In the picture above is my garage and my 1986 Toyota truck, my first air-conditioned car that I bought in residency in Augusta, Ga to use to moonlight in Millen, Ga for extra money. On the truck are our three cats, in order from right to left, Kitten, Annie, and Kibber. On the hood is Penelope as a puppie. Penelope is there to eat cat food. My wife had the habit of feeding the cats their” three cans of “stinking can” cat food on the hood of my beloved truck. When I would come home at night, if I walked by the truck, the cats would congregate there hoping to be fed. Penelope loved the canned cat food as well and that explains why she is there. Sadly, Kibber and her daughter Annie have passed away since this picture was taken. The picture says so much however about my life at the time. The sprayer, the ramp for my John Deere lawnmower, the for rent sign for the many failed property investments I’ve made, in the foreground the covered 65 Mustang, my cats, Penelope, old golf clubs that a patient gave me that I never use, an air tank that doesn’t work or hold enough pressure to be of use and the seeder I don’t use because my wife did not like how I kept the yard so is not used because we now pay someone to do that, and if you look closely on the driver’s side of the hood is an old broken fishing rod I found and have on a magnetic rod holder that attaches to the roof and hood to hold rods without having to break them down between rivers, I save old rods for the guides to use to repair other rods…the………………
I know, I need to get a life. About six months ago I started this blog thing. It was initially meant to provide a multifaceted role. One, to promote my book and two, to serve as a diary of sorts and then to offer up some things I have experienced and learned about prostate cancer as a patient and a urologist that might be helpful to others.
The first thing I discovered is that prostate cancer message boards don’t want a urologist on them acting like know it alls. They as a rule don’t like doctors and yet many research and then go to great measures to see one they have learned about on the internet.
I learned that there is a very large ” health pill” population and as a result many patients are taking various herbs and vitamins to keep their prostate cancer at bay. On Twitter search prostate cancer and see how many vitamin ad come up.
I learned about the angst amongst men treated for prostate cancer and now have complications related to that. Many blame the system and the “doctors.”
I learned the difference between doctors that are interested in what is best for the masses versus the doctors that are interested in what is best for the patient who is sitting in front of them. That’s a big difference. Think ACS vs the American Urological Association.
I learned a lot about people diagnosed late in the confusing disease that is prostate cancer, and they are writing about where they are and what their PSA is and yet don’t have a good feel for where they are in the course of the disease. ( How can a patient sense what I sense as a urologist that has practiced for over twenty years and have seen this diseases, in all forms, play out over many years in many and varied patients. I have witnessed from start to end in many of my favorite patients. Could that be helpful to someone that would listen?
I learned about Richard Albin and his father.
I learned about the American Cancer Society. I would have thought that I would be on the same page as them….but I am not.
I have learned about the passion many feel about active surveillance, and if they pursue that route wear in on their sleeve as if it were a badge of ” enlightenment.”
I have seen the concept of a ” little knowledge” practiced so often by the prostate cancer internet society…that I can no longer bring myself to comment on it.
I have met by way of comments and emails many beautiful people who are either struggling with this disease or are living through it vicariously by way of a loved one. Look at the link to Team Winter and you’ll see what I mean or the link to Dana Jenning’s NYT blog.
And then all the famous people that have the disease.
And much more….but back to blogging.
Did you know that one of the services of WordPress has to do with tracking who visits your blog and where they click to and what searches bring them to you? This is the subject of todays post.
Top search: Is one PSA enough to have a biopsy? (I will not comment on the other most popular search….”masterbation and tomatoes.”)
Answer: No…one PSA is usually not enough to have a biopsy. Several things can make a PSA high. Prostatitis, sex the night before, lab error, Padgets disease, certain meds and of course prostate cancer. Because of this either a repeated value after a period of time and often after a course of antibiotics is probably in order. Even better is a series of PSA’s confirming the elevated value in addition to a trending up of the value over time.
So is a biopsy after one elevated PSA wrong? No. I have done that. Remember, and many folks forget, the patient – doctor relationship is two-sided. I have had patients whose ” mindset” doesn’t allow for a delay or there is a strong family history of prostate cancer. In their mind they would rather ” put it to rest” and I have in these patients done the biopsy. Remember by the time you and your family doctor have gotten you to a urologist, it about time to ” fish or cut bait.” The urologist did not go out and advertise for you….you showed up at the urologist’s office with an abnormal lab value and needing a disposition.
Finally, be proactive about all of this. Get a second opinion, ask questions, get another doctor if you feel he or she is biased. “Ain’t nobody gotta to make you do nuthin you don’t wanna do.”
Yesterday I told a family that the patient had prostate cancer in his biopsy specimen. The patient said, ” I have a friend and he said that if my biopsy showed cancer I should have seeds. What do you think about that?”
I said, ” In some cases that is the appropriate thing to do. You have some work to do however to determine if that is the best route for you.”
The patient looks at his wife and says, ” He must be alright. My friend said if your doctor says that you have to have surgery then you should get another doctor.”
I don’t advise playing games with your doctor, but there are times in your visit that if you pick up on bad vibes or that you don’t feel good about your relationship you should get another opinion. My advice is to sap each caregiver you meet for any and all information you can get. Then you make an informed decision that is best suited to you.
In “The Decision” the emphasis is on you and that you ultimately make the decision based on facts pertinent only to you…with the doctor facilitating that.