Dr. Moyad: Hi, welcome to our first and it may be our last edition of 'Off the Cuff!" Off the cuff! I have absolutely no notes and I just spontaneously bring in a world-renown expert to ask questions. And then this person off the cuff answers them, and then we edit as freely as we want to, to make each of us look really good.  

Take me through a basic rehab program if I'm having surgery or radiation or treatment. What's some of the basic things you offer? 

Dr. Auerbach: Right. So one of the things would be, if you take L-Argenine, and you can take 500 to 1000(mg)...

Dr. Moyad: Whoa, that's a supplement!

Dr. Auerbach: I know.

Dr. Moyad: A doctor just said that you might take a supplement that helps you? 

Dr. Auerbach: Could be.

Dr. Moyad: Winning! Anyways..

Dr. Auerbach: Now I'm your friend!

Dr. Moyad: Now you're my friend.

Dr. Auerbach: I'm really your friend.

Dr. Moyad: But that makes a lot of sense, cause L-Argenine creates a compound that widens the blood vessels, right, and brings more blood in. So you actually as...I know you have a whole bunch of options...as part of your rehab program, you offer the supplement L-Argenine.

Dr. Auerbach: Correct.

Dr. Moyad: Wow! And wow spelled backwards.  Anything else you want to tell me about it.

Dr. Auerbach: Uh, no. It just helps to increase blood flow.

Dr. Moyad: And it's cheap.

Dr. Auerbach: It's cheap, yes.

Dr. Moyad: So you just send them over the counter.

Dr. Auerbach: Right. So you can get 500 to 1000mg twice a day. I don't know what you tell them to take usually when you...

Dr. Moyad: They have to take larger amounts 'cause it takes a lot to convert to nitric oxide to make that effect. So I understand why you probably recommend

Dr. Auerbach: How much do you usually tell them?

Dr. Moyad: It kind of depends. We'll use centerline which is another product that does that.   But Argenine, unless you use those kind of dosage, the same dosages, you can't really get a good effect. So most of your clinical trials use them as higher dosages. Which is anywhere from 3,000 to 5,000 to 10,000.  

Dr. Auerbach: Oh really?

Dr. Moyad: Yeah, so..

Dr. Auerbach: Wow.

Dr. Moyad: You have to use what you said, the grams. So 5 to 10 grams. It's not unusual.

Dr. Auerbach: Okay.

Dr. Moyad: So, you use that. You tell them to take it everyday?

Dr. Auerbach: Yeah.

Dr. Moyad: Okay. And is this happening right after surgery, before surgery? I know it's not happening during surgery, that would be awkward.

Dr. Auerbach: Yeah.

Dr. Moyad: But um, you're telling them to start it when? After a procedure or before?

Dr. Auerbach: Yeah, uh, I usually start after but..

Dr. Moyad: And how soon after?

Dr. Auerbach: Once there's no bleeding; you know, the drains are out. And there's no bleeding going on.

Dr. Moyad: So when they get a thumbs up that the catheters out or no bleeding is happening, then you start L-Argenine.

Dr. Auerbach: Right. And..

Dr. Moyad: What else?

Dr. Auerbach: And then I would start Cialis, 5mg daily.

Dr. Moyad: Okay, Cialis 5mg daily. Why do you like Cialis more than the other ones that have tv commercials?

Dr. Auerbach: Because it's a little bit more practical. It's got...and you could go even every other day, because it has the longer half life. It has 36 hour half life. Full life, 17 and 1/2 hour half life. But it's...you can take that. I would take it. If it was me I'd take it daily. It becomes expensive, but it's, it keeps the blood flow there. And then I would start with a vacuum device, and we do what we call a 10-2-2 program. So you take the vacuum over the penis, and the whole idea is to get blood flow going into the penis. It's not to get an erection to use it, but put the vacuum up against the penis and you activate either if you do the vacuum one, which is a battery operated pack or a hand pump, to draw blood into the penis. It's fresh blood. Hold it there for 10 seconds, and then you let it down. So you do a cycle of one, and then you do ten of those in the morning..

Dr. Moyad: Wow.

Dr. Auerbach: ...and ten in the afternoon or at night. 

Dr. Moyad: Does that take a while? 

Dr. Auerbach: Well, it's going to take ten seconds times ten. Some people do it for five seconds. They hold it. So the whole idea is to bring fresh blood in; let it in, let it down. It's going to take, you know, a few minutes to do.

Dr. Moyad: Okay so, they're doing L-Argenine everyday..

Dr. Auerbach: Correct.

Dr. Moyad: They're doing Cialis everyday or every other day.

Dr. Auerbach: Correct.

Dr. Moyad: And then they're using a vacuum erection device which they get from...They can't pick up from the store. In fact, the store ones make me nervous - over the counter. You have to write them a prescription, right? Or not necessarily?

Dr. Auerbach: You can call. Now I think you can get them without a prescription. We just write it down on a prescription pad, and they can call. There's an ozbaun company, there's a lot of different companies. They're a lot cheaper now, 'cause they're...you can get them without prescriptions I believe. And Medicare doesn't cover them now. So they used to cost $400, and I think you can get them for like $100 bucks or cheaper now.

Dr. Moyad: So that's not bad. So, the third thing is they're using the vacuum erection device daily, ideally. Is there a fourth thing? That's a lot.

Dr. Auerbach: That's about it.

Dr. Moyad: So, every man should be doing those three things?

Dr. Auerbach: I think that will get them pretty much started and doing well.

Dr. Moyad: Okay. So, if you're about to be treated or have been treated, in your specialty you're doing L-Argenine, you're doing Cialis, you're doing the vacuum erection device. You better have your diabetes under control and your cholesterol under control and your blood pressure; you better take care of your business.

This has been another episode of "Off the Cuff!" with Dr. Moyad. See you next time!