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Archive for the ‘a gainesville georgia urologist’ Category

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So…this is a classic convoluted story told in the fashion of your’s truly…”Dad quit skipping around and finish the story.”

My wife and I were married thirty-seven years ago in Augusta, Georgia. She had it in her head that we should recite the vows by memory. I was in medical school at the time and did not quite get around to memorizing my part. By the way there is a reason why the preacher breaks up the vows for the “bride and groom” to repeat because the long phrasing lends itself to errors. Well, I stayed out until about 4 a.m. doing the bachelor’s party stuff with my old college frat brothers and my new med school friends and witnessed my best friend climbing to the top of a confederate statue in downtown Augusta. “I climb to the top of statues all the time,” he tells me.  In the aftermath of this, I am left to memorizing my lines the morning of the wedding and this was, let us say, not ideal. I get up at about 7 a.m. and drive to car wash parking lot and set about to memorize the damn lines. I had to go there because I was at the time living out of a dining room of a classmate and needed the privacy.

During the wedding I recited my part to perfection and my wife to be forgot a line or two and needed the help of the preacher to get through it. (Served her right-hint…don’t add the stress of memorizing something to an ready stress laden affair.)

When we get in my 1978 Toyota Corolla to begin our honey moon, my best friend from high school, Weasel-a DNR officer, has put skunk oil in all of the air vents and has put some type of deceased animal grease on all of the door handles and window levers. He had broken into the car during the wedding reception.

We drive to Savannah for the evening on our way to the final destination of Ft. Lauderdale. We stay in a motel on Tybee Island and the next morning we stop by a C and S bank to get some money from an ATM. The suitcase is in the back seat and when I put my hand in it to get my wallet something crawls over my hand. I jump out of the car and throw the suit case onto the parking lot and out of it slithers away a large black and orange snake. All I can think is that, “I’ll  get that “f..ing” Weasel back! You went to far this time as…..hole!” This meant that the snake had been in an opened suit case in the motel room all night the night before.

So…this morning I am pondering the 37 years of marriage and all the phases. The dating process at North Georgia College, and as a medical student in Augusta. The marriage event itself, the children, the trip to California and back in the 1.2 liter Toyota Corolla with a four month old child breast feeding, and pulling a pop up camper. We spent the night in an Oklahoma state park restroom with the ranger during a tornado and in Oakland were in a Motel 6 next door to a domestic violence episode. I went to tell the manager, who was behind a prison bar like office, and when I returned my wife, holding our 4 year old in her arms, was out side the door of the perpetrator with ear up against the door. After asking my wife, “What in earth are you doing?” we pack an leave. She told me later that she was only trying to help-I guess using our newborn as a  weapon?

Then the three children, my wife teaching art, med school, residency, and then moving to Gainesville, Ga to start our career with a golden retriever Meg, the three children-the youngest two months old. My wife is a petite person but after the pregnancy and childbirth her breast enlarged and they did not fit her body, so none of her clothes fit properly. About a week after arriving in Gainesville she got her hair cut by a new stylist and they cut her hair way too short. When I come home from a very paltry and sparse day of seeing a smattering of patients, she is crying in the kitchen and holding the two month old. The kitchen had 60’s era wall paper and appliances and the linoleum floor was orange. I remember the wall paper was green with streaks of gold thread.

There she is, red faced, tears everywhere, big breasted with a shirt way too small, a really screwed up hair cut shorter than I had ever seen and to top it off holding  the crying baby.

“This house, these clothes, my breast, this hair cut…It’s not me!”

Then the children grow up, the schools and teachers, the sports, ballet, soccer, AUA basketball, baseball, vacations, trips out west, issues with most everything we participated in, then each to college and so on and so on.

Thirty years later the children are out of sight but not out of mind. All the children are in their thirties but no one is or has been married. I’m ok with it.

I’ve been treated for prostate cancer, have been in four law suits, and my wife broke her hip last Christmas almost to the day, actually on Pearl Harbor’s anniversary. She was born on D-Day. Not sure what to think about military holidays and my wife.

So…I do these microscopic vasectomy reversals-I do as many as anyone in Georgia. I also enjoy social media and have several blogs and connections  on Linkedin. One such connection, a urological professor in Italy Fabrizio Dal Moro, several times a week posts urological pictures he has drawn. They are very good. I commented on one that I do vasectomy reversals and would it be possible to draw “a sperm navigating the vas deferens to get to the promised land.” The next day I see the picture below and the comment “To my friend John McHugh M.D.”

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Well it is a long journey from a vasectomy, to a reversal, to achieving pregnancy. The artist then states, “In the spirit of Louis Armstrong.” Well I know a lot of Armstrong stuff and I love jazz. So I look up Long Long  Journey and find the song and that’s the youtube at the top of this post.

So…this morning I get up first and make the coffee and turn on the fireplace (that’s right turn on..it is gas logs and it is wonderful (having made hundreds of fires in my lifetime) and begin searching around for different version of the song and best youtube to represent it. My wife comes in and says,”Happy Anniversary.”

I say, “Happy Anniversary.” We hug and she gets coffee, I play the song and tell the story about the picture that the urologist from Italy (Padova) drew for me and that he labeled it Long Long Journey.

And then my wife says, “Well it has been a long long journey John, hasn’t it?”

And then the song waffles about in the background and I hear this verse…….

It’s a long, long journey
And I can’t make it on my own

There’s seven million people
Living right here in this town
There’s seven million people
Living right here in this town

I don’t need but one person
So, baby, why won’t you, please, stay around?

 

So,Karen…Won’t you please stay around?

 

 

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I’m reading a book about Edison suing Westinghouse in the late nineteenth century and the development of alternating current. The Serbian who “conquered” alternating current was a idiosyncratic man named Nikola Tesla. It is very interesting however I am in love with the nineteenth century and the men and women of history of that era. Think Twain, Edwin Booth, Henry James, Grant, Kipling, Osler, Roebling, Carnegie, Frick, etc and etc.

So about the study that follows and there are a lot like them. The advent of the MRI for the prostate and what does it mean, does it help, is it really that much better than systematic ultrasound guided biopsies considering the cost and time element.

In a time of all the talk of cost, why is there not more condemnation of the cost of the MRI and the interpretation of it by the radiologist by our “experts.”

Anyway here is the article. Keep in mind I have done thousands of prostate biopsies in my career and the expense of the procedure, the ultrasound, the materials used and what is paid to me for doing is less expensive than an MRI alone. Where is the outrage?

Poor little ole PSA. The Rodney Dangerfield of Medicine. Are the letters MRI more sexually appealing than the letters PSA. Oh by the way…why do you order a MRI in the first place? You guessed it…an elevated PSA…that dirty rascal keeps popping his knarly little ole head…don’t he?

Feel free to opine…if you are well versed in the MRI movement, the benefits, the cost, and why it should be the only study done on men suspected of prostate cancer please…comment. I truly want to be enlightened. Predict the future.

Prostate MRI in the Prebiopsy Setting

Urology – June 15, 2016 – Vol. 34 – No. 3

Prostate MRI in the prebiopsy setting may help identify Gleason 7 and higher cancers.

Article Reviewed: Prebiopsy MRI and MRI-Ultrasound Fusion-Targeted Prostate Biopsy in Men With Previous Negative Biopsies: Impact on Repeat Biopsy Strategies. Mendhiratta N, Meng X, et al: Urology; 2015;86 (December): 1192-1198.

Background: Prostate MRI has seen an explosion of use over the past 5 years. The perceived benefit of prostate MRI is in the identification of high-grade disease and thereby decreasing the overdetection of clinically insignificant prostate cancers.

Participants: Patients presenting to a single institution with elevated prostate-specific antigen (PSA) levels.

Methods: Patients underwent multiparametric prostate MRI with a 3 Tesla unit. Prostate lesions were scored on a scale of 1 to 5, with 5 being very high probability of cancer. Patients with target lesions underwent targeted biopsy with a standard 12-core template biopsy. Patients with a normal MRI were not included in the study, as targeted biopsy could not be performed.

Results: 352 patients were included in the study. Prostate cancer was identified in 207 men. Cancer detection rate was higher in the standard template group (49.2%) than in the targeted biopsy group (43.5%). However, targeted biopsies detected more Gleason 7 or greater disease (88.6%) compared to the standard template (77.3%). Higher volumes of clinically insignificant prostate cancers were detected by standard biopsies. Using suspicion level of 4 and 5, 85.9% of patients were found to have prostate cancer, with 69.1% having Gleason 7 or higher. Using suspicion level 4 and 5, sensitivity, specificity, and negative and positive predictive value were 78.0%, 81.6%, 87.6% and 69.1%, respectively, for finding Gleason 7 or greater disease.

Conclusions: For men with elevated PSA levels, multiparametric MRI is a valuable tool in the prebiopsy setting for detecting clinically significant disease.

Reviewer’s Comments: The authors present compelling data for the addition of MRI in the prebiopsy setting for patients with elevated PSA. What is not included in the study are the data for those patients with negative prostate MRI. In addition, MRI is an expensive imaging modality. Does improved detection of Gleason 7 prostate cancers justify the cost on a population level?(Reviewer–Michael Poch, MD).

 

Author: Mendhiratta N, Meng X, et al
Author Email: samir.taneja@nyumc.org

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The Real Prostate Cancer Second Opinion-That’s Right…I don’t have a dog in your fight!

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The prostate cancer “real” second opinion. I don’t have a dog in this fight!

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A song and movie staring Penelope and a cameo by Tootsie and Brother!

Merry Christmas!

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