Dr. Arpeet Shah
speaker
84 appearances
1 recordings
1 series
first heard Sep 2024
last heard Sep 2024
Dr. Arpeet Shah’s voice in public audio — every appearance, attributed to the second.
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Yeah, so we have a... You created that one? Yeah, through our practice. It's all QR code based. It's all virtual. We used to have printouts, but we do have printouts for our patients who just don't want anything virtual or electronic, I should say. But that booklet kind of gives an introduction to our program. It actually has our pathway. written out.
So, you know, you're going to have AUA symptom scores. You're going to have, these are the tests that you could consider. There's going to be a little blurb about each test. And then all the procedures that we offer, whether, you know, green light, urolith, resume, simple prostatectomy, aqua ablation, all the things that we can offer a patient will be listed there.
We have office, ASC, and hospital. So it's all those things. I also sit on the clinical board of BPH for Solaris, our national group. And Physicians are very passionate about how they feel about particular procedures. There's no way we can convince every physician to say that this is right or this is wrong or this is better. And I don't think that that's the goal of any of this.
The goal of this is to make sure physicians are doing all the diagnostic tests before they make a decision. We've all seen that patient that's in the hospital that you know, has like a 200 gram prostate, came in with retention and had a procedure that's really not made for that kind of a prostate. Eight clips.
Yeah, we see, you know, eight Urolift clips and a 200 gram prostate and the patient's as confused as you are about why they're there. And so it's impossible to say which procedure is better and convince it to all your group. And that's not the goal. We still know that there's still somewhat of an art in medicine.
And, you know, we want the physicians at the end who are going to do the procedure deciding what procedure they feel is right. And that's good. And I think that's what we want. But we want to make sure that they got all the testing, that they have all the information, because that tends to make sure that they choose correctly. And you're a center of XLO of resume. Are you doing them in the office?
Yeah, we do 100% of our resumes in the office. We utilize a combination of local and local anesthesia, just a prostate block and Pronox. which is a patient-controlled delivered anesthetic. The key thing about Pronox is it kind of gets out of your system in a couple minutes after using it.
So we really think it's a drive-in, drive-home procedure, meaning you could drive in, get your BPH procedure, drive home, and
Specifically for our patient population, where it's difficult for them in terms of getting off from work or, you know, having the support from family necessarily to bring them into the office, this is a really kind of, it's a procedure that really strikes them as an appropriate thing for them.
Yeah. So I'll tell everybody, you know, there's, you know, eight or 10 things we can do from a procedural standpoint for your prostate. Once we get the objective data, we'll bring it down to two or three. And then we talk about it. And, you know, one of the benefits for resume specifically is that it can be done in the office and patients can drive in, drive home. You can do it on blood thinners.
I think I have done many on blood thinners. They're okay. Done for a variety of prostate sizes and shapes. You know, if you see a median lobe, you don't see a median lobe, it's fine. And the biggest thing is it's reproducible despite surgeon skill, right? We're really utilizing the technology to do the work.
It's not like, oh, I'm very good at doing terps or he's very good at doing, you know, a simple prostatectomy or whatever the case might be. There's really normalization of surgical skills with resume. And I think that makes it very enticing.
Typically three days. If a patient's in retention, I leave it in for two weeks. I think one of the complaints about resume from patients and providers is the irritative symptoms that occur afterwards. And they tend to last longer than your other BPH procedures. And that's the truth. They have irritative symptoms that last longer than the average BPH procedure.
Patients aren't worried about it if you let them know beforehand. You let them know the day of the procedure. You let them know when the catheter comes out that things are going to get worse before they get better. You know, as a physician, it took a little bit to not have that immediate gratification to see an open cavity. And I took every chance I could in getting a cystoscopy.
I have a patient that grows hematuria a year later. I was, you know, I was doing a cysto on them. Because I wanted to see. And sometimes you'd have patients get CAT scans and you could see the defect. The defect is significant. And there's no doubt about it. What's the largest you're doing? I mean, I know off-label, how big will you go?
So, you know, for particularly comorbid patients who are in urinary retention... I have a 90-year-old who comes in, urinary retention, 120, 130-gram prostate. I'll try it. I think it's worth a try. I usually, for patients with just BPH, not urinary retention, I'll do My average is one stick per 10 grams. So a 50-gram prostate, I would do five sticks.
When we started with Pronax, patients were so comfortable that we were over-sticking patients. And I think their results were great, but their irritative symptoms lasted longer. But for those patients in retention, like the 90-year-old who comes in, I'll do 120, I'll do 130 gram prostate as long as they know that it's off-label and they know that it might not be successful, but it's worth a try.
Yeah, it's certainly difficult and certainly reiterating it over and over again is necessary. There's a great platform actually called Vidscripts. I'm not sure if you're familiar with it, but these are pre-recorded videos that are sent out to the patient on a particular cadence around when a procedure is done. And I think that patients really appreciate it. So when
When they're having their irritated symptoms one week, two week, four weeks out from the procedure, if they get a little video saying that you might still be having this and this is normal, it puts them at ease. But yeah, certainly, you know, it's easy for us to say it on our side to say that things are going to get worse before they get better.
But living through it is obviously a different story.
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