we do need to take a short break. But i want to ask you quickly about diagnosis. Is this a diagnosis that you make by history and rectal exam or are there other tests that you need so we do start with history and rectal exam to kind of gauge the symptoms and we have what we call a severity score either a us symptoms score or an international marriage urological association american urologic symptom score or international prostate symptom score where it looks at several domains of how they're urinating and we can use that to grade kind of where they are in the treatment paradigm once we have that we do other tests such as euro flow. Were men pee into a bucket. We see how fast the flow is going. We put an ultrasound on the stomach to see how much they're actually emptying their bladder. We may do something called a stoskopf. P which is putting a teeny tiny telescope through the peanuts to determine the morphology or what that prostate looks like from an anatomic standpoint because not all prostates saying they come in different shapes configurations and certain treatments won't work for certain prostates and then sometimes we do an ultrasound of the process to get an idea of the size because certain procedures and technologies are only good for small prostates. others are better for big prostates. What we've learned is it's not one size fits all you have to treat the individual and the individual prostate. So all of those things will help you decide on a treatment regimen. That's appropriate for the individual correct. I think they're basically two medication and surgery. So how do you start at. How do you decide. So it's all based on the severity of the symptoms for the patient. So if they say boy this is really bothering me or if they say this. Isn't that much of an issue. I'm okay. I can live like this as long as we do. An assessment and mu. Make sure they're not doing any damage to either their kidneys their bladder or overall. Then we're okay. There are absolute indications for surgery that i needed to before his if they can't urinate if the kidney function starting to be affected if they're developing bladder stones or sometimes the prostates get so big. Just like you get varicose veins on your leg you can run into bleeding situations and once you start to get bleeding from the prostate to fix that so that you don't have any more bleeding sometimes. We advocate treatment though situations as well so a lot of it's based on the symptoms of the patient as well as the medical need for what guides our next steps in terms of treatment. Do the medications work pretty well and do they have side effects so the medications do work very well. There's a host of different medications and we can get into the classes. they do have side effects from them. I'm the biggest side effect that men complain about from the site of from the profile. The medications is what's called retrograde ejaculation. So instead of During sexual intercourse instead of the semen coming out of the tip of the penis it will go backwards in the bladder. The prostate is relaxed Some men do not like that feeling Most women prefer that feeling so some of the medications as well. we'll have side effects where they get on that medication. Slow guy. i have had wives come afterward for the foul checkup and say why. Didn't we start these medications along time ago. So those are just real conversations that happened patients we do this program continue and then there are newer classes of medications and some of them work better. In combination the tricky thing about prostate is. You don't always just focus on the treatment of the prostate itself in the enlargement but sometimes that enlargement can cause side effects to the bladder and the way the bladder behaves. So you have to treat. Maybe the bladder becomes overactive. And they've got a lot of urinary frequency where they're going every ten to fifteen minutes a lot of urinate urgency where they gotta go and they got to get the right away or their start leaking urine and so your medication therapy has to be tailored to treat not just the prostate but the downstream consequences of what the prostates done to the bladder. Now these medications just help you urinate better. Or did they. Can they actually shrink the prostate. So one class of medications in particular can help shrink the prostate. That's called process. Cards of five alpha inhibitor. It's the same medication we use to grow hair and what it does is it prevents the conversion of testosterone to dihydrotestosterone prostate and at hair follicles. So what that will do is it will shrink the prostate and will also decrease the psa. Okay now that's that's called proscar. Proscar finished ride okay. Is that the same as flow x. No flow max is an alpha blocker which basically the prostate has smooth muscle in in that flow. Max will relax smooth muscle to open up the channel. You'll see an effect from flow. Max within seven to fourteen days where the process are. You may not see an effect because it works through a hormonal pathway. For four to six weeks. And you may not see the maximum effect for up to six months and does the process call 'cause retrograde ejaculation. All the medications have the ability to cause retrograded declaration surgery better option with the side effects of the medication it seems like maybe so depending on the prostate and their symptoms the severity of their symptoms. You may want to consider surgery earlier than the medication treatments. Especially if that patient has what's called a median lobe that prostate grows into the bladder and acts like a flap valve to block the channel. Medications are not very effective in treating this particular situation in which case surgery is going to be much more efficacious for those patients. What's happening during the surgery. What are you doing so it depends on what surgery were talking about. And and that's where it gets very confusing because there's a spectrum of treatments and it goes everywhere from very lowly invasive to maximilian base of and minimally effective to maximum effective. And so we have these minimally invasive surgical therapies which office based therapies things that you hear in the common park called euro lift which is a device that you implant and opens up the channel There's something called resume or steam. Therapy to create scarring within the prostate to open up that channel If you can think about it people have done it to the prostate but the more effective the surgery. The more you are that tissue remove the longer the results are going to be. The less re-treatment is going to be once the surgery that the guys are telling each other you need to go see my guy and have this done. That's the whole up home laser nuclear of the prostate. And that's what gets us back to that orange model when you think about the orange the orange. Peel what we're able to do without making any incisions. In the bodies we go and repeal the then warranty away pushing into the bladder so that small channel through the prostate becomes a wide open. Almost kaverner cistern in. We put another instrument in their called a more slayer which more slates all that tissue up and pulls it out. The advantage of that is one tissue. We get out. We're able to look at under the microscope. To make sure there is no prosthetic disease such as prostate cancer. Things like that. Even though a minimum amount of prostate cancer grows in the centre part of the prostate while the majority grows not orange. peel But we're able to remove the catheter on same day or the next day and they're able to get back to their normal activities in seven to ten days so men really appreciate any kind of procedure where they can come in. They can leave the same day or the next day. They don't have to make friends with their fully catheter. And then they can get back to their normal activities and seven to ten days without worrying about bleeding or things like that and they're in the re-treatment rate on that is less than one percent so it becomes a lifelong solution for him. No more need to take medications. They don't have to spend the money they don't have to take the time with it and it's a permanent solution for them after pretty skilled to do this operation. Don't you. I mean not all urologist do this. It's probably one of the most difficult surgeries and all of your algae just because you have to take two dimensional object and translate into three dimensions once you learn how to do it. It's not challenging but being able to identify the planes and things like that. There's probably about twenty five centers in the united states. That do it at mayo. Clinic probably has the highest expense Experience in the united states. We've done about twenty five hundred personally just in arizona have done twenty. I've done over twenty five hundred and arizona. Are you making three. D models of their particular prostate. Or is that going overboard to prepare for each surgery. No after twenty five hundred you pretty much. There's not much the prostate can throw at you so we don't use models. It's all about the identification of the surgical plane. That's where the challenges and then it's all about after that efficiency. The nice thing about this procedure is the laser so static so even if they're on anti coagulation like aspirin or something that they need to be on for some other health reason you're able to take care that prostate. The other nice thing about the whole up is there's no size restriction you can do. Small prostates medium-size prostates. Big prostates small process are probably the most challenging. I would say those are probably the ones that don't need this procedure. But once they're over a certain size in most prostrates normally twenty to forty grams. Prostates any thing. Greater than eighty grams is considered a large prostate the average prostate icy in my practices about one hundred and fifty and the biggest prostate. I've done with the whole. Technique was about seven hundred seventy. That's his about an orange. It's about a sack of oranges and it was. It was a big one. They do this procedure at all three sites all three male clinics. Yes so they've got somebody in jacksonville doing it. They had somebody here in rochester doing it but they don't currently right now. I was up here before teaching somebody in rochester. But right now they're looking to fill that position right now. In the past decades when someone had prostate cancer part of the problem would be if we take that prostate out with can end up doing more damage than if we were to just watch. Leave it in and watchful wait. Is that day gone with this new type of surgery. We've got to be careful what we're talking about because what we're talked about with whole up is for benign. Bph not necessarily cancer the cancer surgeries are little bit different than the big risk of the cancer surgeries is damaging the nerve that caused erectile function in this filter that allows you to be continent or not leak urine. So i would say that we've come a long way in the cancer operation. And that we're in we do what's called an anatomic radical prostatectomy usually now anymore. We do it robotically. I'd say where the next frontier on that is going to be is going to be focal therapy of the prostate. And so if somebody has prostate cancer instead of treating the whole prostate we're gonna use a myriad of other technologies to our full potential such as genetic testing prostate cancer the same and even though we know that prostate cancer can happen in multiple parts of the prostate. Maybe it's only that one prostate cancer that the lethal one. So if we treat the lethal one the other ones we may not have to worry about the problem with prostate cancers. Want somebody. Here's the diagnosis of cancer. They think it needs to be treated. That's not necessarily true. And that's the message that we need to do a better job. Educating about all can't not all prostate cancer is lethal cancer. Over fifty percent of year old men have prostate cancer but not fifty percent of eight year. Old men are dying from prostate cancer. It's the lethal. Once we identify and treat. June is men's health month and there's a reason to raise awareness of preventable health problems in men and also to make an early diagnosis and treatment started as early as possible. Women live five years longer and they go to the doctor much more often than do men men. We need to take a lesson. From the women of the world and we've talked about benign prostatic hyperplasia or hypertrophy enlargement of the prostate. Most men can get by with medication but there are surgical options available and it sounds like would you say the whole procedure is now. The gold standard is the gold senator. The only thing that keeps it from being the gold centers. Not enough people know how to do but the outcomes. The patient outcomes the less risk. They easier recovery up by far in the literature supported it all the time over any other potential treatment. Our thanks to urologist. Dr mitchell humphries from the mayo clinic in arizona coming up the latest health and medical news williams high indian williams for the mayo clinic news network. Well it's tick season as you may know the first human bite in the us by the asian longhorn tick has been reported. Dr bobby A parasitic diseases expert at mayo clinic says it was first discovered in the us on a sheep in two thousand seventeen. It's now in about eleven states mostly in the eastern part of the country. So is there cause for concern about the asian longhorn tick dr prett- says they do know. It has bitten humans in other countries and can transmit some viruses bacteria. That can be serious. The good news is the serious virus associated with it has not been found in the us. She says the us department of agriculture is doing a lot of work monitoring this tick to contain it spread. She says to avoid any tick bites by wearing a tick repellent when you're going outside wearing covering clothing tucking your pants and near socks and then checking for tics when you come inside and in other news there is a saying that you reap what you sow. And in the case of a vegetable garden array tarvisio may bring more than dinner on your guy. A mayo clinic. Dietitian says gardening is good for your body and mind. She says if you have a garden. There's a good chance you'll eat more fruits and veggies because you have them right in your backyard. Gardening also can help reduce stress and anxiety levels and offer light physical activity a wondering what to grow guy says to consider a rainbow variety because different vegetables have a variety of different health benefits unique to each of them. Chili peppers and banana. Peppers for example contain kept sason which has been shown to have a number of health benefits. A homegrown tomato is often gardeners pride rich in antioxidants. Tomatoes contain potassium vitamin c and are a source of fiber. If you don't have the option to garden at home maybe their community gardens in your area to consider by embracing your green thumb. You may be able to unpack your vegetable basket in stead of a grocery bag for the mayo clinic news network. I'm vivian williams. Welcome back to mayo clinic radio. I'm dr tom jives. And i'm tracy mccray after surviving a heart attack. Most people do try to make some lifestyle changes healthier diet or exercise may be getting some pounds off. But what about sex if you had a heart attack and forgot or were reluctant or hesitant to ask your doctor about intercourse. You're not alone so we're here to answer that question for you. That's what we do. Our guest today is mayo. Clinic cardiologist dr francisco lopez jimenez dr lopez human has also serves as an editor for the mayo clinic health letter. Welcome back to the program. It's nice to see you again. Thank you thank you for the petition. Beshir zimin is so nice to have you back I guess if you've had a heart attack and you're leaving the hospital sexual activity is probably not high on your list of things to talk to your doctor about does actually very common is avid common concern. That patients generally don't talk. The doctors must people will think about it in one way or another but they just don't talk about it. Do they figure that they'll just see how it goes or that. Maybe they'll talk about it a follow up appointment. Have you ever gotten that far into the weeds. Probably some patients. Just don't see that as a relevant or important thing at that point in their lives But others might feel afraid to talk about these maybe a they probably don't want to be perceived as focusing the wrong things I don't know but it's actually very common that we the eulogies have to bring it up rather than the patients asking about it. Do you generally make it a point to bring it up. Guess if the patients don't say anything about it. I i basically asked him. Would you like to talk about your sexual life. And i more often than not. They will say guests absolutely so how physically taxing is intercourse. It all depends and it is different from women and men and also i mean is is say range but generally speaking it will be about going upstairs at the slow pace A light jogging. How many flights good point As long as the duration of the activity so so it's taxing walking upstairs. It is similar at a slow pace slope. yes slow pace which is about the same as a mile. Jogging depends men and women and some people. My exercise more strenuous activities doing sexual activity. So do you also bring up exercise when you're having these appointments. I mean if you're going to equate that to walking up stairs or light jogging. I would assume that this falls very easily into something that you bring up with patients. Yes absolutely we. We talk about exercise and other issues about lifestyle stress management Taking the medications on time. It set it up but So this is generally part of the recommendations but we also want to be sure that the patients understand the fact that in most cases sexual activity is okay after a heart attack after taking some specific Precautions and in some cases. It might not be okay you. They may have to wait because the condition might be serious enough that they just cannot do that at least for some time specific precautions. Yes generally speaking. We recommend patients to go to carry rehabilitation after the heart attack and that that applies to everybody and that's a good way for patients to go back to their normal lives. They get confidence exercising. And they get Confidence performing the day to day activities The second thing is to do an exercise distresses We want to be sure that when they exercise the heart is okay there we we also want to be sure that they They know that the combination of some medications light nitrates nitroglycerin. Don't go very well. With so many cases us to to increase the sexual performance in men so the nitrates do people take nitrates nitroglycerin. Yeah that's given generally to open up the arteries of the heart. The coronary arteries is also given to treat patients with chest pain after heart attack. So those medications dilate. The irony is open the ironies and what happens. Is that the medications use viagra medications for sexual performance. They generally have the very similar effect. They shouldn't use the two together not at all because the combination. My actually dropped the blood pressure a lot. So do you tell patients Basically to avoid sex and tell they have had a stress test. Get outta speaking. Yes yes and we also give recommendations to avoid stressful situations is well known that had attacks after sex generally occur on their very unique circumstances like extramarital sex or or sex in situations that are unusual. Set right and that's rare. Yeah it is uncommon. It is actually very rare but but when that happens nearly united happens on their circumstances that i mentioned you know usually with extramarital affairs or in in unusual situations of of trail and bangor. You said that the patient after they've had a heart attack they have to do cardiac rehab and that you suggest they do not have sex right at the beginning of that cardiac rehab time. How long is the patient usually in a cardiac rehab program. What is usually between a month to three. Months is is a time. Actually they don't have to wait for the three months to do it. When they are attending rehabilitation they will be exercising every time they go to rehab so at any time if they can prove that they can be on the treadmill performing a physical activity that will be at the same level in in terms of effort that they will be okay. And what do you tell them about. Alcohol well to to drink alcohol with moderation and particularly to prevent the dangerous thrill the dangerous three or is taking a biography pill taking a hot tub and then drinking alcohol because the three of them will Actually caused the same effect as nitrates so they may actually have a big trouble in the blood pressure but the cardiac rehab is is certainly key not only in Improving your physical activity after a heart attack but also Allowing you to pass the stress test so that you can give him the ok absolutely is and also we recommend patients if they develop it call this function after the attack is generally caused by some trauma or some unrealistic Fierce so something that has to be discussed because many patients develop depression after a heart attack and part of it is actually the fact that they are really feel that their ability to do normal activities has diminish and many times. It's just a matter of reassuring that they can actually do it. And one of those key things. He's of course Sexual activity for those who are sexually active. Alright well had a heart attack and wonder if it's okay to resume sexual activity and you haven't talk to your doctor about it. Well now you know an interesting avoid. The dangerous trio biogra- hot tub and alcohol. Thanks the doctor. Francisco lopez android avenue on the county fake they. We'll after years of observing that patients private parts were often left exposed during certain medical and surgical procedures. Especially those around. The hip and pelvis after bruce levy an orthopedic surgeon at mayo clinic and his wife. Heather decided to do something about it and are the surgeon. No less rather amazing. They're is what they are. Dr levy joins us in studio to share the story. Hello nice to meet you. Hi thank you so much. I feel like. I've had this idea who anybody who's had to wear a cover up in the hospital has said. Can we get a little more more fabric here but you actually did something about it. Yeah the one thing about that tracy is. Nobody ever steals that stuff they will now. Well you know. I i do a lot of hip arthroscopy and So we put the little telescope. Been to the hip and kinks. Whatever's hand fixed whatever's wrong and During that procedure tom. Patients are fairly exposed there Somewhat spread eagle than the operating room because we put them in a traction setup so that we can get access into the hip joint and historically we've covered their private areas with the blue towel but as we move the patient around during the operation and just to get them prepped and draped. The blue towel often falls on the floor. And then i'm yelling at my team blue towel. Bhutan blue towel like we need to keep the patients privacy and dignity enhanced and ultimately the the blue towel was inadequate in. How would you keep the blue towel in place. with difficulty Believe it or not there are some places where they staple the blue towel to. The skin of the patient is asleep absolutely. Yes and so despite. Our best efforts in china maintain patients privacy and dignity. There just wasn't a really good way to do it and still give me as the surgeon access to the medical site to do the operation. So it's not like you could just move under out the way you gotta prep and drape the whole field so We looked online. My wife heather. And i and we the first place you go is your spouse your your very very bright and i said we. We have to find a better way. There's gotta be something out there that can protect patients signature but still give me access to do the operation and we look online. We look to all the different draping gallon companies and we couldn't find anything. We're just dumbfounded. So i went down to mayo medical ventures and i asked them to do a patent search and see if there was anything available and there were no patents so you can imagine how excited mayo was To to come up with some of these patents utility and design and once again view the leaders in healthcare providing patients around the world with a higher level of privacy and dignity then than anywhere else in the in. The planet develop this. I read someplace that you and heather went out and bought a bunch of pairs of underwear started. That is true. We actually went to target. And we bought a ton of different Types of briefs if you would and we started cutting and Clipping and it was poking and and eventually we came up with a rough design and then we found a seamstress in town and we got some materials together and created our first design and through the process after say Mayo is just been incredible. Every department we went to We are met with open arms for this concept people hugging us and thanking us. And saying how come nobody has thought about this or or taking it to this point and so we went through many different trials in various departments at mail and Eventually we came up with the product that is now. Fda regulated class one medical device that meets every standard and criteria for draping gal using the operating room including algae. There's no latex it's even flammability every criteria you can imagine. It was not an easy process through. His name is on the patent both of yours. so mayo actually owns Many of the patents and Any of the patents were. I'm the inventor since male owns my intellectual are the owners but subsequently we've developed other other designs That our team has invented so cover does have some of those bands. So you've got the first version that was for hip surgery. The other two styles for so What we found actually. Interestingly is that everywhere we went. Someone said wow. We could use us for our procedure and the amount of procedures around the hip and groin and lower. Extremity is just increasing Astronomically because of all the minimally invasive techniques and catherine's asics and things so we have a a half short garment that magin. It's like a half short and that's what we use for all the hip and knee replacements and all the hip surgery then we have a What's called a bilateral cover which is one that imagine a regular underwear that then retracts to the mid line to get access to both grind. So that's what's being used in for. Angiogram cath labs around the country vein. Ablation things like that where you need. Access to to both sides of the coin okay One of our hip replacement surgeon used that for bilateral hip replacement surgery. And then we have. What's called the unilateral which gives exposure all the way up the entire flank. Even up to the exellent so that could be used for any kind of biopsies or harasser or abdominal procedures. Orthopedic surgeons they not only are skilled. They have great ideas. A little surprised about a little bit about your background. How did you. Why did you decide to become an orthopedic surgeon. Oh oh we're getting personally okay Well as a youngster in. You may not know this tom but used to race motocross and I had a full sponsor. And i raced all across canada. And even in the united states you an orthopedic dream yeah and seventeen orthopedic surgeries later After many many spills last one la- got me in the hospital for a little over three months. I fractured multiple extremities and my skull and had a pulmonary. Embolism and in those days with all those open fractures in the hospital for months and months and you were probably exposed for for a number of i most likely was yes and my mom actually was friends with an orthopedic surgeon and she said i'm gonna call him. His name is mardi kerner and he showed up in the emergency room and there i was with multiple fractures and thinking. You know this is just awful and obviously very scared and he came in and he said i got this and i said well you got and he goes all take care of this. I'll take area. I'll get you all fixed up and you'll be here for a couple of months but you know you're you'll be able to resume a relatively normal life when i'm done with and you're howell. I was eighteen. where were you in. Montreal canada is that where you grew up. That's where i grew up and so this guy impressed. You obviously breslin. I thought to myself tom if one person ever looks at me the way i looked at this this person my life would be fulfilled. I could not believe that somebody could just walk on like no problem. I got this take and so there. you have. that's what That's what drove me to to go after a medical career and ultimately orthopedics or you've never experienced that in with your career as a surgeon. I'm sure you've certainly will now with this product that helps people feel a lot more comfortable when they're undergoing surgery. Yeah it's it's been extremely rewarding. I use it every day on my patients and there isn't a day that goes by the people don't show their appreciation it's it's been overwhelmingly. Heart heartwarming. did you get to name them. Or they named levi pants. Or what are they called no. They're they're just they're cover all right. Maintaining patients privacy for various medical procedures. We've now got you covered. We've been talking with mayo clinic. Orthopedic surgeon dr. Bruce levy who along with his wife heather is designed garments to keep patients private parts private after leaving quarter. Thanks so much for being with us. Thanks for having me appreciate it. And that's our program for this week. You've been listening to mayo clinic radio on the mayo clinic. News network producer for the program is jennifer o'hara for mayo clinic radio. I'm dr tom shy. I'm tracy mccray. Thanks for joining us. Any medical information conveyed during this program is not intended as a substitute for personal medical advice. And you should not take any action before consulting a healthcare professional for more information. Please go to our website. News network dot mayoclinic dot. Org please join us each week on this station for more medical information you want from mayo clinic specialists note.