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Big News for Individuals Who Need Insurance Coverage for Fertility.

On April 13, 2022, Governor Polis signed into law HB22-1008 on Implementation of Fertility Coverage.

In 2020, Colorado passed HB20-1158 Colorado Building Families Act requiring insurance plans under Colorado law to provide coverage for fertility diagnosis, preservation, and treatment. However, a provision of the law required an affirmative determination that the law would not trigger defrayal (a requirement that the state could be financially responsible for any increase in premiums) under the Affordable Care Act. That determination was not made and the law did not go into effect. However, defrayal is not an issue under the Affordable Care Act for large group market plans, but the Colorado Building Families Act did not distinguish between different insurance markets.

HB22-1008 requires large group plans (applicable to employers with over 100 employees) under Colorado law to provide coverage for fertility diagnosis, preservation for cancer patients and others at risk of medically-induced fertility, and treatment, including up to three rounds of IVF and unlimited transfers, for plans initiated in 2023 or later.

Note that HB22-1008 did not resolve coverage for individual and small group markets under Colorado law. Further, Colorado law does not affect insurance plans under federal law (self insured, Medicare, Medicaid, TRICARE, etc.) or the law of another state, which may or may not require or provide fertility coverage. Be sure to check whether your employer is self-insured or fully-insured and part of the large group insurance market subject to Colorado law.

Dr. Dan Mazur specializes in male infertility and is on the board of Colorado Fertility Advocates (CFA). CFA continues to work with the National Infertility Association to advocate for fertility rights for men and women across the country.

Peeing During Sex is Very Common – Is it Urination or Orgasm?

Peeing during sex is very common.⁣⁣⁣ Approximately 60% of women with urinary incontinence leak during sex⁣⁣⁣. Dr. Tessa Krantz answers common questions that many women are embarrassed to talk about or discuss with their provider.
⁣⁣⁣⁣

What is the Difference Between a Squirting Orgasm, Female Ejaculation and Sexual Incontinence? ⁣


All three involve fluid coming from the bladder during sex. ⁣⁣⁣

  • Squirting is the expulsion of a large quantity of liquid during sexual stimulation. This type of orgasm includes a rapid ejection of urine from the bladder.⁣⁣
  • Female ejaculation is a release of both urine and a substance from the skene’s glands; the secretion is of thick, milky fluid
  • Sexual Incontenence aka Coital Incontinence is when someone loses control of their bladder during sex.⁣⁣⁣
  • Ejaculation in people with vaginas may include a small release of a milky white liquid that does not gush out. Squirting, on the other hand, is usually a higher volume. It is possible to squirt and ejaculate at the same time. ⁣⁣⁣
  • What Other Research is Available?


    The results of a few studies have indicated that Squirting, FE, and CI are different phenomena.
    ⁣⁣

What Treatments Are Available?


There are several treatments available for coital incontinence. The most commonly suggested treatments include: Strengthening the pelvic floor with pelvic floor exercises that can be done on your own or with the assistance of pelvic floor physical therapists , bladder retraining and lifestyle changes. Some of the changes we recommend are: ⁣⁣⁣

  • Understand your triggers, and learn patterns to avoid before sex, including avoiding caffeine and alcoholic ⁣⁣⁣
  • Try different sex positions that place less pressure on the bladder ⁣⁣⁣
  • Empty your bladder before sex⁣⁣⁣
  • Weight loss if overweight may help⁣⁣⁣
  • Decrease fluids before sex⁣⁣⁣
  • Lubrication- this will place less pressure on the bladder⁣⁣⁣

If these treatments do not help, seek help from your provider, there are more options available! Dr. Tessa Krantz is a UroGynecologist at Urology Associates. For more information on women’s health topics, visit her Instagram @pelvichelp

Fact or Farce – Do Cranberries Cure Urinary Tract Infections?

 

When does the population consume more cranberries and drink more cranberry juice than during the holidays? For some who suffer from urinary tract infections (UTI’s) they have a little cranberry juice or even a cranberry pill every day.

Urinary tract infections are common, in fact, they are the second most common infection that people seek treatment for.  Over a lifetime, a woman has a fifty percent chance of having a bladder infection. But it’s not just women at risk for these pesky infections, men get UTI’s too.  It just happens to be more common in women because they have a shorter urethra, in comparison to men, and that makes it easier for bacteria to get into the bladder.

The most common cause of a UTI is bacteria, but viruses and even yeast can also travel through the urethra and into the bladder causing an infection. There are also several medical conditions that can put one at higher risk for a UTI.  Individuals with diabetes are at a higher risk, as we age the risk goes up, and women in menopause can have a higher incidence. Sexual intercourse can increase the risk and bowel conditions such as constipation or loose stools can also increase the risk of a UTI. It’s important to be aware of the signs and symptoms of an impending bladder infection, because if you catch it early, you may not need medical intervention.

Early symptoms of a UTI include:

  • Urgency to urinate
  • Discomfort – painful or burning sensation during urination
  • Frequency – visiting the bathroom frequently even if there is little urine

Advanced symptoms include:

  • More severe urgency and frequency
  • Cloudy, dark, foul-smelling or bloody urine
  • Difficulty urinating and emptying the bladder fully
  • Fever
  • Nausea or back pain

The first line of treatment for a suspected UTI can start at home – start by increasing your consumption of fluids. Make sure you are emptying your bladder often and fully. And finally, add a little cranberry to your diet. It is a farce that cranberry will cure a UTI; it will not kill the bacteria.  It is a fact, however, that cranberry juice can be a part of the cure because cranberry actually prevents the adhesion of bacteria to the bladder wall allowing the body to win the battle against the infection. Some studies show that it provides up to an 80% reduction of bacterial adhesion. So, while cranberry doesn’t kill the bacteria, it does make it unable to grab onto the bladder wall and bacteria can then pass through and out of the bladder easier. Therefore, cranberries have been shown to reduce the risk of a symptomatic urinary tract infection by about 40%.

There are a couple ways to add cranberry to your diet. You can drink one 8 oz glass of cranberry juice each day, or for those who don’t like cranberry juice or are watching their sugar intake, they can take cranberry tablets, one pill should be equilivent to one eight-ounce glass. Both contain the active ingredient proanthocyanidins. This is what helps to prevent infection.  Bladder infections can go away on their own – especially if you catch them early enoughand if you can take enough cranberry to help fight it off. If following these steps, you are still unable to get relief from your symptoms, see your health care provider to have a urinalysis and possibly a culture.  If you have more than three infections in a year you should consider an evaluation with a urologist.

 

What Happens If Prostate Cancer Comes Back?

If prostate-specific antigen (PSA) levels remain high or become elevated after prostate cancer treatment, these are indications of a prostate recurrence. The approach for treating a prostate cancer recurrence varies based on a number of factors including the following.

  • The type(s) of previous cancer treatment(s) received by the patient.
  • The extent and location of the cancer recurrence.
  • The age of the patient and other existing medical conditions.

Patients treated with traditional surgical, radiation and chemotherapy treatments often require follow-up treatment. CyberKnife can be used in conjunction with traditional cancer therapies, as well as immunotherapy and proton therapy, to manage and reduce prostate cancer recurrences.

Prostate cancer recurrence is often emotionally deflating for patients who have already endured treatment and their loved ones. Fortunately, Anova Cancer Care’s CyberKnife radiotherapy treatment may be an appropriate therapy option for recurrent cancers, with fewer side effects and less down time.

Learn What to Expect from CyberKnife Treatment

How oncologists diagnose prostate cancer recurrence

After prostate cancer treatment, the amount of PSA in a patient’s blood typically drops and remains stable. Following treatment, many men receive regular medical checkups that include routine PSA testing. If PSA levels begin to rise, it can be a sign of a prostate cancer recurrence.

Additional testing may be required to determine if rising PSA levels indicate a recurrence or the spread of the cancer to other parts of the body. Doctors may use X-rays, bone scans or perform an Axumin PET scan, which uses calcium-related radioactive substances to locate cancerous cells throughout the body. Unlike standard methods of screening, which require PSA levels in the 10-50 range to detect cancer, Axumin can identify cancerous tissue in patients with PSA levels under 10.

Types of prostate cancer recurrence

The two major types of prostate cancer recurrence that can be treated using CyberKnife are local and distant. Prostate cancer recurrences in the tissue surrounding the prostate, such as in the seminal vesicles, pelvic floor muscles or rectum, are known as local recurrences. Cancer recurrence outside the pelvis is known as a distant recurrence or metastatic cancer recurrence, for example, if a tumor has developed within distant lymph nodes.

In some cases, an individual may experience heightened PSA levels with no other clear indication of a cancer recurrence. For example, there may be no visible instances of cancer in the patient’s imaging tests. Patients with slow growing prostate cancers such as this may opt for active surveillance over treatment.

Likelihood of prostate cancer recurrence

Upon a patient’s initial diagnoses, several factors can point to an increased risk of prostate cancer recurrence. These include the size of the tumor, the stage/grade of cancer and whether the cancer has affected any of the lymph nodes.

Patients who have been diagnosed with more advanced stages of prostate cancer and patients who have higher Gleason scores (or grades of prostate cancer) are more likely to experience a recurrence. Patients who have larger tumors, or whose lymph nodes have been affected by prostate cancer, are also more likely to experience a recurrence.

CyberKnife for prostate cancer recurrences

CyberKnife offers patients precise treatment of recurring cancer tumors, with minimal side effects. CyberKnife stereotactic treatment is noninvasive, requires fewer sessions than traditional radiation, is often more effective than traditional treatments, and is often more comfortable for the patient than treatment alternatives. Unlike common treatments for prostate cancer recurrence such as radical prostatectomy and cryotherapy, CyberKnife carries little risk of causing incontinence, erectile dysfunction or lower sex drive.

Recurrent prostate cancer patients with hard to reach or inoperable distant tumors, and patients looking to avoid the harsh side effects and complications of other treatment options, should discuss CyberKnife with their physician. It’s important that these patients discuss their full medical history and previous cancer treatment protocols with their care team to determine an appropriate treatment plan.

CyberKnife after radiation therapy

CyberKnife can be a safe and effective alternative for patients who have previously undergone traditional radiation therapies, as these patients are often not eligible to undergo radiation therapy again due to an increased risk of severe side effects.

Make an appointment with our office, or contact us with your questions.