So for the next question: let’s go to one of our off-site interviews and we are very fortunate to have with us dr. Gregory Burke of from my mother’s Medical Center, dr. Gregory bakov is the director of the cardiothoracic surgery at my mother’s medical center and associate professor of cardiothoracic surgery with permanent tenure at New, York University here in New York, dr. Ribicoff, you as a heart surgeon, see a lot of patients with advanced heart disease and the medical literature says that there is a link between erectile dysfunction and heart disease. How do you explain that link? How do you view that link well as coronary artery disease is hardening of the arteries? It’s a thorough sclerosis. It’s building up of plaque in the vessels, and that is a process that, when it occurs, it occurs in across the whole body. So let’s just talk about it, so it’s it’s basically disease of the blood vessels. So in the coronary arteries it happens that you build up plaque in the vessels that bring blood supply to the heart muscle, and if these things have stopped completely, it can cause a heart attack. We do coronary artery bypass is to try to avoid heart attacks and try to make people live longer and we bring extra blood supply to these coronary arteries, but at the same time, that obstructions are recovering in the in the coronary arteries they’re occurring in the other vessels. So let’s talk about a lot of these things that so they tend to attend to go along with obstructions of the carotid arteries, the arteries in the neck, that from blood supply to the brain. It also tends to happen in the blood vessels of the legs and people who have coronary artery disease, often have a disease or a problem called claudication, which is pain in the legs when they walk well. Erectile dysfunction is just another example of this. In this case the penis isn’t getting enough blood supply and it cannot function normally without enough blood supply. In many ways it’s no different than a heart not functioning properly. If you don’t have enough blood supply to your heart, it won’t pump. Normally, it will actually look weaker than it appears to be, and it seems that virtually any organ that doesn’t get enough blood supply will behave in a similar manner. Thank you, dr. reebok off my next question to you: do your male patients talk to you about erectile dysfunction, because we heard from dr. Musa our cardiologists that maybe half to three quarter of men with heart disease have erectile dysfunction? So do your patients ask you, questions about erectile dysfunction? How does that come up in your practice? It’s interesting I mean you do here, patients complaining that it, but for the most part, the overwhelming majority of patients don’t want to really talk about this and when you ask them symptoms and what’s going on in their lives, if you ask them about those things, a lot of times, they’ll tell you everything is fine or they’ll tell you that they have no problems. If you do what we call a review of systems when you take a history and do a physical exam or a patient you, if we ask about every organ and its function and many times we won’t get the answer. As a matter of fact, oftentimes I, don’t even patient all. You can talk to me that, until after the through with their heart surgery, but in my practice and at my mind at ease medical, something we try to encourage people to to talk about all the different problems that they’re having, because obviously these problems are interrelated and if, if I took somebody’s hard, but their life still isn’t fulfilled in many other ways, then they don’t really have a chance to get the joy out of the lots of things that they need to, and my own philosophy in doing heart surgery has always been that that the idea is to extend good life, and so we till we try to bring these things up, and then patients do confirm to ask afterwards and when they do, we give them recommendations. Thank you, dr. river, cough and my other question to you, which comes from all so many of our patients. What do you say to your patients after heart surgery about six? When can they have six? Can they have six? What do you see say to the men? What do you say to their women after your heart surgery grid? One? That’s also that this is a great question. Patients of both genders often ask in in the office after they’ve, recovered from heart surgery when they can begin having sexual relations again and exactly what they can and can’t do, and this question comes from both male and female patients. It also comes sometimes from the patient and sometimes from the spouse, so Mike. My answer varies depending on who’s. Asking it to be perfectly honest with you. The question comes more often for males and it does from females, but when a when a man asks me early on after heart surgery after coronary bypass, whether they can have sex again or when they can have sex and what they should do, I usually tell them well to be perfectly honest with you. If you feel ready to have sex, you can have sex, but if you’ve just had heart surgery, I generally prefer that your spouse does most of the work that that’s generally my answer. That would be true of both a male and a female. Although again, the question comes more commonly from the males, thank you. Definitely back off and I would like to ask you now the general question, in your capacity as a heart surgeon and knowing the link between erectile dysfunction and coronary heart disease and heart disease in general. What would you say to men out there, and especially men out there with erectile dysfunction, who happened to be middle-aged? The reptile dysfunction we’ve had discussions about this before the reptile dysfunction is, is a marker for atherosclerosis disease of the blood vessels for blockages hardening of the arteries, and it’s very commonly related to disease of the heart and I. Think a man who has a reptile dysfunction is lucky. If his doctor then tells him to go, see his internist or his cardiologist, because the erectile dysfunction can be can be dealt with, although it’s absolutely critical for them to know the state of their heart and their blood vessels to their other major organs, because, obviously you don’t want to put somebody in a situation where they’re exercising they’re getting the heart rate up there, getting the blood pressure up, as can happen during sexual relations. Without knowing that there that their heart is okay, it’s very much the equivalent of somebody go coming to me and asking me about exercise and a man in this little late, Middle Ages, even a woman in the middle age as well I mean I, don’t just send a patient in and say: oh, yes, it’s very important for you to exercise just go to the gym and start I will always tell somebody go see their internist go see their cardiologist get a heart evaluation before you do these kinds of exercises, which can be which can be life-threatening if you don’t have a good blood supply to your heart. Thank you, dr. lobokoff, that was dr. Gregory Burke of the director of cardiothoracic surgery at my mother’s medical center speaking to us from the hospital in Brooklyn. Thank you now that the Carson you mentioned pelvic surgery or radical pelvic surgery, most commonly removal of the prostate or radical prostatectomy. What is special about that in relationship to ed anything, that’s done to the prostate, which includes radiation therapy by the way, but radical prostatectomy is the most severe. There are some very important nerves that that follow the prostate into the penis and those nerves that are often damaged during radical prostatectomy, even in a very, very good, so-called nerve-sparing prostatectomy, those nerves can be damaged and those nerves are what signal the penis to produce an erection. If that damage occurs, then the the resulting erectile dysfunction is very severe. Erectile dysfunction that often does not respond to the to the pills to the pde5 inhibitor type Hills, so men who had radical prostatectomy to survive cancer, how important is erectile dysfunction for them. It’s very important. Obviously, their first goal is to sur
vive the cancer and to get rid of the cancer and that’s by far the most important issue, with prostate cancer. But often a year or so after the patient has had a surgery. Then he wants to regain his normal life. Again. He wants to be continent, he wants to be sexually active. He wants to have good erections today, many of the patients that were treating with radical prostatectomy or far far younger than they were a decade or two ago when they were in their late 60s, now, they’re, often in their early 50s, sometimes late, 40s and often have younger wives and and and and are interested in, maintaining their intimacy and their ability to have sexual activity. So prostate cancer is being diagnosed in younger men with strong sexual desire with younger partners of wives and erectile dysfunction, for them is a very important condition to be treated. They are very successful treatments that we will hear about in the following segments of this episode of the doctor. It won’t show on erectile dysfunction, so we will discuss all treatments and we will discuss also the treatments for those who fail. Medical therapy stay tuned and we will return with the doctor is one show.