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!

Deductibles - Sorting out the confusion

Deductibles can be confusing. Most insurance holders know they have one... but what does it mean? In the simplest terms, it means the amount of money the policy holder must pay out of pocket prior to the health benefits being used to pay for medical bills.

Early in a new calendar year or a new insurance plan year most people have not yet met their deductibles. At our office, when we verify your insurance we also verify the amount of your deductible you have met to date. If you have not met your deductible, our office bill will be used in full or part to satisfy it. This means we will collect your deductible (or portion of it) along with any copay you may be responsible for at the time of your office visit.

Then as a courtesy to you, we bill your insurance company. Your benefits are then calculated by the insurance company and an explanation of benefits is sent to you. Once the insurance company has calculated your portion of the responsibility for our bill if there is additional money you owe, we will send you a bill. If you have overpaid, we will immediately and cheerfully refund the amount we owe you.

With Health Savings Accounts (HSA) this can be a new and shocking experience to pay for your care to meet a deductible which can be very, very high. HSAs have money in a special savings type account which is used to meet your deductible. Most people with HSAs have a special debit-type card which is used to pay the bills from that savings account.

The reason we collect your unmet deductible at the time of your visit is twofold. One, it reduces the amount of paperwork involved in sending out bills and two, it reduces time spent trying to collect from patients who choose not to pay the part of the bill they are responsible for.

Trying to keep the lid on burgeoning health care costs is a goal we are committed to. Please feel free at any time to ask to speak to Dr. Roesel about concerns you have about your bill or if you have questions about your insurance coverage. We will do everything we can to help answer your questions to the best of our ability, and if we don't have an immediate answer, we will contact your insurance company and get an answer.

Only 28 days left until spring!