Blood in the semen

So scary, but usually so meaningless...

Blood in the semen, or hematospermia, is a fairly common event that can occur at any point in a man's life. Men are not accustomed to seeing bleeding from any body part or in any secretion. So when blood is present, most men panic.

"Could it be cancer? Infection? Injury? Will my genitals shrivel up and fall off?" are questions that race through men's minds when they see blood in a place that is not expected.

It can be bright red, clots, speckles, or just brown tinged. The good news is that hematospermia is not rare and is almost always a meaningless finding of no concern.

Usually not associated with any pain or discomfort, blood probably enters the semen from a small blood vessel that tears during ejaculation or even straining with constipation. Sometimes it just happens.

And as fast as it comes on, it can disappear. Other times, blood may linger for days, weeks or even months. If the bleeding is heavy or prolonged, then further evaluation by a urologist is in order. If there is pain or burning, then it is time to see your urologist.

For older men over 45, it is probably a good idea to get a prostate exam and PSA blood test, just to rule out any prostate cancer concerns. The good news is that if and when it occurs, it is not an omen of pending death or spontaneous combustion of your genitals.

Related Topics:

• Prostate Health
• Assess the Health of Your Erections

Technorati Tags: hematospermia, blood in semen, mens health

Insurance: Deciding who benefits

Part II- Deciding who gets what, or "I've always wanted to be a psychiatrist"

Several years ago I accepted the position on an HMO's medical review committee. Wow, the power. Getting to decide who gets what. This was apparently an important committee for those who were looking to move up the ladder. I was very excited.

At my first session, I was handed requests for care from a number of surgeons. As a urologist with several years of intense general surgery while a resident at the Mayo Clinic, I felt comfortable making decisions about surgical patients. Hmmm. An elderly lady needs a hip replacement. Yes, of course. A new knee after an injury. Absolutely yes. Reconstructive arm surgery with skin grafting after a severe burn in a 6 year old girl. Sure, who could think otherwise?

"Excuse me, Dr. Marks. Apparently you have not read the indications approval guidelines. I, as the committee chairman will have to override the approval for the girls arm surgery. You see, she does not qualify."

"What do you mean she doesn't qualify? Her family pays a lot of money each month for this comprehensive insurance. She had a bad burn, and now she is seriously scarred and disfigured. Aren't we as her doctors supposed to care for her?" I asked.

I had no idea how he was going to get out of this. And this was going to be one of those moments where you start to wonder about some doctors, and who they are working for.

His answer: "You see, Sheldon, page 176, paragraph 4 clearly says that she still has a majority of arm movement so even though this is an emotionally crippling injury, and though she does have a serious impairment of the use of her arm, we are not required to pay for any additional reconstructive surgery."

Despite several minutes of heated arguing, it was clear I could not win this battle. I was after all just a lowly urologist and he was a senior internist who had apparently gone over to the dark side.

In punishment for my obviously non-team behavior, I was moved over to review psychiatric requests for office visits.

"Harmless," they must have thought. "He can't cost us much over there." So request after request, Board Certified, licensed, practicing psychiatrists were requesting anywhere from 2 to 6 additional visits to handle a multitude of patients with serious psychiatric problems.

Heck, I had done a rotation in psychiatry. I knew that these problems did not go away overnight after one visit. Who was I, a urologist, to tell a psychiatrist what number of visits were appropriate to care for his patients? Here, again I was apparently wrong.

"Dr. Marks," he started out again. "What could I have done wrong this time?" I thought. He went on, "Just because they tell us they need 6 visits does not mean we need to approve 6 visits. Here, give this request 2 visits. If it is that important, he can request more in a few weeks."

I responded, "But he's a psychiatrist that our clinic hired to care for patients. If we don't trust him to do his job, shouldn't we fire and replace him? ...and by the way, are you having a bad day?"

Apparently the wrong thing to say on both points. As I packed up my stuff and departed from my short-lived committee experience, I realized that simply going to medical school doesn't make everyone a caring doctor. So sad.

Related Topics: Learning about Outpatient Services, Mental Health Insurance Pays

Technorati Tags: HMO, managed care

When it rains, it pours

When it rains it pours.

As we continue to manage one family member's 8-1/2 year battle with ovarian cancer, another family member was just diagnosed with a fairly aggressive and somewhat advanced melanoma. After extensive research and discussions with a number of experts, we arranged for him to enroll in a promising vaccine protocol. It is overwhelming to simply be diagnosed with an advanced version of a bad cancer. Then, to top it off, to be told that most of the standard therapies have not been shown to prolong life span. Tough news to absorb when you are feeling great. So he has opted for a combination of a new chemotherapy agent, Abraxane, with a protocol using his own melanoma cells to create a vaccine.

After many visits and quite a few blood tests and x-rays, the moment has finally come to get his first dose of chemotherapy. As he sits, waiting for an unknown but potentially unpleasant experience, the nurse comes out and announces, "everything looks good but there is a slight glitch" that must be taken care of. Even though the world's experts in melanoma have recommended this new and exciting chemotherapy agent, apparently Medicare and the FDA have not approved this drug specifically for melanoma. This means he is now responsible for almost $5,000 dose of medication, or he can come back in a few weeks for another treatment to be decided at a later time.

What a decision to have to make under such pressure! How do most people deal with this unexpected problem? What if there are no other options and you cannot afford the high price of a new chemotherapy agent? But how can you not proceed, knowing that all the other treatments are relatively ineffective? And why, if the world's specialists in melanoma feel that this drug is the best thing to do to save his life, do the bureaucrats and pencil pushers at Medicare and the FDA have the power to override these doctors' recommendations? At what point is this interfering with the doctor-patient relationship?

This is not the first time we have encountered stupid, blanket decisions from non-medical decision-makers that can and do hurt patients. Going back to my other family member with ovarian cancer, year after year we have found that having a PET scan has been the most reliable way to diagnose her recurrent cancers. Even though the medical literature is filled with dozens of articles supporting the use of the PET scan for a evaluating recurrent ovarian cancer, our federal government is still many years behind the experts so each $1200 scan is still not covered by Medicare. "But what about private insurance companies," you ask? I'm sure you won't be surprised to learn that they, for the most part, follow the Medicare guidelines. These companies that claim to care about you have chosen not to follow the recommendations of the very experts and specialists that they employ. Sadly, I think it is not about doing what is best for the individual. It seems to be about the money.

What is the solution? It is relatively simple. Allow the doctors to be doctors. It is quite clear that the CEOs and accountants at the helm of our medical insurance companies (including Medicare) feel that cost control and bureaucracy are more important than caring for patients and saving lives. Why do non-medical business people feel qualified to interfere with and override your doctor-patient relationship? If you find yourself in one of these situations, become vocal. Call and write to the medical directors of your health plan. Call and write to your congressmen and senators. Tell them that unless they have gone through decades of training and practice, to get out of your doctor-patient relationship. It's just not right. Ask them if they are willing to assume personal liability for a negative medical outcome as a result of their decisions. It's about time we all say enough is enough.

Related Topics: Is Workplace Health Coverage Dying?, Milestone Medical Tests

Technorati Tags: ovarian cancer, melanoma, Medicare, cost of healthcare