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Why Get a Second Opinion? Your Health Deserves It

If you’re facing a major surgery, serious diagnosis or expensive recommended testing, get a second opinion – your physician should welcome that option.

Second Opinion for Cancer | Denver Urology Associates

Healthcare is as much art as it is science. Doctors base their clinical decisions on their education (medical school, publications, etc.) and their personal experiences. If they are unfamiliar with a procedure or the outcome data, they are naturally less likely to present that as an option to their patients. It’s only human nature. When it comes to you or your family’s health, you want to consider all of the options.

When should you get a second opinion on a medical diagnosis or treatment? And how do you go about doing that?

Most people, fortunately, don’t have experience with these questions. We do at Urology Associates, because we give second opinions all the time, and we have our medical opinions second-guessed, so to speak, by other physicians as well. Getting and giving second opinions is practicing good medicine.

Getting a second opinion for a patient could be life saving. It’s your right and often a very smart thing to do. Rule of thumb: if you have doubts about what you are told or if you just feel uncertain, get the second opinion.

No matter what the second opinion turns out to be, you’ll have greater peace of mind knowing you made the right decision for your health. You don’t want to have What If’s? bothering your thoughts as you fight your medical condition.

This is particularly true for cancer diagnoses and treatments. Urology Associates, as well as many other top institutions in the country, offers an online second opinion option. Many cancer patients, particularly prostate cancer patients, seek second opinions. At Urology Associates we offer this service at no charge.

When is a second opinion a good idea?

In general, consider getting a second opinion when your healthcare provider recommends a major surgery (non-emergency), test or treatment. Common reasons include the following.

  • A diagnosis of a life-threatening condition, such as cancer
  • Your insurer requires a second opinion
  • The treatment recommended is risky or potentially harmful
  • You no longer have faith in your physician and what he or she is telling you. This is tricky territory, but if you have confidence in doctor, you’ll know it.
  • You have several medical problems and complications
  • You have a choice of different treatment options or tests with very different costs.

Those are good reasons to get a second opinion. But many patients think, I can’t get a second opinion, I like my doctor and he will think I don’t trust him. Aside from situations in which you actually have lost trust, you shouldn’t worry about this. Most doctors want you to get a second opinion because it will validate their first opinion. And this is what happens most often.

Patients sometimes wonder if they should tell their doctor they are seeking a second opinion. For the reasons above, yes. For the practical reason that you will have to get your doctor’s office to hand over your medical records so you can show them to the second-opinion doctor, you will have to tell your doctor. (Law requires your physician to give you access to your records, though a fee may be involved.)

At the Urology Associates second opinion site, prostate cancer patients can use their most recent laboratory results to help complete a 10-minute questionnaire about their condition. A physician will review the information and provide you with a second opinion in just a couple of days. If you’d like to learn more, an in-office consultation will be needed.

Who to ask, what to ask them

If the second opinion is important – and it is – who gives you that opinion is just as important. You’ll want to go to a different institution because each provider has its own culture, which is often followed by all physicians. Different institutions have different approaches to medicine, which is good for a second opinion.

Seek a physician whose skill level and experience are just as good as, or better, than your current physician’s. Specialized providers, for example a cancer treatment center or cardiac center, are good options.

Okay, you’re all ready to go. So what do you ask?

  • What choices do I have?
  • What is the outcome data for each option?
  • Is the diagnosis/treatment recommendation I have received correct in your opinion? Why or why not?
  • What about my option of doing nothing? What might happen then? And please give me the worst-case and best-case scenarios.
  • What should I do with the opinion you have given me?

Take notes during your second-opinion consultation. You may receive a written recap or it may be sent to your original provider for you.

The questions above are good ones to start with. Your first-opinion physician can also help you formulate a good list of questions. And if the second opinion agrees with the first, you can move forward with the first-opinion doctor.

If two opinions are better than one, are three opinions better than two? Sounds like it might be but most medical experts say two opinions are generally enough. It’s not a good idea to keep seeking opinions until you get the one you want to hear. You will probably never hear it.

However, if the two opinions disagree, you may want to seek a third opinion. Medicare and many insurers will pay for this if they determine it is needed. Your other option would be to go back to your first doctor and talk more about your condition. More discussion may clarify things and give you the peace of mind you need.

Kidney Gone and Cancer Free

Diagnosed with kidney cancer, Don Bosson found both comfort and success at Urology Associates.

Don Bosson’s urine was darker than normal one day after he finished his morning coffee. A little concerned, Don figured he was just a bit dehydrated. Physically, he felt fine and went out for a round of golf, making sure to drink more water throughout the day.  When he returned, his urine was still brown – even darker.

“I knew something had to be wrong,” says Don. “I didn’t want to overreact, but I booked an appointment with my internist that week.”

Don’s internist sent him to Urology Associates where within a week he saw Dr. James Fagelson. Dr. Fagelson ordered an MRI, sent Don home and told him he would call him when he had news. Three days later, Dr. Fagelson called with some less than promising words, “We have a problem, how about you come in and we can talk about it.”

The diagnosis of kidney cancer

Don had kidney cancer and was shocked with the reality of his diagnosis. But he and Dr. Fagelson struck a bond immediately. Not only was Dr. Fagelson’s office wall plastered with specialty degrees from impressive institutions, but it also included dozens of photos of his family, children and grandchildren. Don, who was thinking about his family, children and grandchildren, says he somehow felt at ease during the entire appointment.

Dr. Fagelson showed him the MRI results and exactly where the cancer was. “He couldn’t have explained anything better or been nicer about the whole situation. I related to him immediately and I knew I was in good hands after that day,” says Don.

Many people are born or live with only one kidney instead of two. The kidneys are two small organs that sit below the rib cage and work to filter blood and produce urine – essentially cleansing the urine system. The human body can support all cleansing functions with only 75 percent of one functioning kidney. It’s possible to live with just one kidney and many people do, leading normal, active lives.

Just over 61,000 Americans (mostly over the age of 65) are diagnosed with kidney cancer each year. Twice as many males get kidney cancer as do women. Kidney cancer is normally found before it spreads to other organs, however the tumor masses tend to grow pretty large before they are physically noticed.

Kidney cancer typically can be diagnosed without a biopsy, so there was no need for an invasive surgical biopsy of Don’s kidney tissue. Don left Dr. Fagelson’s office with all his apprehension banished.

“He was probably the most reassuring guy I had ever met or spoken to,” says Don.

From cancer to cured in two weeks

Don had surgery to remove his right kidney in the summer of 2015. The surgery, performed at Sky Ridge, was on a Tuesday and he returned home that Saturday. Don says when he woke up from his surgery, he felt as though he had just been beaten up from the surgery, but it only took a short time to recover.

Dr. Fagelson visited Don in the hospital following the surgery to deliver some good news. The pathology from his removed kidney came back and he was able to determine that every last cancer cell had been removed and Don would not need to undergo chemotherapy. Only two weeks following his diagnosis, Don was cancer free.

“Obviously, this was just about the best news I could have received,” says Don. “That speaks to the thoroughness of Dr. Fagelson and the entire team and staff at Urology Associates.”

Don feels completely fine now and has resumed all of his activities. He regularly plays golf, he’s lost weight and is living a healthier life overall than before his diagnosis.

“I couldn’t be happier with my treatment, with my surgeon and with Urology Associates,” says Don. “Getting a successful outcome has everything to do with your surgeon. I would recommend Dr. Fagelson to anybody on the planet. I can’t sing his praises enough.”

Don says that he plans on spending the rest of his retirement playing as much golf as possible and avoiding any more surgeries.

Do I Really Need a PSA Test?

The PSA test is helpful in detecting prostate cancer, but has its drawbacks.

Denver Urology Associates PSA testIf you’re a man who expects to live past 50, expect to hear a lot about prostate cancer detection, treatment and the prostate specific antigen (PSA). Commonly referred to as the PSA, this is a protein produced in the prostate glands that indicates prostate cancer (as well as other irregularities of the prostate, such as benign prostatic hyperplasia or BPH). The PSA marker has been one of the most revolutionary discoveries in men’s health.

The prostate consists of hundreds of proteins and a group of dedicated research physicians in the 1970s set out to discover the one that indicated prostate cancer. The Food and Drug Administration (FDA) approved the first diagnostic kit in 1986 and in 1994 the kit was approved as a screening aid for diagnosis.

Before early detection of prostate cancer with a PSA test was possible, a prostate cancer diagnosis was often made at a late stage with a 5 percent cure rate. The PSA exam now contributes to 80-90 percent cure rates in modern day prostate cancer diagnoses.

PSA testing is simple. A small blood sample is drawn and sent to a laboratory. Results are reported in a ratio of nanograms of PSA for every mL of blood. PSA levels below 4.0 ng/mL are generally considered normal. The higher the PSA level, the more likely a man has prostate cancer. If a PSA exam comes back high, a biopsy ultimately can confirm whether or not the patient has prostate cancer.

In 2011, the United States Preventive Service Task Force (USPSTF) recommended reducing PSA screenings for men. This task force was comprised of 16 volunteer clinicians including family physicians, general internal medicine physicians, nurses, obstetrician-gynecologists, occupational medicine physicians and pediatricians – there were no urologists directly involved in the recommendation. The task force went so far as to recommend PSA screening only when symptoms are present. The problem is that prostate cancer is slow growing and it is usually in its later stages when men start experiencing symptoms. Urology Associates believes that this recommendation is a disservice to all men.

If your PSA is high, consult a urologist

When changing the PSA screening guidelines, the USPSTF should have clarified and recommended that all men, no matter their risk of prostate cancer, be under the treatment of a urologist, not a primary care provider when it comes to prostate health. The American Urologic Association and Urology Associates recommend an annual prostate exam and PSA test in low-risk individuals every other year for men ages 55-69.

One in 6 men will at some time be diagnosed with prostate cancer, but only 1 in 35 will die from it, thanks to advancements like the PSA. Men with a family history of prostate cancer should consult with their primary care provider or urologist to decide when to start screening. Most men should get PSA screening once they turn 55 if they do not have a family history of prostate cancer.

For undetermined reasons, men of African and Caribbean descent are more prone to prostate cancer, while Asian men are not. Other risk factors of prostate cancer include being obese, aging and certain inherited genetic mutations. Diet may also play a role in susceptibility to prostate cancer. Men who eat higher levels of red meat or dairy products and fewer levels of vegetables have a slightly higher chance of prostate cancer.

The best step men can take toward proactive prostate health is to have an active and engaged relationship with their primary physician or urologist so they can understand all the implications of the PSA – and what to do with the results once they have them.

While the PSA is not perfect, it remains an important indicator for potential prostate issues. Men should talk to their primary care provider today to determine if they should get a PSA this year.

Can Supplements Legitimately Improve Fertility or Are They Just a Farce?

Nutritional supplements not a Holy Grail solution for male infertility, but worth considering

fertility Supplements| Fact or Farce | Urology Associates | Denver

A variety of nutritional supplements are available on the market touted to reverse male infertility by improving sperm count, health and morphology. But do they really?

Physicians and patients alike want to use therapies proven both effective and safe to use. Many studies have been conducted on several supplements to evaluate whether they are, in fact, safe and effective.

The problem with some of these studies is that there is no standard dose for many of the supplements, and few of the studies attempted to assess whether there was any deficiency in patients before initiating therapy. Also, keep in mind that a well-balanced diet will already include many of these supplements.

So how do we interpret such mixed results? When there are contrary results from different, well–designed, randomized studies, it raises questions such as:

  • Was there a different patient population being studied?
  • How long was the population studied?
  • Was there a deficiency in this substance prior to enrolling in the study?
  • Are there are other variables that are not being adequately controlled?

When in doubt, ask the expert urologist

Urologists specializing in male infertility can help the male and his partner achieve a pregnancy in many ways. Most studies on nutritional supplements include patients with idiopathic issues (i.e. without any identifiable cause). It is therefore imperative to work closely with a physician with this expertise to look for and correct any other underlying issues before self-treating with a supplement.

Regardless of what supplement you choose to take, it is important to limit the amount ingested. Even if the supplement is beneficial, consuming excessive amounts of over-the-counter supplements may be detrimental to sperm production and can have serious adverse effects, ranging from gastrointestinal upset to effects on the central nervous system (fatigue, irritability, headache, vision changes). It is important to work closely with your infertility specialist to identify which supplements are appropriate at what dosages.

Physicians Ko and Sanbanegh and Zini and Al-Hathal recently reviewed the medical literature to see if supplements are helpful or not. The following represents a partial list of supplements that have been purported to be helpful.

Supplements: some work, some don’t

Selenium supplementation has been studied mostly in combination with other vitamins. The results in these studies have largely been positive, once again suggesting that selenium supplementation may be beneficial, particularly in those who had low selenium levels.

Carnitine is an energy source for cells in general, and in particular for sperm. Some studies have shown it to be effective in improving sperm count, motility (ability to properly move through the female reproductive tract) and pregnancy rates. While in other studies, no significant benefit was observed. Given the demonstrated benefit in at least some of the studies, it is possible that carnitine supplements will be beneficial with those patients who have an abnormal semen analysis.

Coenzyme Q-10 protects cells from oxidative stress, so in theory it would seem beneficial for damaged sperm. Unfortunately, the data supporting its use are contradictory, with some studies showing improvement in sperm quality and other studies showing no improvement whatsoever. Given this fact, the conclusion that can best be drawn is that coenzyme Q-10 may be beneficial.

Vitamins A, C and E, generally regarded as the main antioxidant vitamins, have been studied largely in combination to assess for any benefit in male fertility. Once again, the data are confusing, with some studies showing some benefit and others showing no benefit at all.

N-acetylcysteine decreases free radical levels, and thus may decrease oxidative injury to cells. Several studies have demonstrated improvement in semen analysis parameters. However, due to high risk of significant side effects and the difficulty of absorbing adequate amounts into the bloodstream from oral supplementation, this supplement is seldom used.

Zinc supplements, taken in the presence of zinc deficiency, have shown to be beneficial. However, with a well-balanced diet, zinc deficiency is quite rare. Given the low incidence of zinc deficiency and the potential side effects of zinc supplementation, it is seldom recommended.

Arginine has an important role in preventing oxidative injury in cells. So in theory, this would be a useful supplement to improve sperm quality. No randomized clinical trials have demonstrated efficacy, so the use of arginine cannot be recommended.

Remember, there is no magic bottle or potion that will ensure a pregnancy. But taking steps, such as working with a urologist to identify possibly beneficial fertility supplements, will put you in the best possible position to conceive.

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