The High Cost of Prescription Medicines

Those of you who are already patients of our practice know that Dr. Roesel is nosy. She will ask about your pets, your sex life, your urination, what good or bad things are going on in your life... and she will ask you if you know about your prescription plan. Why does she do this? Doesn't she have anything better to do?

The fact is, prescription medicines, especially brand name drugs can be very expensive. And if you are do not know the type of coverage for prescriptions that you have, you could be in for an extremely unpleasant surprise at the pharmacy check out counter.

Dr. Roesel is aware of this because several of the medicines she commonly prescribes do not have a generic equivalent available. So she asks because we may have ways to help you get your medicines at a reduced cost. Some drug companies provide money off coupons to help reduce your co-pay. Some even provide coupons for a free month's supply of the medicine. And there are some programs that will provide you with your medicine free of charge if you qualify, usually based on financial need.

With the many confusing options you have when choosing an insurance plan it is hard to figure out what your prescription benefits are. Here are the basics. Most insurance companies have what is called a "formulary". This is a list of drugs that they believe are cost effective and will be covered with certain exceptions. These drugs are then usually classified into "tiers". (For the specifics of your particular plan, you should contact the company directly or visit their website for subscribers.)

Tier one drugs include most generics. These are the medicines that have the lowest co-pay of all. Tier two drugs include brand name drugs and have an intermediate co-pay amount. Tier three drugs are the most expensive and may require prior authorization or have quantity limits.

The difficulty arises when you have a plan that includes the cost of your prescriptions as part of your deductible - that is, you must meet your deductible before your insurance company will pay for your medications. If you have a high deductible plan with no separate prescription plan the cost of brand name medicines may be very high for you until your deductible is met.

There are so many different plans that we cannot possible know them all. So please don't be offended if we ask you to check with your insurance company to find out what a particular medication will cost you. Often you can call your pharmacy that has your insurance information on file and they will tell you.

Dr. Roesel prescribes what she thinks would be the best medication for your specific condition. If it is a new medicine, she will usually give you samples to see if you have any side effects before you actually fill a prescription. If we have coupons we will always offer these to you. Talk to us. Let us know if you can't afford a medicine. We want to help.

And we want to avoid this!

Testicular Cancer

Uh oh.

Lump felt in testicle.

Let me feel it again

And again.

And again.

And again.

Now it hurts.

Uh oh. Better call the doctor. Uh oh.

Just as many women are taught to examine their breasts for lumps, men are told to examine their testicles for lumps. Lumps could be cancer and if detected early, testicular cancer is one of the most curable cancers around.

Problem is, not too many men have actually been taught what is normal to feel and what is not. (Any of Dr. Roesel's male patients who have been through her testicle tumor teaching moment may skip this next part.)

Unlike other organs found in the trousers, HARD is BAD in the testicles. If you feel a hard lump that feels like a rock, see a urologist right away. Cancer tends to be hard and painless (unless you have felt it so much it is now hurting).

On the other hand, soft and squishy is usually okay but any lump should be checked out. There are many things that are benign that can cause lumps in the scrotum, remember that. But always err on the side of caution and get it checked out.

The treatment for testicular cancer has one of the highest success rates of any cancer, if the cancer is detected and treated early. For some types of testicular cancer surgery alone is curative. Sometimes radiation and/or chemotherapy are needed.

If a testicle is has be removed, prosthetic (replacement) testicles are available. The funny thing is, they are available for dogs too. Those are called "Neuticals". (I am not joking.) The clear one in the photo is filled with saline, the opaque one is solid silicone, in case you were wondering.

There are reports linking smoking marijuana to the development of testicular cancer. Just so you know.

Call us if you feel a lump or something. We're here to help.

Oops I Did It Again - A Quick Post About Premature Ejaculation

Premature ejaculation brings feelings of shame, frustration, inadequacy and embarrassment to many people every year.

What exactly is premature ejaculation? The American Urologic Association defines it as follows: "Ejaculation that occurs sooner than desired, either before or shortly after penetration, that causes distress to one or both partners." Wow. That's pretty vague.

The key to determining if it is a problem or not is if it bothers you or your partner. If it doesn't, it's not a problem. And until sex becomes an Olympic sporting event, it's not a competition, either. Just because your friends may say they take 45 minutes to ejaculate doesn't mean it's the standard.

There you have it. (Or maybe you don't). But it's common. There are a number of things that can be done to help improve it.

The "squeeze technique" is a very well known trick. When you feel yourself getting too aroused you stop and squeeze the penis just behind the head. May work, may be too late.

Thinking distracting thoughts may help. Garbage, the Bengals and hockey statistics are examples of things people think about.

Avoid desensitization creams and lotions. If you look closely you can see the active ingredient is a powerful topical anesthetic. If it gets onto your partner's genitals, your partner will feel..... nothing. Your partner's genitals will be asleep.

Now there are some oral medications which can help. Call for an appointment to see if they might be right for you. In this case, don't delay!

What's Wrong With This Picture?

A) This woman's bustier is too tight

B) This woman has a bad dye job on her hair

C) This woman forgot to put on her nail polish

D) This woman is SMOKING

A) This woman's shirt is too short

B) This woman needs to go on a diet

C) This woman's upper arms aren't very toned

D) This woman is pregnant and SMOKING

A) Grandma has dirty fingernails

B) Grandma needs an eyelid lift

C) Grandma is not sharing

D) Grandma is SMOKING

A) Penises do not have arms or eyes

B) Scrotums do not have legs

C) Scrotum legs do not wear boots

D) The penis is SMOKING

The correct answer in each case is of course, D. Smoking.

Smoking has been positively linked to bladder cancer. Not possibly, definitely.

And smokers who continue to smoke after a diagnosis of bladder cancer have a very large risk of developing metastatic disease within 2 years. Once bladder cancer has become metastatic life expectancy is usually less than 3 years.

Many bladder cancers start as superficial lesions that can be treated if caught early. Unfortunately, bladder cancer isn't always very obvious so if your doctor tells you that you have blood in your urine even if you can't see it, follow your doctor's recomendations to have it checked out.

Common risk factors for bladder cancer are age (over 40), being male and smoking.

If bladder cancer is caught early before it becomes invasive, treatment is much simpler. If it is invasive, then the discussions change dramatically to options such as removal of the bladder and/or radiation and chemotherapy.

People often fear quitting smoking for fear of gaining weight.

You can lose weight. It is much harder to lose cancer.

Other people fear becoming irritable if they stop smoking. There are lots of good ways to help cope with this, though.

There is hope and help if you want to quit.

And each time you try to quit, one day you really will.

The saddest part of Christmas this year was going to the funeral of one of my favorite patients who died of bladder cancer. She never stopped smoking.

Please try. For everyone who loves you but most of all for yourself.

We can help. Talk to us.

Mea Culpa - the blog has grown stale

Mea maxima culpa

It's not for lack of time

Since most of my last three months have been spent like this outside of work

Let's see if we can bring this thing back to life, shall we?

Happy Holidays 2010!

Whether it is Christmas

Or Hanukkah

Or Kwanzaa

Or anything you celebrate this time of year

We wish you all the peace, love and happiness in the world.

(Our favorite Christmas present was Obama signing the bill that prevents any further Medicare cuts to physician payments for one year.)

We look forward to helping you achieve optimal urinary and sexual function in 2011.