Paul Szmal: Our guest on FLX Morning is Dr. David Schnapp from AMP Urology, AMP of NY. We continue our conversation on urological symptoms. Let's turn our attention to sexual symptoms. We all know about erectile dysfunction. Is a small degree of ED something that's acceptable or expectable for an older man? Maybe you aren't getting as complete an erection or as long-lasting an erection?
David Schnapp: Acceptable, right? That's relative. Every case is different. A small degree of ED in one guy could be life-threatening to him and his partner where in another guy he doesn't care. But ED could be a symptom of something more serious going on. Typically the mechanism of the ability to get an erection involves having an intact vascular system and intact vascular and structural anatomy of the penis. But systemically, if you've got arterial insufficiency that may be causing ED, then you may have underlying either symptomatic or asymptomatic peripheral vascular disease that could affect your extremities, cerebrovascular disease, which could cause a stroke in the worst-case scenario, or even coronary artery disease, which could cause a myocardial infarction or heart attack.
If you're suffering from ED, again, you have to look at it, you have to put that in perspective. Are you completely healthy otherwise with no medical problems? Are you diabetic with severe peripheral vascular disease and have sick stents in your heart? These are all things that have to be taken into consideration. But if you've got ED coming out of nowhere and you've got no other real problems to speak of, it's not something you should completely ignore. You should bring it up to your medical doctor, let your medical doctor then decide whether or not you should be referred to a urologist.
Paul Szmal: Well, and I thought about it after I asked that. I mean, it obviously is a concern to some degree anytime you're not getting complete blood flow to any part of the body.
David Schnapp: Right, sure. I mean, you know, I mean, if you've got new onset ED, you shouldn't be going to HIMS and just taking pills without looking at the broader picture. And, you know, if you're not in, you know, in the greatest of physical health, if your fitness is not what it should be and you're a little bit overweight, maybe pre-diabetic or otherwise, you're going to be at increased risk of having underlying coronary artery disease or cerebrovascular disease, which could be life threatening. So, again, this really requires that you have a conversation with your primary care doctor, say, doc, I've got this problem now. And let the primary care doctor decide, OK, should you be seen by a urologist?
Now, oftentimes I could tell you I've seen patients referred from primary care for ED and the primary care doctor hasn't paid attention to the fact that ED might be a symptom of some underlying disease. So, you know, oftentimes we'll communicate back with primary care saying, listen, the guy has ED. Certainly we can try him on some Cialis or Viagra, whatever. But you should consider whether or not this patient should be evaluated further for a coronary artery disease or peripheral vascular disease, either with a stress test or at least a visit to a cardiologist or consultation, you know, or possibly a carotid artery Doppler to look at the carotids, make sure they're clean. You know, so, again, these things can't be looked at, ED can't be looked at in a vacuum. You've got to look at the broader picture of the patient's overall health.
Paul Szmal: So give us your closing elevator speech. We've talked about all these different possibilities. Why in seeing what you've seen over 30 plus years, why it's so important that if we notice a change, we at least have a discussion about it and get it checked out if needed?
David Schnapp: Well, look, right, we all want to live to be nice and nice and gray and old, and we don't want to wind up at the end of our days, you know, in a diaper, not knowing our not knowing who's coming to visit us at the bedside. Yeah. So it's like anything else. I mean, staying on top of your health is important. Paying attention to symptoms that are new and bothersome is important because all of these things could could indicate some something under some underlying disease process that if picked up early, you know, can be managed effectively and allow you to age more gracefully, so to speak, and in better health.
Paul Szmal: You can read more information on these things we've been talking about today and the related treatments at ampofny.com, Associated Medical Professionals. Dr. David Schnapp has been our guest, and thanks for the great information as always.
David Schnapp: Thanks, Ted. Have a good day.
