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!