“I have a long history of interacting and working with Cardiologists. Actually, this started over 25 years ago, when I took my first faculty position at the University of Minnesota, and I was in charge of the Erectile Dysfunction Clinic. What I noticed was that men in their thirties, forties, fifties were coming in to me – mostly men in their forties and fifties – after either an angioplasty, after a heart attack, and they were coming in to me for their ED. And as I was treating them, and I was working them up, I would just ask them, ‘When did you first develop erectile dysfunction problems? Was it after your heart problems, or before?’ And I was getting 2/3 of these men, who on the surface looked fairly healthy, they weren’t medical train wrecks, but they were telling me that they had ED anywhere from 3 to 5 years before their heart problems.
I kept hearing that story over and over and over again. And it just so happened that my fellowship training – I did a three-year research fellowship, after Urology residency – was all on Vascular Biology and Vascular Medicine. So it clicked with me that there was something more going on.
So I just approached my Cardiology colleagues, and I said, ‘Look, I think there’s something more going on. Tell me about heart disease.’ And I would tell them about the penis, and the blood flow, and why we thought it was a marker. And to make a long story short, this was 25 years ago.
If you look at the literature now, it’s very clear. The things that were somewhat speculative before, are now very clear, that erectile dysfunction can be an early marker. But what it did for me early on was, I worked very closely with Cardiology, because when I pick a man up, one of the things I said is, ‘This guy may need a preventive Cardiology work up.’ So some of the latest research that we’ve done has shown, not only do you need for instance a stress test, if you have erectile dysfunction, especially if you’re a man between, say, 40 and 50, or, say, 40 to 60, that you probably need, if you have erectile dysfunction, there’s a good chance that you need to be further evaluated.
Now, that could be Primary Care. A lot of times it’s Cardiology. So we may get a stress test, we may actually get what’s called a calcium score, to look for sub-clinical or undetected cardiovascular disease. So the Cardiology link has been really critical with what I do, because I think it’s the most important link with erectile dysfunction.
So I have a great relationship with my Cardiology colleagues, especially once they get to know me. Because, at first it was like, ‘Why is this Urologist sending these problems in?’ But once we talk, then we have a great rapport, it becomes a two-way street. There’s a lot that I’m going to see, I’m going to send to them. And I’ll tell you, we pick up men, who come in, who look fairly healthy, with erectile dysfunction. They go to Cardiology, they get assessed, they pick up blockage in the coronary arteries that needs to have intervention. So, we do pick these men up.
On the other hand, I tell my Cardiology friends, ‘Look, many of the men who you see have erectile dysfunction. And I know that you’re busy, and you have a lot of things that you’re focusing on. But these men, a lot of them have ED. If you’re too busy, or if you are uncomfortable, send them in to see me.’ Because one of the things that we do know is, many men in a Cardiology practice will be on medicines, where the pills aren’t the best option for them, or aren’t really a good option, so they need to come in for injections.
So what started out 25 years ago as really kind of an observation that developed into a lot of research, has really turned into a great two-way pathway. Especially at Hopkins, I had a great relationship. Matter of fact, I was actually an adjunct member of the Preventive Cardiology Group there. That’s how closely we worked together.”