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Oral Testosterone (Jatenzo) is Finally Available

Clarus Therapeutics has finally gained FDA approval for Jatenzo, the first oral form of testosterone available in the United States. Previously, oral formulations of testosterone had been shown to cause liver toxicity. But, Jatenzo has been shown to successfully bypass the liver, instead entering the lymphatic system and then the blood circulation.

Jatenzo comes in several different dosages and is taken twice daily with food. Due to its frequent dosing, testosterone levels stay quite stable on treatment. This is an excellent treatment option for men who don’t want to perform weekly injections, or who haven’t responded well to topical treatments.



For many couples, having a reliable and permanent method of birth control equates to peace of mind. Many women are unable to take hormones for a variety of reasons; therefore, a vasectomy may be an option worth exploring. A vasectomy is a procedure done to block or cut both of the vas deferens tubes within the scrotum (tubes that carry sperm). If the sperm cannot make it out of the tubes, and into the vagina, it is impossible to achieve pregnancy. If you are in a committed relationship, already have children and/or you and your partner are confident that you will not want any future children, a vasectomy might be right for you.

However, many men are still reluctant to take the plunge. Some are concerned about the pain and recovery. Some are concerned about potential sexual side effects. Some are worried they may regret it, or that it somehow won’t work, and they could still get their partner pregnant. Let’s assuage these fears!

First, let’s address pain and recovery. A vasectomy is a minimally invasive and thus minimally painful procedure. Your doctor will first make you as comfortable as possible and use local anesthesia to numb up the area. At Maze, we perform what is called the “no-needle, no-scalpel vasectomy.” This is when the doctor makes one tiny puncture hole to reach both vas deferens. Your tubes are then tied off, cauterized, or blocked, and the puncture site heals quickly. No stitches or scarring required! This method also helps to reduce bleeding, bruising and risk for infection. A win-win!

Next let’s discuss potential issues with reliability. After a vasectomy, you may be uncomfortable for a few days. You can start to have sex after the discomfort subsides, but just remember that the vasectomy WILL NOT prevent pregnancy right away. It does take a good 3 months from the time of the procedure for your semen to be completely free of sperm. Therefore, you will want to use a condom or other form of birth control during penetrative vaginal sex until that time. At the 3-month mark, your doctor will check your semen to make sure there is no sperm – and then, you get the green light! At this point you can be assured that this method of birth control is more than 99% effective!
A vasectomy is one of the most reliable forms of birth control available, and this peace of mind can be very reassuring for both partners in the relationship.

Now – let’s talk about sex! One very important point to make is that a vasectomy will NEVER prevent you from getting a sexually transmitted infection. So, if that is a concern, a condom is still the best bet. With regard to erectile functioning after vasectomy – impotence is EXTREMELY rare. This is because erections and ejaculation involve stimulating nerves, increasing blood flow to the penis, muscle contractions and mental stimulation. A vasectomy only affects the vas deferens – whose only job is to help carry sperm from the testes. In fact, erectile dysfunction sometimes can improve after a vasectomy. When a couple can have sex without the worry of pregnancy, they relax and can enjoy the experience that much more!

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Primary Care vs. Pain Specialist: The Benefits of Pain Management

If you suffer from chronic pain, you’ve probably already had discussions and possibly started treatment with your primary care physician. Many patients have been seeing the same primary care physician for their entire adult lives and feel very comfortable with them, therefore preferring to receive all advice and care from their own doctor. Other patients have cited that they prefer that their primary care physician treat their chronic pain for efficiency – seeing one doctor in one location works better for their schedules.

The best thing your primary care physician can do for you if you are suffering from chronic pain is refer you to a pain specialist. To truly reap all of the benefits of pain management, it is best to see a doctor trained in your specific type of chronic pain.

What Do Pain Management Doctors Do?

Pain management doctors are specialists with a high level of training and experience in diagnosing and treating different types of acute and chronic pain. You may wonder what pain management doctors do that is different from your primary care physician, and the answer is a lot. The pain management field has grown over the years and continues to become more and more complex, making it that much more important to work with a specialist. Here’s a list of what pain management doctors do that a primary care physician cannot:

  • Perform specialized test for diagnosing chronic pain conditions
  • Appropriately prescribe and manage medications to unique conditions at varying levels of severity
  • Conduct procedures like nerve blocks and spinal injections
  • Coordinate additional care, including physical and psychological therapy or rehabilitation

To be referred to a pain management specialist near you, talk to your primary care physician.

Benefits of Pain Management

While your primary care physician is knowledgeable about a wide variety of health and physical issues, they have not received the same level of training on specific conditions that a specialist has received. In fact, in 2011 only four medical schools in the entire United States included courses that focused solely on pain in as a part of required curriculum. As a result, a survey of 500 primary care physicians in the same year revealed that only 34% of the participants said they were comfortable treating patients suffering from chronic pain.

Part of what our pain management doctors do after medical school includes completing additional residencies, internships and fellowship training specific to the treatment of chronic pain. This additional training not only deepens their knowledge of chronic pain itself, but also the interventional procedures that can help reduce suffering and increase quality of life. The main benefits of seeing a pain management specialist include:

  • Extensive experience and training in pain management
  • Access to specialty equipment and treatment options that are highly focused on specific types of chronic pain
  • The ability to prescribe and manage the types of medication that can help suppress chronic pain during

One of the benefits of pain management care at Pain Relief Centers is that our specialists will work with you to create an individualized treatment plan for your unique condition and its level of severity. Our approach is to use the most innovative and minimally invasive methods the industry has to offer. To schedule an appointment, find a location near you.

erectile dysfunction

Best Solutions for Erectile Dysfunction

Simply put, erectile dysfunction is a man’s inability to have or maintain an erection. Nearly 30 million men in the United States have been diagnosed with erectile dysfunction. And while it’s a fairly common health concern for men, especially those who are age 65 and older, erectile dysfunction surprisingly isn’t a normal part of aging. Nearly everyone has an occasional lapse in performance, however, most men are unwilling to talk about it, even with their urologists.

Identifying the cause of erectile dysfunction is the first step toward diagnosis – and treatment. The good news is that there are a variety of solutions that can address and treat erectile dysfunction. Here are some causes of erectile dysfunction and solutions to address them.

Low Testosterone

One in three men who have erectile dysfunction reportedly have low testosterone. Primarily produced in the testes, testosterone is the hormone that fuels a man’s sex drive. When testosterone levels are low, it can reduce a man’s sexual ability. If you are diagnosed with low testosterone, your doctor may prescribe testosterone therapy, which could include injections or medication, as well as lifestyle changes such as an improved diet or exercise program.

Traumatic Brain Injury

The brain controls everything, so when the brain is injured, it prevents messages from being properly transmitted to other parts of the body. The penis is no different. Traumatic brain injuries, as well as trauma to the spine and nervous system, often impact a man’s ability to get or maintain an erection. If this is the case, your doctor may recommend medication, but he also may recommend seeing a therapist or other mental health care professional if the trauma has resulted in depression or feelings of inadequacy that impact performance.

Trauma to the Pelvic Area

Trauma to the pelvic area or penis will have the same result as if blood supply is interrupted or nerves are damaged. Erectile dysfunction that occurs as a result of pelvic or perineal trauma can be treatable with revascularization which, in a sense, is a surgical strategy that doctors use to place new blood vessels around existing blockages to restore necessary blood flow.

Vascular Disease

Vascular diseases reduce the amount of blood flow to organs, including sexual organs. In 50-70 percent of men who have erectile dysfunction, poor blood flow or vascular diseases is the underlying cause. Treatments available for vascular disease can be effective in eliminating erectile dysfunction. Your doctor will diagnose the condition and then prescribe treatment, which may include medication to address blood flow. Other lifestyle changes might also be suggested by the health care professional. Smoking for instance, has a negative effect and can lead to erectile dysfunction.

Underlying Conditions

Erectile dysfunction can be a symptom of another condition. Address that condition and the erectile dysfunction will also be addressed.  Clogged blood vessels, high blood pressure, diabetes, nerve damage, HIV and cancer are all relatable causes of erectile dysfunction.

Dr. Desiderio (Desi) Avila, Jr., is a fellowship-trained urologist who specializes in male infertility, low testosterone, prostate health, and erectile dysfunction. If you live or work in the greater Phoenix area, call Ironwood Urology to request an appointment with Dr. Avila. He will assess your situation and prescribe a treatment plan to meet your urological issues. You may request an appointment at Ironwood Urology, by calling 480-961-2323 or request an appointment online.


COVID-19: CMS Issues FAQ Regarding Emergency Medical Treatment and Labor Act

Hospitals across the country are questioning whether and how the Emergency Medical Treatment and Labor Act (EMTALA) requirements apply during the COVID-19 pandemic. Last week, CMS issued a list of Frequently Asked Questions (and answers) for hospitals and critical access hospitals (CAH) regarding EMTALA (the FAQ). The FAQ offers a number of clarifications and insights for hospitals seeking EMTALA compliance guidance during the COVID-19 emergency, including guidance related to signage, the use of alternate locations for screening, and the use of telehealth services.

We have summarized and analyzed some of those clarifications and insights below, arranged by the subject headings CMS utilized in the FAQ. (We note the relevant FAQ number under each subject heading.)

Patient Presentation to the Emergency Department

Hospitals may place a sign outside an Emergency Department (ED) stating “COVID-19 testing is not being offered to asymptomatic patients.” In addition, hospitals may use signage to inform individuals about the availability of COVID-19 testing or to provide direction to alternative sites on the hospital’s campus where medical screening examinations (MSEs) are available, including, e.g., a parking lot COVID-19 test site. Hospitals also may encourage the public to go to off-campus sites for COVID-19 screening, instead of the hospital. CMS emphasizes, however, that it is a violation of EMTALA for hospitals and CAHs with EDs to use signage that presents barriers to individuals, including those who are suspected of having COVID-19, from coming to the ED (FAQ #2).

Hospitals may redirect patients to another location (e.g., an offsite alternate screening location) to receive a MSE pursuant to a section 1135 waiver and a state emergency preparedness or pandemic plan, regardless of the presence of COVID-19 symptoms. Even patients transported in ambulances owned and operated by a hospital may be transported to a different hospital as long as the ambulances are acting in accordance with a community-wide EMS protocol (FAQ #3).

Where Does EMTALA Apply?

Hospitals and community officials may encourage the public to go to off-campus sites for COVID-19 screening, instead of the hospital, as long as those sites (i) are operating in accordance with the state or local pandemic plan; (ii) are identified specifically by the hospital as the location to receive a MSE; and (iii) have the capability and capacity to provide the required MSE. In addition, for the duration of the public health emergency (PHE), hospitals may, pursuant to a section 1135 waiver, re-direct patients that had presented to the ED to an offsite location for a MSE in accordance with a state emergency preparedness or pandemic plan. (FAQ #1)

For the duration of the COVID-19 PHE, hospitals may, pursuant to an 1135 waiver, establish and operate, as part of the hospital, a location meeting the Conditions of Participation (CoPs) for hospitals that continue to apply during the PHE. The waivers also allow a hospital to change the status of its current provider-based department locations to the extent necessary to address the needs of hospital patients as part of the state or local pandemic plan. As such, it is acceptable to triage and treat patients in Temporary Expansion Locations, as described in CMS’ Hospital’s Flexibilities to Flight COVID-19 article (FAQ #2).

Even in situations where a hospital may not have necessary services or equipment, if an individual is determined to have an emergency medical condition (EMC), the hospital is required to provide stabilizing treatment within its capability for that individual prior to arranging an appropriate transfer. For example, in cases where the hospital does not have available ventilators, establishing an advanced airway and providing manual ventilation can assist in stabilizing the individual until the hospital can arrange for an appropriate transfer (FAQ #4).

The use of telehealth to provide evaluation of individuals who have not physically presented to the hospital for treatment does not create an EMTALA obligation (FAQ #6).  The use of telehealth in the EMTALA context is addressed below under the heading “Telehealth.”

Qualified Medical Professionals

Hospital governing bodies must still approve qualified medical professionals (QMPs) to perform MSEs. Hospitals may, however, request a case-by-case section 1135 waiver to allow MSEs to be performed by qualified medical staff authorized by the hospital, who are acting within their scope of practice and licensure, but are not designated in the hospital bylaws to perform the MSEs (FAQ #1).

Medical Screening Exam

QMPs, including emergency physicians, can perform MSEs using telehealth equipment. The QMP may be on-campus and using technology to self-contain, or offsite due to staffing shortages. The MSE may be performed solely via telehealth if clinically appropriate. If the patient is seen by a QMP located on campus via electronic two-way technology, the service is not considered a telehealth visit. Regardless of location, the QMP must be performing within the scope of his/her state practice act limitations and approved by the hospital’s governing body to perform MSEs (FAQ #1). Additional uses of telehealth in the EMTALA context are addressed below under the heading “Telehealth.”

A hospital may set up alternative sites on its campus to perform MSEs and may redirect individuals to those sites. Whether the individuals are seen at the alternate on-campus site or in the ED, they should be logged in where they are seen. Individuals do not need to present to the ED first, and if they do present to the ED, the hospital may still redirect them to the on-campus alternative screening location for logging in and subsequent screening. This is a triage function, and the person providing the redirection from the ED should be qualified to recognize individuals who are obviously in need of immediate treatment in the ED (FAQ #3).

EMTALA applies if a patient who is solely seeking COVID-19 testing makes a request for medical treatment while on the hospital campus or demonstrates a medical condition that a prudent layperson would believe, based on the individual’s appearance or behavior, indicates that the individual needs examination or treatment of a medical condition. However, patients who present solely for the purpose of COVID-19 testing and are not making a request for treatment of a medical condition, do not necessarily require a MSE (FAQ #5).

If a hospital sets up a COVID-19 testing location offsite, and patients only present to the hospital for testing without requesting additional services, those patients do not need an MSE before they are referred offsite, unless they are requesting examination or treatment for a medical condition or demonstrate a medical condition for which a MSE is necessary (FAQ #9).

Transfer and Stabilization of a Patient

Hospitals may transfer patients (including non-COVID-19 patients) to a designated facility to better isolate or cohort patients in accordance with a state emergency preparedness and pandemic plan, following an appropriate MSE and determination that the individual is stable for an appropriate transfer (FAQ #2).

Hospitals must provide a MSE to all individuals who come to the ED requesting treatment for a medical condition, or where the individual is demonstrating the presence of a medical condition, to determine if an EMC exists. Once the MSE is complete and if a QMP determines that the individual does not have an EMC, the hospital’s EMTALA obligation ends and the hospital may refer the individual to an urgent care center for continued care of a non-emergency illness or injury. However, a section 1135 waiver gives hospitals the ability to re-direct patients that had presented to the ED to an offsite location for the MSE in accordance with a state emergency preparedness or pandemic plan. Under the section 1135 waiver, hospital EDs may redirect incoming patients to alternative screening sites staffed by qualified medical workers to ensure that symptomatic or COVID-19-positive patients are directed to appropriate settings of care (FAQ #6).

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