Month: November 2014

This will probably be TMI  (too much information) but I think  it will make a point nicely. When I was a urology resident in 1983, my wife was pregnant with our second child Bess. As a medical student, I had done a rotation in Savannah, Ga in obstetrics. I must have delivered about twenty babies and checked hundreds of women at various stages of pregnancy. One of the things you are taught is to determine how close a women is to delivery after the patient’s water breaks. What you do is a mini-pelvic exam to see how  far apart the cervix has spread. No spreading means that the birth is not imminent. If the cervix is 10 centimeters and thin, then birth is very close. You place two finger in the vagina, find the cervix, spread your fingers to the width of the opening then estimate the distance. I had done it hundreds…

And they say sexual intercourse may not have the same protective effect because of the possibility of contracting a sexually transmitted infection, which could increase men’s cancer risk.

Australian researchers questioned over 1,000 men who had developed prostate cancer and 1,250 who had not about their sexual habits.

Men who ejaculated more than five times a week were a third less likely to develop prostate cancer later in life.

Fluid

Previous…

A couple of days ago, on a most interesting patient, I performed a prostate biopsy. As we got started it came up that he enjoyed doing impersonations, ” I particularly like doing Australians,” he said. As I was performing the prostate block and with the patient now on his left side I say,” Do some if you don’t mind.” He had taken a pain pill and a sedative I had given him before the procedure and with the addition of the prostate block he was having very little discomfort. At this point he does Russians, Australians, Roger Moore, and all sorts of neat snippets of movie and cartoon characters. ” I think the favorite of the girls I work with is a baby crying,” he said and then proceeds to do that to perfection. It was perfect and the pitch so high it was hard to imagine how he did…

This was a comment/question a few days ago….this issue is confusing  but I think I can simplify it-here goes.

• The ongoing debate about the PSA has to do with pretreatment decision-making. The PSA is often times elevated before the diagnosis of prostate cancer is made for many reasons other than prostate cancer. So some want to “throw the baby out with the bath water.” If you come into my office and you are referred to me for an elevated PSA (anything higher than 4) a couple of things could happen. I might repeat it, I might give an antibiotic and repeat the PSA several weeks later, or if on rectal exam there is an abnormality-I would recommend a biopsy then without repeating the PSA (the rectal exam trumps the PSA if the prostate feels abnormal.)
• If the PSA is elevated pre diagnosis (by this I mean at this point we don’t…

Family guy sues doctor for rectal exam. Violated! 

The reason the above resonates as funny is that many men really feel  this way about a doctor doing  the prostate exam. This in turn leads to attempts at early detection being thwarted. 

You hear about a famous person being ” stricken” with terminal prostate cancer almost weekly. What has happened here is a male that , for whatever reason, had not had a prostate exam or a PSA. They were most probably in good health otherwise, no voiding symptoms and life was perking along just fine. The prostate cancer slowly grows, not causing any voiding symptoms and that is the kicker, and spreads to the bones which does cause symptoms and then and only then does this class of patient goes to the doctor. He then finds that he has “terminal” prostate cancer. 

To me it seems there is a…

“And the universe is a lot like the earth, if you go straight around you end up where you were, and the universe is a lot like the earth….”

Modest Mouse