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.