Archive for the ‘no needle no scalpel vasectomy’ Category

when you say your are sorry...stop right there....no need to say "but.....

What makes my book special ( I think ) is the attention that only a urologist who has been through the prostate cancer process and treatment could make of the voiding issues. That’s what urologists do…we are human plumbers. We understand how men void, the difference between obstructive (slow stream) and irritative (frequency, urgency, getting up at night) and the medicines and surgeries used for each. It is confusing. In my book there is a very large chart showing the differences in each and how all the treatments affect each.

I once wrote on a prescription pad the symptoms and the meds for each for another doctor. A year later, he pulled it out of his wallet to use to treat a patient in my presence and said, ” John, you just would not believe how many times I have used your little cheat sheet!”

Back to the question. Obstructive…i.e. an  enlarged prostate, slow stream, secondary frequency and nocturia, stop start stream, no pressure, small caliber…….”You can’t piss and run under it.”

If you have obstructive symptoms and want to do radiation you had better beware!

If you want radiation and you have obstructive voiding symptoms…you can fix the symptoms before but not after. Things don’t heal well after radiation.

So….you have big prostate and obstructive symptoms and you want radiation, particularly seeds….

  • Microwave therapy
  • Laser prostatectomy
  • TURP
  • Maximum medical therapy if with very good response

After the above…then seeds…in most cases of prostate cancer with favorable pathology, the delay of a month or so is not a medical issue.

When  it comes to obstructive voiding symptoms and a male that want to do radiation…..

“It is better to cure at the beginning, than at the end.”

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penis pool after icy precipitation....say that three times real fast!


“John, don’t let short-term gratification out weigh long-term gain.” That’s what my mother said to me many times and that is why I am a doctor. It is however not why I am a urologist.

“Mom….this is John. I have decided to be a urologist.”

“Ye Gods John. Do you know what they do.” Priceless and why I loved my mother so. So real and uncensored. She was the best. Period!

So to the question: Will the urgency get better after radiation.

In my book I make a big point of saying that every prostate cancer patient should know what the prostatic urethra is. Do you know what it is and why it is important? The prostatic urethra goes away with a radical prostatectomy. The prostatic urethra is irritated with radiation and the reason why patients have urgency, frequency, getting up at night and not making it to the bathroom after radiation. Will you have these symptoms? If you have them will they be severe? If you have them will they be short-lived? Will they ever show up three to five years down the road? Will they go away? Will they mild and associated with diarrhea? Will they not got away?  Are there medicines that will help? Will I ever have blood in my urine three years after I have been treated with radiation? Will I get a cancer because of radiation? Can I have surgery if I have had radiation and by that will radiation affect surgery of my prostate or any other abdominal surgery that I might need?

Good question. The truth of the matter is that you will not know the answers to these  questions until you have radiation and see how your body responds. Some people’s tissues can take it, some can’t. In my book I am an expert witness for a urologist and a patient that brought a suit against him. This particular patient’s body did not like radiation….in a bad way.

So…urgency or the irritative effect of the radiation on your prostatic urethra….may get better, it may get worse, it may respond to pyridium, it may be short-lived, it may be nothing , it may be debilitating.

As a radiation therapist said to me about the treatments of prostate cancer……

“Choose your poison.”

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i want to be the person my dog thinks i am

From The Decision:

a small amount of cancer got out of the prostate before the treatment got there, so it never really left at all.


  • Patients often ask about the cancer coming back.  If the prostate is removed and the cancer is already “silently” in a lymph node or just outside the prostate, then cancer is still in the body after the prostate is removed.
  • The way you know this has happened is that the PSA will slowly rise “after” the prostatectomy.
  • So the cancer did not come back, it was outside the prostate at the time of the surgery.
  • If the cancer “comes back” after radiation, well that is a bit different.
  • There is always a chance that the radiation did not “kill” all the cancer cell. In the case of external beam, maybe the dose was not strong enough. In the case of seeds, maybe a “skip’ area where the activity of the seeds missed a spot.
  • In radiation, there is always the chance as well that as well, the cancer was outside the gland before the treatment.

So, did the cancer come back…or was it there all along. I speak a lot about luck in the treatment of prostate cancer. you’re lucky if your Gleason’s is low, your disease volume is low, and confined to the prostate.

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the people dancing are viewed as insane by the ones that can't hear the music

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 of times over the course of my rotation and felt I was good at it. At one time I wanted to be a obstretcian, because my mother had always told me she loved her “baby doctors.” I wanted to be the doctor that mothers loved just like my mother loved hers. Savannah talked me out of that idea, but that is another story. So…

In 1983 we live in Martinez, Ga which is about twenty minutes from the hospitals in downtown Augusta. One morning my wife who is very near to the “expected day of conceiving” tells me she thinks her water has broken. She was not sure. ” Will you check me John and see if I need to go to the hospital?” What she was thinking was that if I could tell if she was not that far along, she could at her leisure  make an appointment with her doctor and maybe be seen later in the day without the drama having a baby you see so often on television.

“I don’t know Karen. I don’t know about that.”

Anyway against my better judgement and after her making a compelling case that me checking would help both  of our schedules for that morning logistically, I consented.

I checked. To me I felt that the cervix was closed. In other words, things were not imminent, there was some dilating of the cervix to be done and she had time to see how things progressed and maybe make an appointment later in the day for her “real” doctor. I had a surgery that morning and left to go to the hospital. I had a bit of pride about the situation.  I had a M.D. degree but had not really practiced medicine. I felt like that I had learned something about pregnancy in Savannah and that I had put it to practical use.

About forty minutes later, I am in surgery at the Talmadge Memorial Hospital and a nurse comes in with message from my wife’s doctor.

“Dr. Echols just called.  He said that you wife began having contractions and drove herself to the hospital. He plans to deliver in the next thirty minutes if you want to be there.” 

So…a rectal exam by a man’s wife or girlfriend to see if there is a lump or something…I don’t know about that. It won’t hurt anything.

  • If they think something is abnormal and it prompts a doctor visit…no harm there.
  • If they think it is normal and as a result don’t have exams or PSA then that’s an issue.
  • You can’t hurt anything…it would be unusual for the rectal mucosa to be “injured.”
  • The normal prostate feels like the thenar emminence (that pad on the base of the thumb.)
  • If there is no lump, one can have prostate cancer anyway. You have to have a PSA…so that is a doctor visit anyway.
  • Wonder how the Otis Brawley’s of the world feel about this…it’s screening isn’t it?
  • To my knowledge nurses don’t do rectal exams. Why aren’t nurses doing prostate exams.?
  • Maybe as a gift certificate for Valentine’s day, a urologist could come to the home…is that where this is going?
  • Summary statement: Anything that increases awareness and prevents the tragedy of those men diagnosed in their fifties of the kind of prostate cancer you can’t do anything about…is a good thing.


Valentines Day Self Exam-What?

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success as a doctor? one group, one city and ....one wife.... jm

A guy goes to a urologist because of difficulty with sexual function. The urologist greets him and then escorts him to a room. ” My nurse will be in, in a moment.”

The attractive and provocatively dressed nurse enters the exam room, undresses the patient and then “does things to him.”

“Wow” the patient says. ” I guess everything is alright down there. Thanks very much.”

The doctor enters and says, ” The nurse says she has corrected the problem. I’ll see you again if the problem recurs.”

“Thanks doc.”

As they are leaving they pass another exam room with a glass window showing with about fifteen men all sitting around in a circle playing with themselves. The patient looks through the window and is intrigued.

“Doc. What are those men here to see you for?”

“Oh” the doctor says, “They are here for the same problem you are here for…except they have Obamacare!”

be careful what you wish for

Thougths blog

What’s good for the goose will be good for the gander. Vasectomies? The elderly with hip issues? The elderly with an elevated PSA? Cataracts?

Not a political comment, just don’t know. Just don’t know.

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I love the part about, ” McHugh got the name of his surgeon from a traveling salesman.”  Too funny!

Well, the book is about making a decision about what to do…not who will do it. It turns out my drug rep was right on. 

The US Review of Books


The Decision: Your prostate biopsy shows cancer... Now What?
by Dr. John C. McHugh
Jennie Cooper Press
reviewed by Carolyn Davis

“The newly diagnosed prostate cancer patient… needs to know what is pertinent and specific to him in making a decision on how to treat it.”

A urologist, McHugh, was inspired to write this informative book after he developed prostate cancer and dealt with treatment options as a patient. Part guidebook, part autobiography, it is intended for men who are facing the often perplexing choices of potential treatments.

McHugh encourages men to begin regular rectal and prostate examinations in middle age, and cites examples of patients who developed cancer well before age 50. The ‘big three’ examinations that he recommends are a test for Prostate Specific Antigen (PSA), the rectal exam, and a biopsy report. The author uses various charts, including a “McHugh Decision Worksheet,” that surveys a man in ten categories to help him to determine if he is a “radiation type,” a “surgery type,” or “undecided.” Diagrams illustrate and define the different types of prostate cancer, specific locations of cancer within the prostate, the options for treatment, and each option’s likely effects and side effects.

The doctor describes many of his personal experiences as a patient, for example “I did not get good vibes from the urologist I spoke to initially in Atlanta… he repeated, an inordinate amount of times, how many of the procedures he had performed. … Remember, a lot of this decision process [for the patient] is a gut feel.” Ultimately, McHugh found the surgeon he used through the recommendation of a visiting pharmaceutical representative.

“Prostate stories” and more of McHugh’s autobiography complete the book. The Decision is recommended for its combination of empirical tools, personal anecdotes, and overall compassion.

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Northeast Georgia Urological Associates Vasectomy Page

This has nothing to do with prostate cancer. I have been using the Madajet Technology to perform no needle vasectomies and it has made a difference on several fronts. I just thought it might be interesting to you ” needle phobic ” men out there.

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