New Books in the Waiting Rooms

Everyone hates to wait. Especially in a urologist's office where patients dread coming in, dread what might happen and dread that it might hurt or be embarrassing.

We try to have as short a wait time as possible for our patients. We know your time is valuable and many of you have had to take off work or make arrangements for child care so you could come for your appointment.







As you know, we have the usual waiting room magazines: Oprah, Time, Architectural Digest, National Geographic, Reader's Digest Large Print, Self, Good Housekeeping, and the occasional Car and Driver.


Recently we added a few small books that have a wealth of information about some things you might have wondered about but didn't know exactly who to ask or where to find out.


And since we are plumbers, after all, it only seemed appropriate that we have these two books not only in the waiting room but in each exam room as well.

These are both really funny but very informative books. We hope you enjoy them.

Why No E-mail?

Lately we have had a number of patients who would like to be able to ask questions or communicate with Dr. Roesel via e-mail.  Our practice does not use e-mail as a form of communication with patients except for sending blank forms such as registration or medical history forms which are nice if they are completed and returned before your first appointment.

The reasons for this are several.  First, and most importantly, e-mail communications are not secure.  There are privacy laws that protect your medical information from being released to anyone but yourself and your designated individuals.  If we send medical information to you via e-mail we have no control over who could access your account and potentially see private information.

Second, all communications are considered to be part of the permanent medical records.  It is important that all questions and concerns are recorded in the record as well as the answers. We use an electronic medical record system which allows us to track calls, questions and answers and make them part of your medical record.   Although e-mails theoretically could be scanned into the record, it would be easy to forget or lose an e-mail.

We understand that many physicians now offer a special level of service to patients who wish to pay an additional fee each year and this gives them wider access to the physician via e-mail or telephone.  Our practice gives each patient the best service possible and does not charge any additional fees.    When a call with a question or a problem comes into the office it is sent to the person who is best suited to answer it.  Many medical calls are handled by Dr. Roesel's nurse.  Billing questions are handled by Dr. Roesel's office manager.  Scheduling questions are handled by our receptionist.  Please rest assured that Dr. Roesel is aware of your calls but may not be the one who answers them.

We appreciate that everyone's time is very valuable and understand fully that convenience is an important part of saving time.  We make every attempt to help you obtain care in an efficient and timely manner.   We are sorry that we cannot use e-mail for important, and private medical information.  Please remember that you are always welcome to call us at 513-271-2862.

New Guy In Town

We have a new tenant in our waiting room.  He is a Fire Belly Toad and used to live with our nurse but heard our office is a pretty nice place to live so he moved in this month.

The underside of Fire Belly toads is very colorful.  Our guy usually hides in his den behind the plant in his cage or takes a soak in his private pool.  He is not too shy so you have a pretty good chance of seeing him the next time you come to the office.

Free Prostate Cancer Screening - It's a Man Thing

The purpose of prostate cancer screening is to detect prostate cancer at its earliest stages before any symptoms have developed.  As with any cancer, early detection is key.

The screening process involves a digital rectal exam (DRE) and a PSA blood test.  PSA stands for prostate specific antigen and it is a substance released in small amounts from prostate gland cells.  Other things besides cancer can cause an elevated PSA so the combination of the lab test and the DRE is used to determine if a man needs further work up.

During the month of July you can get a free prostate cancer screening if you mention that you read about it on this blog.  Your exam will be free and we will bill your insurance company for the PSA test.  Just call for a time:  it doesn't take long, you can even run in on your lunch hour if that works for you.  

It's better to know.

Father's Day

For all the fathers who are no longer with us

And all the fathers who are

And all the fathers-to-be

Happy Father's Day with love.

First Day of Summer

Today is officially the first day of Summer.   It is also known as the Summer Solstice and is the day of the year with the longest period of daylight and the shortest night.   This marks the first day of the season of Summer and will last until the first day of Autumn which falls on September 22 this year.  After the first day of Autumn the period of daylight will get shorter each day as the earth moves in its rotation around the Sun.

"Solstice" is derived from two Latin words: "sol" meaning sun, and "sistere" meaning to cause to stand still.  This is because, as the summer solstice approaches, the noonday sun rises higher and higher in the sky on each successive day.  On the day of the solstice, it rises an imperceptible amount compared to the day before.  In this sense, it "stands still."

People around the world have observed spiritual and religious seasonal days of celebration during the month of June. Most have been religious holy days which are linked in some way to the Summer Solstice.  Some of these  Summer Solstice celebrations are: Alban Heflin, Alben Heruin, All-couples day, Feast of Epona, Feast of St. John the Baptist, Feill-Sheathain, Gathering Day, Johannistag, Litha, Midsummer, Sonnwend, Thing-Tide and Vestailia just to name a few.   

And of course, there are many different forms of celebration of the Summer Solstice that have no religious connection at all.   These range from art festivals, parades, concerts and all kinds of parties.  Some of these parties involve quite a bit of nakedness.  There is a famous celebration at Stonehenge in England that brings thousands of visitors each year.  This is the only time that visitors are allowed to park for free, get free access to the monument and spend the whole night at Stonehenge.

We are happy to see the sun in the sky for so long these days.  We'd like to wish everyone a very wonderful first day of Summer and leave you with a little "mom-like" list of things to do to stay happy, healthy and safe:

1. Wear sunscreen

2. Wear your seatbelt

3. Wear clean underwear if you are going out

4. Drink lots of water

5. Don't smoke

6. Be kind to one another

7. Tell the people you love that you love them every chance you get

 

Father's Day thoughts.... to snip or not to snip?

Vasectomy. This word can make a grown man nervous and instinctively reach down to protect "the boys". Totally understandable. The idea of somebody cutting on your scrotum doesn't rank very high on many lists of favorites. But it doesn't have to be terrifying thing. Here is a short "True or False" quiz to take to see how much you know about a vasectomy. The answers follow below.

1. A vasectomy is the same thing as a neuter. The dog had a neuter and he came home with no testicles. T or F

2. If I have a vasectomy it will make my voice high and ruin my sex drive. T or F

3. A vasectomy is very painful. I will certainly suffer post traumatic stress disorder. T or F

4. You can resume sexual relations immediately after a vasectomy. T or F

5. Having a vasectomy is 100% effective in preventing pregnancy. T or F

And here are the answers:

1. False: A vasectomy involves the removal of a small part of each tube that carries sperm from each testicle to the penis. The testicles are NOT removed.

2. False: Testosterone is produced by the testicles and is responsible for sex drive and thickening of the vocal cords at puberty (leading to a deeper voice). Because the testicles are not removed, the amount of testosterone produced before the vasectomy will be the same afterwards.  The vocal cords will stay the way they are and your voice will remain as it was.

3. False: A vasectomy does not have to be painful - before, during or after. There are many very effective pain medications that are used to ensure your comfort. Dr. Roesel believes strongly in making any procedure as painless as possible and will explain this to you during your vasectomy consultation visit.

4. False: You must refrain from ejaculation for one week after the vasectomy to let things heal, and then you must continue to use another form of birth control until your semen is tested and found to be free of sperm.  Men who do not follow this advice may possibly be called "Dad" 9 months later.

5. False: Other than abstinence, there is no method of birth control that 100% effective. Vasectomy failure rate is between 0.5% and 1%. It is possible for the cut ends to grow back together and "recanalize" or reform a channel that sperm can get through. This is why the postop semen checks are so important.

If you are interested in having a vasectomy we encourage you to make an appointment to talk to Dr. Roesel. She will explain the procedure to you and if you like, she will put you in contact with patients who are willing to talk about their experience having their vasectomies done in our office.

Most insurance companies cover vasectomies but it is always a good idea to check your specific policy to see if this is a covered benefit for you. Our office is always happy to check for you and if needed, will obtain precertification or provide a letter of medical necessity to the insurance company. We can make the entire process as painless as possible... just give us a call.

We Have Made the Change to Electronic Medical Records!

No more this.

Our office is now using electronic medical records.  There are many reasons for this change and we hope that after we get past our initial learning curve it will make everything more effcient and convenient for everyone.

For all our current patients, everything in your paper chart is scanned into your electronic chart and can be retrieved with the click of a mouse.  If another doctor needs your records we can easily send them to him or her and if you would like a copy of your records we can easily transfer them to a CD for you.   

For our new patients, we will continue to have you fill out the initial paperwork which will help us get your record started in the new system.  If we have your paperwork prior to your appointment we can have it already loaded into the system and ready when you arrive.

The system we are using is called Meridian.  It has a number of excellent safety measures for patients built into the program.  For instance,  the medication checking feature allows us to make sure any new medicine we prescribe for you does not interact dangerously with anything you are already taking or allergic to. Soon we will be able to transmit your prescriptions from our office to your pharmacy electronically as well. 

For those of you who remember the movie 2001: A Space Odyssey - look how far we've come!

Two liters a day helps keep kidney stones away

One of the biggest risk factors for developing kidney stones is chronic dehydration.  We are not talking about this kind of dehydration:

We are talking about mild, chronic dehydration.  This type of dehydration does not result in a parched and thirsty feeling.  However, your body knows how much fluid it needs to function correctly and will adjust the amount of urine you produce in order to make sure it gets enough water for the basic life processes.  The end result is if you do not drink enough fluid or get enough fluid through the food you eat, your urine will be more concentrated and in turn, the minerals that cause stones will be more concentrated in your urine.

When minerals are more concentrated in urine it is easier for them to form crystals by sticking together.  Calcium and oxalate make up the majority of kidney stones and these two things love to bind together in concentrated urine.  Usually the crystals are washed out with urine flow but if they are lodged in the kidney they can stay there and act as a place for more crystals to be deposited, eventually resulting in a visible stone.  Small stones may pass on their own with urine flow.  This could be something you are totally unaware of, or if the stone is big enough and gets stuck, you would be VERY aware of it.

Working or playing outside when it is hot will cause sweating and increase your fluid requirements.  A good rule of thumb is for every hour you are sweating you should increase your fluid intake by at least 16 ounces or one pint.   Drinking alcoholic beverages speeds up urine production and can make dehydration worse, so if you are out in the sun enjoying a cocktail (or two... or three...) you should drink extra water as well.

Concentrated urine is obviously yellow and may have a strong odor.  Here is an easy chart to look at to tell if you are dehydrated or not based on the color of your urine:

If you make around 2 liters of urine a day this will help protect you against dehydration.  The problem is, in order to make that much urine you need to drink a lot.  Very few people really do drink enough to do this.  A little more realistic goal may be to try to drink at least 2 liters of water or other fluid a day.  This will ensure a good production of urine unless you are sweating heavily, have a fever, diarrhea or other source of fluid loss.

Drinking at least two liters (about 2 quarts) of water a day can be difficult.  It is better to drink it gradually than all at once, and preferably not just before bed unless you don't mind getting up at night to go to the bathroom.

We recommend starting out slowly, adding a glass of water to each meal and one or two in the midmorning and midafternoon.  Work up to the two liters a day slowly and you will be more likely to be able to continue to do this on a regular basis.  Drink up!

Memorial Day

Thanks to all the men and women who gave their lives serving our country, then and now.

The right way to take "those pills"

Drugs like Viagra, Levitra and Cialis are often prescribed for men with erectile dysfunction. Unfortunately, sometimes you don't get the "owner's manual" with them that tells you how to take them correctly. To maximize success with these medicines here are a few pearls of wisdom and a few tips to follow:

1. These pills are not "after dinner" mints. They work best if taken on an empty stomach. Empty like the first thing in the morning, not empty like one hour after eating Chinese food. Food in the stomach interferes with absorption of the drug. High fat foods delay stomach emptying - so even waiting the recommended four hours after eating may not guarantee that your stomach is empty.

2. It takes time for the drug to be absorbed from the stomach and into your bloodstream. If you take one of these pills and have a nice erection 5 minutes later, it's YOU, not the drug. In some ways this can be very reassuring... the equipment works on its own. It may just be having temporary technical difficulties for some other reason. Absorption takes 30 to 45 minutes.

3. You must have some kind of stimulation to help get an erection. These pills are not magic. They do not result in an instant flawless erection. The stimulation can be anything that you find arousing: touch, visuals, fantasy... the list is endless.

4. If the quality of the erection you are able to get with the drug is not satisfactory, talk to your doctor. You may need a different dose. You may have better success with a different drug.

5. Remember that it may take 6 or 8 tries before you have the success you want. Don't give up if the first time doesn't work.

6. If you have an erection that lasts more than 4 hours after you have an orgasm or ejaculate, call your doctor. This condition is called "priapism" and although rare, needs to be treated to avoid lasting damage.

7. As with everything else, if you are using these pills with a partner, communication is key. Many men are nervous or anxious when trying these drugs for the first time. Make it shared experience with your partner. Maintain a sense of humor. Set aside time when both of you are not rushed or have another commitment.

8. Relax and enjoy!

Erectile Dysfunction

Erectile dysfunction (ED) means the penis does not get erect or stay erect long enough for satisfactory sexual function. It is safe to say that nearly every man will experience erectile dysfunction at some time in his life. It may be transient and due to anxiety or anger, certain medications, fatigue, overconsumption of alcohol or drugs (especially cocaine and valium) or idiopathic which means unexplained.

An evaluation for erectile dysfunction includes a careful history and physical exam as well a review of medications and a thorough discussion about medical problems and social or relationship problems.

Sustained ED is usually due to medical problems such as diabetes, injury to the blood vessels to the penis, vascular disease, heart disease as well as smoking. Diabetes and smoking are two of the worst things for erections. Smoking causes small blood vessels to constrict which makes it difficult for the penis to fill with blood, which is what makes it hard. Diabetes causes damage to small blood vessels so if you are diabetic, do your very best to keep your blood sugar under control.

ED can lead to all kinds of issues with self confidence, self esteem and relationship problems. Men may be very upset by an episode of ED and lose confidence in the ability to get or sustain an erection. The partner may feel that the ED is their fault (I'm not sexy enough, I've gained weight, he doesn't find me attractive any more) or that it is a sign that the man is seeing someone else. The man may feel like a failure and then not want to try again.

Communication with your partner is an essential part of treating ED. This is not an easy thing to do. Your partner may have problems with vaginal dryness or pain with intercourse. These are things that can be treated as well. Dr. Roesel sees many women with this type of problem.

The treatments for ED vary from medicine to injections and/or mechanical devices to surgery. In order to determine what is the right treatment for you, it's important to find out what is causing your particular problem. Don't be afraid to discuss ED with your doctor. We are here to help.

Saturday appointments now available!

If you are like a lot of people these days... you are BUSY. All the time. Every day. Work. School. Home. Time gets away from you and it's easy to put off getting things done that you would probably rather not do. Like go to the doctor. Especially if it's a urologist you need.

In an effort to make things a little easier for those of you who are busy, or who hate weekday traffic, or have long work hours during the week, we are now offering Saturday appointments once a month. The office hours will be shorter, from 9 AM until 3 PM but all regular office services including cystoscopy, prostate biopsy, vasectomy, urodynamics and ultrasound will be available.

Dates for future Saturdays are May 23, June 6 and July 11. Call 271-2862 for your appointment and we'll see if we can help you get just one more thing off your "to do" list.

Happy Passover and Happy Easter

We wish you a safe and happy holiday surrounded by those you love and care for.

Spring has arrived!

March 20 is the first day of spring this year.  The first day of spring is also known as the vernal equinox.  On the first day of spring, the sun's light is directly over the equator.  There are an equal number of hours of daylight and darkness.  The number of hours of daylight will increase every day until the first day of summer which will be June 21 this year.  The first day of summer is the longest day of the year.  As summer progresses to fall, the days become shorter as the sun moves farther away from the equator.

We are happy about the new season and hope yours is filled with all kinds of good things.  We'd also like to take this opportunity to remind you to be healthy and safe: wear sunscreen, drink plenty of water and be sure to take the time to stop and smell the flowers.

Happy first day of spring!

Bladder cancer

Bladder cancer is a scary disease. It is more common in men, and more common in people over the age of 40. Cigarette smoking is a known risk for developing bladder cancer. At present, there is no recommended routine screening test for bladder cancer but certain symptoms or problems suggest the need to be checked. These are:

Blood in the urine

Pain during urination

Urinary frequency

If you have any of these symptoms, your doctor will check your urine and look for other causes besides cancer. If your doctor suspects bladder cancer, you will likely have a CAT scan or other test to examine your kidneys and you will also need to have a cystoscopy. A cystoscopy is a test where your doctor will look inside your bladder with a special camera that can examine the lining of the bladder. If anything abnormal is found, biopsies are taken to make a diagnosis.

Probably the best advice we can give you at this time to prevent developing bladder cancer is not to start smoking, or if you do smoke, STOP. It is difficult to stop smoking, in fact, the nicotine in cigarettes is one of the most addicting substances known. Your doctor can help you stop smoking with a variety of methods if you want to stop. At our office Dr. Roesel will be happy to talk to you about quitting smoking. Just ask. We are happy to help.

The Prostate...

The prostate is a little like your car - as long as it's not causing any problems you don't think about it much.  But when it does, it can be a small problem that is easily fixed, or a big problem that requires a lot of time and energy to fix... but either way it becomes something you have to think about a lot.  

Unlike a car, a prostate is free.  Men are born with a prostate gland.  It starts to enlarge around the age of 45 or 50 and may cause bothersome symptoms such as needing to get up more at night to urinate or a weak urine stream as it gets bigger.  Some men never have any problems with this until they are much older.  Chances are if your dad or brothers had an enlarged prostate you probably will, too but whether or not you will have symptoms is completely unpredictable.

Prostates can also get inflamed or infected in any age man.  If this happens, you might experience pain with urination, pain in around your rectum or pain with ejaculation.  This can be pretty severe pain accompanied by a fever or even inability to urinate in really bad cases. You will definitely need to see your doctor for any problems like this, the sooner the better.

Besides getting larger with time, prostates can also develop cancer.  The two main risk factors for prostate cancer are being male and age, neither of which can be controlled.  A close relative such as your father or brother with prostate cancer makes it more likely that you could develop cancer as well.

Just like preventative maintenance on a car, there are certain recommendations for "prostate maintenance".  The American Urological Association recommends yearly screening for prostate cancer in men with no symptoms at age 50.  This is involves a digital rectal exam and a PSA test which is performed on a blood sample.  Men at higher risk, such as African American men or men with a family history of prostate cancer should be screened earlier, often starting at age 40.  The decision when to start screening should be discussed with your doctor as many factors besides just age go into the decision.

Your urologist is the best person to have a detailed discussion about specific questions you may have about your prostate.  The Mayo clinic has an excellent page about prostate cancer screening which you might want to read.  You can access it at the following address:

www.mayoclinic.com/health/prostate-cancer/HQ01273#

Only one more week until spring!

Kidney Stones

If you've recently had a kidney stone you might want to skip this post to avoid painful memories...

Cincinnati is considered to be in the "Stone Belt" of the United States.  For some unknown reason,  kidney stones are common in this area.  Men get stones approximately 3 times more frequently than women do, and once you have one stone, your chance of having another one rises.

Kidney stones that do not cause complete blockage may cause dull or intermittent pain, usually in the flank area or high up in your back.  If a stone is blocking farther down the ureter (tube between the kidney and bladder that carries urine made by the kidney) it can cause a complete obstruction.  This means PAIN and SUFFERING.  This pain may be sharp and excruciating.  It can be bad enough to cause vomiting and it may seem you can't find a comfortable position to lie in.  The pain can radiate down into your groin or into the scrotum or genitals.

If you are having pain like this, the best thing to do is go to the nearest emergency room.   If the doctors suspect a kidney stone, you will get a CAT scan.   The upper left picture shows a CAT scan with an arrows pointing to stones in the kidney.  Of course, pain can be caused by other things so the doctors will certainly check you out for other possibilities.

If you have a stone, your treatment will likely involve control of pain,  IV fluids and anti-inflammatory medicines as well as medicines that may help you pass the stone.  Being admitted or sent home depends on a number of factors such as whether or not the pain can be controlled with oral medicines, if you can drink enough fluids to stay hydrated and whether or not you have a urinary tract infection.

If you are discharged from the ER, follow up as soon as possible with a urologist.  We hold open appointment times every day for urgent visits such as these.  The correct treatment for your particular stone will be discussed with you at the time of your visit.

If you know you have a stone here are the warning signs to call your urologist and then go immediately to the closest ER:

1. Pain that cannot be controlled with oral medicines at home

2. Nausea or vomiting that prevents you from drinking and eating

3. Fever over 101 degrees

4. If you have a single kidney or have a transplanted kidney.

The best source of general information on the web for more information about stones is from the NIH.  Here is the link:

http://kidney.niddk.nih.gov/Kudiseases/pubs/stonesadults/

 Just 21 more days until spring!

Our terrarium and its inhabitants

You may have noticed the terrarium in our waiting room. It has a small fountain, live plants and is home to five little tree frogs. These tree frogs are not poisonous.

There are three marbled tree frogs who look like this:

Their scientific name is Hyla marmorata. They are found in Central and South America.Marbled tree frogs are often called"bird dropping tree frogs" due to their color and shape. This camouflage protects them from predators.

They have very bright orange colors and spots on their undersides so if you catch them while they are sticking to the side of the terrarium glass you might see something like this:



There are two little green tree frogs that look like this:

The green tree frogs can change color. Sometimes they are green, sometimes they are brown and sometimes they are almost white. Their scientific name is Hyla cinerea. They are native to the United States and can be found in Cincinnati in the summer time. The females are typically larger than the males.

Both these species of frogs are nocturnal so when you see them in the office they are likely to be sleeping. They are very good at hiding. Children have the best eyes for spotting them it seems. The marbled tree frogs like to sit around the fountain or stick to the back of the cage. The green tree frogs hide under or on leaves or high up near the top of the terrarium.

We hope you enjoy looking at our little tree frogs as much as we do!

Patient Suggestions

We LOVE them!

Good or bad, we want to hear your suggestions. Your satisfaction with your care in our practice is extremely important to us. If you have had an unsatisfactory experience, we want to know about it right away so we can make it right for you and also never have it happen again.

As a patient, you have lots of rights. You have a right to prompt, courteous service. You have a right to have your questions answered. You have a right to understand the plan of care or treatment Dr. Roesel has reccomended for you. You have a right to being treated in a clean and modern facility.

If you ever feel something is not right, please feel free to talk to Dr. Roesel or one of our staff. We will do everything to "make it right".

We have had several recent suggestions from patients which we have immediately implemented. Here are two:

1. Give lollipops after a procedure



2. Use wiper warmers for the baby wipes we provide for patient use after exams



Many thanks to those patients who gave us ideas to make things more pleasant for everyone!

Just 28 days until spring!