How the urologist is like a car salesman when it comes to prostate cancer decision making. There’s an art to both professions.


 

What a week. Monday morning and off to work in my wife’s old 96 Chrysler van that I have been driving for about 10 years or so because she didn’t want it any more. It made a loud sound when you turned the steering wheel, which I admit was a bit obnoxious, and she did not want it anymore.“I bet this sound can be fixed Karen,” I said ever the frugal one.Well the car at that time was about 5 years old and had the wear and tear of three children, dogs, and the obligatory trips to Disney, a shuttle launch, school, scouts, tennis, soccer, ballet, Orange Beach, trips to Lagrange and Fayetteville to see extended family, and on and on. This particular van was special. Did you know that at the time we got it vans only had one sliding door? The Town and Country Chrysler was the first to have dual sided sliding doors. Man it was nice, leather, stereo, three rows of seats, I mean it was nice and I was so proud to have been able to get it for my wife and children. (I have a video of my wife coming home from a soccer game one Saturday and finding it in the driveway wrapped in a big ribbon. Good stuff.Anyway the van, my office staff calls it POS white, (Piece of sh__ white van) died this Monday morning. It could have been bad. My neighborhood abuts a very busy road in Gainesville, Thompson Bridge Rd, and pulling out into that road on a school day is quite the trick. Four lanes and folks barrel down that road. Chicken 18 wheelers going in both directions makes navigating the pull out across one two lane and then into the other two lane in the opposite direction often times dangerous. So I am about to pull out, literally three feet from the road, and the van lurches two feet and stops dead.  Eying left to the north going traffic I see the chicken 18 wheeler coming and a car from my neighborhood approaching me from the back. I quickly put into neutral and rev the motor (that has worked in the past) , as I begin to put it into drive it dawns on me that I may very well be lurching into millions of pounds of momentum of an 18 wheeler loaded with chickens. (What a sight that might have been. Probably would have made someone happy.) Anyway I luckily think better of it and put it in reverse after the truck passes, but that does nothing as well. Between breaks  in traffic and waving every person I know in my neighborhood to “go around” I try to go forward and backward without any results and resign myself to the reality that the transmission has finally perished and that I am going to have call a tow truck.My phone does the little bird sound indicating a text message from my office nurse, “You have four patients here and ready,  Tina.”Since the only way the people in my neighborhood can access Thompson Bridge Road was right where my van died,  car after car has to go around me.  A teenager in a Hummer goes by me and smiles somewhat condescending.  I get the number of a towing service from my wife after hearing for the 1000th time, ” John this is ridiculous. You need to get a new car. This isn’t safe and it really isn’t funny anymore.””May I have a number please. I am in a bit of fix right now, ” I say.

The towing service has a lady answering the phone and I immediately say that, ” I am not in a safe place.” I learned that from calling AAA because if say you are safe they put you at the end of the line and it will be hours until they dispatch someone to you.

“Sir where do you want to tow it to?” she asks.

Well I don’t know. Where should I have it towed? The transmission is dead. Do you know the name of that kind of place to take it?”

“No sir I don’t. Where do you want it taken?”

“I know the Ford place manager. Can I take it there?” I ask.

“Yes. We will bill Greene Ford then,” she says.

“Can you do that without asking them first?” I ask all the while waving cars by to and fro. One neighbor circled around three times to be sure he could not help so I am now talking to good willed neighbor and the curt towing lady.

“Yes sir. We do it all the time. So you want me to have towed there?”

“Yes mam. I’ll call in advance to tell them it’s coming.”

Just as I got off the phone another neighbor drives up and asks if he can help and I initially said no but now that I was about 30 minutes late for work it dawned on me that a ride back to my house to get POS red (Piece of sh__ red 86 Toyota truck) to then go back to the van to get stuff out of it and then continue to work. The towing lady told me it was acceptable to leave the van unattended. She said just leave the key on floorboard.

So now I am getting into the truck of a neighbor and begin to worry that the police will show up at my car and go through it. I mean my van is embarrassing on the inside. Let’s see there is potting soil from when I was going propagate hydrangeas but never got around to it. My broken mountain bike from when it was on top of my van and I ran into the height bar at the hospital parking lot. That episode tore the bike rack off the top of the van. The gallon of unsweetened tea in jug from the week before, and a bag that had a gag gift from my nurses at my surgery center given to me on my birthday back in April and who knows what “urologic” samples I had floating around in the van that I keep on hand to give certain friends. All of these items, and some I can’t mention, I wanted out of the van before any mechanic or officer started poking around it.

This dawned on me as I settled into the truck and I say, ” Thanks so much. Can you get me to my truck quickly. I have some things in my van that I’d prefer no one see. It might put me in difficult position.”

I said it somewhat kidding, but the way it came out was as if there was something illegal in my van. My neighbor looks over at me with a look shock and as he does I note that the truck is now going much faster. The neighborhood was flying by outside the window beyond my friend.

“You mean like guns and drugs John?” half way kidding.

“No not that bad,” I say laughing.

“Well don’t worry I’ve got your back and will have you at your house as fast as possible.”

We must have been going about 45-50 and I was feeling like I was criminal in a get away car.

He drops me off and I tell him thanks and get into POS red and my wife comes out to further chastise me about my car situation. As I back out of the driveway an empty can rolls out of a rusted out hole in bed of the truck and then rolls down the driveway as I speed off to get contraband out of my van. (My wife told me later that evening it was about as funny a thing she’d ever seen considering the circumstances of the morning.)

So I am now back at the van, I get all the stuff out and transfer it to the van, put the emergency blinkers on and then go to work about 45 minutes late. I begin to wonder what to do. Do I let the van be taken to the Ford dealership thinking that this is the end of the road for the van and just get me a Ford truck? Or do I at least have it evaluated to see how much it is going to cost to fix? I mean if it  is less than a thousand dollars to fix the van that might be an option. I just put new tires on it and had the air conditioning fixed. I begin to debate whether I should let a patient of mine who has a shop check it out and then decide. But what about where the tow truck takes it? I did not want it at the Ford dealership yet because that might make me feel I need to go ahead and buy a truck. I call my patient who has had an automotive repair shop for 50 years.

“I don’t do transmissions. Have you check the level of the transmission fluid?”

“No I haven’t. All this happened three feet from a busy road. Is there a light for that on the dashboard? I never saw a light.”

“No there is no light. You just check it. Anyway I don’t do transmissions. I’d send it to Gainesville Transmission. That is where I send my stuff. Maybe it is just low on fluid.”

I get the transmission place’s number and call. I explain the situation.

“Really can’t tell you much without seeing it,” he says.

“If it were your van would you fix it or just get a new car?”

“I really don’t know what to tell you,” he says.

“If I send it to you is it okay if they bill you. They said they’d prefer to bill where it is dropped off.”

Silence…

“I guess so,” he says.

“Well I am going to call the towing place and have them bring it to you. It is a white 96 Chrysler van.”

I then call the towing lady and say, ” I may have you take my van to Gainesville transmission instead of Greene Ford. Is that okay?”

“The driver is in route so let me know,” she says.

“I’ll call you back if anything changes,” I said. (At least that is how I remember what I said. I was at my office and all of this is taking place between patients and having been almost an hour behind.)

“Doctor McHugh, line one,” the intercom blares. It is now about 12:10, around three hours since I left my van at the only place you can pull out of my neighborhood and turn in either direction and three feet from the one of the busiest roads in northeast Georgia.

“John,” my wife says. “What is going on with your van? It is still out there near the highway and the police are here saying they are going to impound it. Is somebody coming to get it?”

Gotta let Penelope chase a stick in the lake to let off some energy. To be continued. Bet no one cares….

ADT therapy may be better off being delivered intermittently

August 17th, 2012 Posted in hormone therapyMen with advanced prostate cancer receiving androgen-deprivation therapy (ADT) may be better off being treated intermittently rather than on a continuous basis, show study findings. Although intermittent ADT (IAD) did not particularly make a difference to the occurrence of adverse events (AEs) compared with continuous ADT (CAD), it did significantly improve men’s quality of life, especially in terms of activity limitation, physical capacity, and sexual functioning. The findings, published in European Urology, come from a comparison of 554 patients randomly assigned to receive IAD or CAD as part of The FinnProstate Study VII.

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