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I wish vasectomies were done on women instead of men!

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It has been about five years since “The Decision” has been published. I am working, minimally I might add, on the next edition. Minimally because very little has changed in the decision process. Yes there are new treatments, the robotic removal is performed better with less problems by more experienced urologists, but this fact remains. You are told you have prostate cancer. You have three options: you can have it removed, you can have some sort of energy to treat it and avoid surgery, or you can do nothing. It really is not about what is new out there it is about the process of getting there and that is why the book “The Decision” is still relevant really without another edition. If you have read this book and it helped…do a review on Amazon.com.

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A smart man learns from experience…a wise man can learn from advice….

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A patient can have fleas and ticks at the same time.- Osler

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I pictured you walking backwards and that you were coming back home...I pictured you walking away from me and hoping you were not leaving me alone...

I pictured you walking backwards and that you were coming back home…I pictured you walking away from me and hoping you were not leaving me alone…

Chapter Two-A dog shows up at the lake
John and Karen had two other dogs, Oscar and Tootsie, both of whom they loved dearly, but there was an emptiness around their home without Meg. The couple felt her memory and presence everywhere in and about the house. The couch, the trampoline, the backyard, the bedroom, the children’s rooms, the porch, and years and years of pictures with members of the family framed throughout the house, served as a constant reminder of Meg. The two remaining dogs were dachshunds; Oscar was the grouchy father, and Tootsie, a high maintenance daughter. The female dachshund next door had been Oscar’s wife and Tootsie’s mother. It had been an “arranged” marriage.

“I miss having a big dog around here John,” Karen said.

“I miss having a dog that likes being in water,” John replied. He thought, “Dachshunds are like cats, they do not like water and don’t swim.”

John and Karen had a small piece of property on the lake near their home. They rarely spent the night at the small cabin on the site, but very much enjoyed going there for “day trips” and always got home before the time the street lights came on.

John and Meg could easily consume a Saturday at the lake with cutting grass, fishing, and working in their small garden there. They often visited the big box stores for stuff needed for whatever they would be doing that day. Meg loved riding in John’s truck, ambling around the property, and dipping into the lake for a swim from time to time as John worked.

“John, what on earth do you and Meg do all day out there?” Karen often asked.

John and Meg looked at Karen in unison and agreed that Karen just did not “get it.”
“Well Karen, Meg and me don’t have nothing to do out there, we got all day to do it, and we may not get but half of it done,” John answered. He wasn’t sharing any of their secrets.

With Meg gone there was a void on Saturdays, not only at home for the couple, but also for John at the lake. John attempted to make the dachshunds his “lake dogs,” but they did not like water and just made a mess out of his Saturdays. Oscar hated it at the lake preferring the warm and known confines of their home and being a lovable grouch on his turf. Tootsie loved riding in the truck to the lake and she loved to cuddle in the warmth of John’s jacket during the ride however, Tootsie was always doing something meddlesome. She explored to the extent that John spent the majority of his time looking for her or keeping Tootsie out of trouble.
On one occasion John lost Tootsie for about two hours though it seemed like an eternity. During the time she was missing, he frantically searched the shore of the lake, the cabin, and the surrounding area. He envisioned Karen chastising him for not “taking better care of Tootsie.” All of his worst fears as to her safety ran through his mind only to find her on top of the boat dock. Tootsie had no problem climbing the steps to the top of the deck, but once there, she would not come back down. He found her accidentally because he saw the silhouette of her small head on the horizon of the dock flooring. His fear of finding the more worrisome silhouette of her body floating in water hence relinquished, John commenced to chastise her under his breath. (Tootsie’s head is small for her body. John’s head is small and Karen often made fun of him for it. John’s mother said her first memory of John as a baby was that he could, “cover his whole face with his hand.” On his high school football team in LaGrange, Georgia, he wore the smallest helmet. It was a size 6 and 7/8, and was specially ordered for him. Karen told John, when she perceived he was gaining weight, “John, you need to be careful about gaining too much weight or you’ll start looking like Tootsie. Your head won’t match your body.”)
On another fateful day at the lake, Tootsie chased a mouse or some other rodent under the cabin, which had only a six-inch crawl space, and it took several hours to determine where she was. Once found, she would not come out and there was no obvious way to get to her or to get her out. Complicating the situation and intensifying the anxiety for John, it was not clear if Tootsie was trapped or just would not come out. Exasperated and about to give up, John found a neighbor with a skill saw to cut a hole in the cabin’s kitchen floor to “rescue” her. The sawed out square of flooring replaced the hole in a patch-like fashion serving as a constant reminder of that day’s three-hour ordeal to free Tootsie from the confines of the cabin crawlspace.
“Karen, I am not taking Tootsie out to the lake anymore. She is a good truck dog and likes to ride, but she is way too much trouble for me out there. I can’t get anything done with her. She gets into stuff. “Dachshunds have a Napoleon complex and that’s her problem,” John thought. He, however, did take her again. It would be a mistake to do so, and it would be the last trip to the lake for Tootsie.
The “last” time Tootsie went to the lake with John, she played the “Napoleon role” that only a foot-long dachshund can do with the great dane puppy which lived next door. She barked and taunted the dog until it grabbed her like a pillow, shook her, and then threw her about thirty feet. All of this transpired in a matter of seconds right in front of John to his amazement and chagrin while he was raking leaves and listening to a Georgia football game. Tootsie’s run in with the great dane resulted in a trip to the vet, a V-neck T-shirt soaked with Tootsie’s blood, ten holes in Tootsie’s abdomen (but no damage to her intestine), two hours of surgery in which John assisted the vet, fifty stitches, and another ruined Saturday at the lake. No Tootsie was not to be another Meg and she would not be going to the lake anymore, period. To make matters worse, on the day Tootsie came home from the hospital, John was holding her in his arms, and was about to give her cheek a kiss when she snapped up and bit him on the tip of his nose. He dropped her to the floor out of shock and a bit of anger, only to find her running to Karen. Karen now became the “good-guy” and Tootsie’s savior in this unprovoked attack, which further aggravated John. Karen then laughed uncontrollably at the situation and particularly at John clutching his nose. John’s nose was now bleeding profusely and when he checked it out in the mirror there was an inch long scratch which was deep and devoid of skin. The area subsequently scabbed over and for two weeks was a painful and visual reminder of the little ungrateful troublemaker that was Tootsie.
“Dr. McHugh, what happened to your nose?” John was asked a thousand times over the ensuing weeks.
“My dog bit me,” he answered. Having to respond to that question in light of the history of the event was “salt on the wound” to John. He did, however, forgive Tootsie.

Several months later after blowing leaves at the lake, John alone and without a lake dog, was resting on an old spring swing left at the lake by the original owner of the property Jessie Jewell. He saw a small puppy walking up the gravel driveway. The lake property is at the end of a road that has a cul de sac. His first thought was that someone had dropped off the dog and left it. As the puppy approached her gait and color made John think that the visitor was a golden retriever puppy and probably one of a neighbor’s dogs. She walked nonchalantly to where he was sitting and sat down right next to him. It was as if she was already his dog and that what she was doing now was what she was accustomed to doing naturally and often.

“Well, what’s your name, cutie pie?” John asked somewhat taken aback by the level of the “make yourself right at home” nature of this stranger.

The dog’s tail began wagging as it looked up at John contentedly. John confirmed that the dog was a female, and as best he could tell, she was a thoroughbred. He figured that someone was probably missing her pretty bad about now. She had no collar. It was unknown to John at the time that this was a foreboding sign. He picked her up, held her in his lap with her belly up, legs open and apart, and began to rub her. To John, a dog that will let you rub its belly is an “at peace” dog and a prerequisite characteristic of one you’d want to have. Oscar would not let you do that, but Tootsie would. This dog was as laid back as you please to be on her back and be rubbed, particularly behind her ears.

“I think I’ll keep you my little friend. Do you like the water?”

When John and the new dog arrived home that evening, he said as he entered the house, “Karen, guess what showed up at the lake today?”

Karen immediately said, “She’s pretty. Look at her tongue; it’s got a black spot on it. That means she has chow in her.”

“You don’t know that Karen. A black spot on the tongue? Are you kidding?”

“It means she has Chow in her. I bet she is a Golden-Chow.”
Karen was right about the puppy having Chow in her as evidenced by the way her bushy tail always was curled up over her back. None of the neighbors near the lake cabin reported losing a dog and so the family adopted the golden retriever looking puppy with the bushy tail and black spotted tongue as their own.

Bess, their middle child who was in sixth grade at the time, named the new pet Chloe. The new dog was the same color as Meg and since Meg was named after the spice, nutmeg, Bess wanted to name her after another brownish colored spice. She thought chloe was a spice as well. That chloe was not a spice was something that John and Karen did not note, but would not have corrected it even if they had noticed the error. John, a poor speller, the next day went to PetSmart to make a tag for her collar, but spelled her name “Clohe” much to the sarcastic delight of his family who never let him forget that he spelled her name incorrectly. Named for a spice that wasn’t, and having to wear a tag with the wrong name on it may have very well been a glimpse into Chloe’s unpredictable future.
The couple and their family fell instantly in love with the gentle intruder. As John’s mother would say, “One man’s loss is another one’s gain.”
The “gift” and the coming saga that was Chloe then commenced; the extent and complexity of which was unknown to John or Karen at the time. Chloe on the other hand, knew exactly what was to come and the role she’d play in the lives of John, Karen, their family, and more importantly, other lives.

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somebody wants in

The Real Prostate Cancer Second Opinion-Illustrated “Factors to consider” in your  treatment decision-making process.

I had my biopsy done by a partner during lunch. I took an antibiotic and  nothing for pain. My partner did attempt a prostate block but  it did not work. He took about 16 samples and it lasted about 20 minutes. It was very uncomfortable. My biopsy experience. I am trying to think if I under tell patients about the pain involved.

I give each patient a sedative and a pain pill prescription (such as an ativan and a percocet) that they take an hour before the procedure and I also perform the prostate block which is guided by the ultrasound. (For any of you that are interested, that is a space easily identified on ultrasound just lateral to the seminal vesicles at the posterio-superior aspect of the prostate. That’s where the nerves that enervate the prostate run and responsible for the pain.)

There are about three kinds of pain associated with the biopsy and my little protocol, and I would be surprised if most urologists don’t do something similar, limits all of them. First there is the pressure pain associated with the ultrasound probe itself, this is like a rectal exam done by large thumb and is five inches long-a generalized pressure pain. Then there is the irritation the rigid instrument has on the prostate and the prostatic urethra. (Any one reading this and trying to determine what type of treatment you are planning to pursue needs to understand the prostatic urethra and how it is affected by all the treatments. This is about a good a tip I could ever give you. I’ll put something today into the ” Decision Process” section of this blog.) The pressure on prostate gives you an intense sensation that you need to urinate, so be sure to empty your bladder before the procedure. And then of course, there is the actual biopsy itself. We all use a spring-loaded biopsy gun now, so you’ll hear a clicking sound before each biopsy and it feels like a bee sting. (A patient told me one time, ” Hell doc, that ain’t no bee sting, that’s a Texas wasp.) By the way, I went up to the river yesterday and while I was looking for a stick to throw into the river for Penelope, I got stung by two or three wasps on my ear….right on the lobe of it. Man oh man… I hate those things.

The blood that is referred to in the piece below is hematospermia and this does get your attention but is harmless. It doesn’t hurt anyone and usually goes away in a week or so, but not always. When there becomes a brownish tint to the fluid, you are almost done with it. It can last for weeks however.  After the biopsy-from ” The Decision.”

As urologists we worry most about a fever or difficulty voiding after a biopsy. This type of stuff occurs about 3% of the time and is why  we give an antibiotic before and after, usually Cipro, and tell the patient and family to call if any voiding issues.  If you are already on a drug to help you urinate or are having difficulties now, you are more at risk for problems voiding and this is something you should make known to your urologist. I do about 100 biopsies a year and in my 24 year career I have had to admit someone for a biopsy complication probably about 5 times.

I feel that I am fairly discerning about the pain. I ask my nurse to watch the patient’s expression and that will often tell you if there is undue discomfort. If we sense it, we stop and do something else… redo the block or consider giving something I.V. This is a recent post of a patient that did impersonations during his biopsy, if that tells you how he did pain wise during the procedure.

The other component to the piece that follows has to do about men and how much they will talk about pain and their medical condition.  I think its fine and appropriate to say to the urologist at the time of the scheduling, like I do with a Dentist, ” I don’t like pain. Can you give me something?” If the urologist says no and you want medicine…get another urologist.  It is really that simple, I doubt many will say no however.

More about men and what they will disclose. If you know someone who had robotic removal, most likely they will almost brag about having had it removed that way. It is almost as if they think they were cutting edge or ” informed.” But… if you ask them how are they doing, particularly with continence and potency, then that’s different story. I mention this to be careful to separate out from the conversation ” the procedure ” and the ” aftermath.” That’s a world of difference and you’ll have to really dig and persist to find out how they are ” really doing.” You might ask, ” Why would persist into something that is personal?” Well, my friend you are trying to make a decision about what to do and if you make it based on how the procedure went but not how things ended up ” functionally” then you have made a decision in error. Robotic and Brachytherapy are similar in this aspect. Patients often make the decision based on the procedure attributes  and not on a full understanding on how they will ” end up.”

As my mother said, ” Don’t value short-term gratification over long-term gain.”

From Chuck Gallagher’s Blog

Urologists Take Note – The Real Truth About A Prostate Biopsy!

At first I thought I was just a “wimp.” At the urging of my family doctor I went to a urologist for a prostate check. She (my family doctor) said my PSA was a bit high for my age – 4.58 PSA and I was 47 years old.

Now let me state…I didn’t even know what a PSA was until she forced the test when I was having routine blood work done. Something I hated as I had a fear of needles.

The urologist did the “bend over boy” routine finding nothing with his “DRE” – Digital Rectal Exam. Now I have to be honest, that wasn’t the most exciting exam, but all in all it didn’t cause me any great pain. But, as the urologist said, “Better to be safe than sorry. Let’s schedule you for a biopsy.”

Now let me be frank…I had no clue what to expect other than what my doctor told me. He said there wouldistock_000002146611small be some minor discomfort but mostly I would be annoyed by the sound of the instrument when the sample was taken. “Other than that,” he commented, “most men don’t really feel much.” I do recall asking if there was pain, and again, my urologist stated, “Most men feel very little. Nothing to be concerned with.”

I have been interviewing men from all around the English speaking world who have been diagnosed with prostate cancer. With few exceptions everyone reports the same thing. The damn biopsy hurts! When they report this, I ask a follow up question: “Did you tell you doctor this?” Their response – “Well, no, I just took it like a man.”

GUYS…WHAT A CROCK!

In Dr. Sheldon Marks book, “Prostate and Cancer” he describes the biopsy as follows:

In a biopsy of the prostate, multiple tiny sliver-like ppeces of tissue are obtained for microscopic analysis to see if cancer is present. These pieces are obtained through a long but very thin needle, specially designed to open inside the prostate, take the sample and then close.

For most men, biopsies can be done as an outpatient office procedure without anesthesia and with usually only temporary discomfort. Now we can get a good representative sampling of the entire gland with minimal trauma to the gland.

He is right…it is done outpatient most of the time. Where I beg to differ is on the pain issue. Thus far, well over 70% of the men I have talked with have reported that their urologist misled them when it came to what to expect and the pain. All but two men interviewed would, in retrospect, have desired pain medication before the biopsy. One man reported that had he known it would have hurt as bad as it did…he would never had submitted to the test. (Although the test might have saved his life).

Several men stated that they felt that ALL UROLOGISTS should have a biopsy on their prostate so that they would know exactly what their patient was going through. In that way, the urologist might be willing to volunteer provide some local anesthesia to reduce the pain and trauma.

Urologists…do you get the picture. What is reported to you is inaccurate (men don’t want to admit to their pain) and it (the biopsy) freekin…hurts – SO GIVE US SOMETHING TO TAKE THE EDGE OFF.

WHAT ABOUT AFTER THE BIOPSY? For most men normal functions – exercise, work, activity will all resume as normal either the next day or day after that. Now, when I say normal functions…that also includes sex.

I’ve scoured the Internet and seldom do I see PRACTICAL ADVICE that men need to know – so here’s some. A few days after your biopsy you may engage in sexual activity. Be prepared! When you achieve orgasm your ejaculation will be bloody. Guys I don’t mean a trace of blood, but bright red bloody. And, gentlemen, if you are unprepared for that, it can cause alarm. That alarm may be to you and/or to your partner. Nothing can change the mood of an intimate evening of sexual play than to achieve an orgasm and find that you look like you just hemorrhaged.

GUYS… The biopsy is necessary so in no way take this entry as anything other than solid information. Have it done, and more than once if necessary. My personal advice is – request pain medication.

Chuck Gallagher is a business ethics and fraud prevention speaker and author. Having been diagnosed with Prostate Cancer, he spends time working to help educate men and their families about the practical aspects of Prostate Cancer and how to survive.

This entry was posted on Monday, November 10th, 2008 at 5:12 am

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my hypocrisy will go only so far...

 

The things people search for (it is often a question that comes up “after” they have been diagnosed or treated for prostate cancer) that got them to this  blog. This also provides for me a subject matter or topic for that day’s post. “Like taking candy from a baby.” Thanks to all for your support.

prostate cancer diaries 561
prostate diaries 251
frank zappa prostate cancer 146
partin tables 2010 117
bill clinton cancer 85
prostate vs breast cancer 83
famous men with prostate cancer 73
theprostatedecision.wordpress.com 73
elevated psa biopsy 71
famous prostate cancer sufferers 71
prostate cartoons 67
prostate nerves 67
prostate nodule 62
frank zappa cancer 60
alberto sabatino 59
prostate spasm 55
richard albin psa 55
nanoknife prostate 55
prostate nodule biopsy 49
prostate cancer 44
prostate biopsy experience 42
prostate biopsy 41

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if you want to know what a man is thinking or why he is acting the way he does.....go around behind him...and look out at what he is looking at.....paraphrased will rogers....one of my favorites

One of my heroes of all time is Will Rogers. If you have not read a book about him….do it. He is the best. He was a Rush Limbaugh of sorts in the early 1900’s. My son, Sam is an Eagle Scout, and he and I hiked for two weeks in New Mexico at Philmont. Waite Phillips donated the land to the scouts many years ago and as such “doing Philmont” is a rite of passage so to speak in scouting. Phillips made his money in oil and was one of the first men to utilize the concept of a “gas station.” Phillips 66 doted Route 66 in its heyday. We went to Waite Phillips house near the beginning point of the house and in the basement was a picture of Waite Phillips and Will Rogers. Rogers had stopped off at Phillip’s place 0n his way to somewhere else.I would like to think that I am a kindred spirit with Will Rogers. He died in a plane crash with Wiley Post at a far away place in Alaska. In his pocket it is reported that he had a lucky wooden nickel, and a set of jacks. I get it.

By the way…in the news this week was a story about how a video of college students having sex on a rooftop at USC going viral. Guess what the building’s name was? Waite Phillips Hall.

Many of you reading this are thinking or Roy Rogers…I am speaking of Will. I have read several books about him and even went to New York to see “Will Roger Follies.” He began his career as a cowboy and had a talent of playing with ropes and making them do tricks, a rope lariat, not poet lariat. He traveled about and as I recall he got on a boat with a circus and refined his lariat skills. He made his way to New York was in Zigfeld Follies. So finally I am to the point I want to tell.

When Roger’s performed he did not talk. He just did rope tricks and did that for hundreds of performances. One day he messed up a trick and the rope fell to the ground not in keeping with the intended trick. He looked up and said, ” I guess I can’t do rope tricks and chew gum at the same time.” He walked over to side of the stage and took the gum out of his mouth and stuck it on the wall. The audience roared in laughter. It was such a hit that he decided he’d drop the rope and mess up the trick on purpose so that he could use the line again. With each successive show he added more lines and in time his show was more talking than roping.

Then he became his own show. He’d have a newspaper and he’d read a story and then comment on it in an informative yet funny way. Rogers quotes are now well-known and timeless. “All I know, I’ve read in a newspaper.” “I am of  no particular or organized party…I am a democrat.” Being from North Georgia and home of moonshining and stills, I like this one, “Nothing helped improve the roads in America like prohibition did.” Think Dawsonville’s Bill Elliott.

He had a daily spot in the newspaper with just a short thought or comment. Again….Rush Limbaugh has used his technique. Read a story, or play a sound bite of stuff that is reported and then comment on it in a funny way. Rogers became the highest paid performer in america. He was an advocate of commercial air travel and his travelling by plane did more to promote the public’s acceptance of it as being safe..somewhat ironic seeing how he died in a plane. But that is a whole nother story. Wiley Post.”Let’s go flying Will!”

My mother loved telling this on Will Rogers and she loved telling me to be “big about it.” This is where the following came from. Will Rogers would be asked to be the featured performer at Presidential functions. Numerous presidents  from both parties had him as a performer. He’d go and make fun of them and their party in a clever way. Someone asked him one time how was it that the most powerful men in the world would invite someone who they knew would be making fun of them and their policies. He replied….” Because…they are big people.”

So. When I was summoned to retrieve my son Sam from the University of Oklahoma and drive him and his car back from there to Georgia, I was delightfully surprised to end up in front of my hero…Will Rogers and the Will Rogers International Airport. An airport that did not have my baggage from Atlanta. No problem. I got it the next day. My son was an issue as well. ” Dad. Can’t come pick you just yet. My battery is dead in my car. I am working on borrowing a car. I’ll let you know. I’ll call.”

No baggage, nobody there to  pick  me up, but I was in Oklahoma with a statue of Will Rogers. Really….I wasn’t working….It could be said that, ” It don’t get no better that this.”

Now it is a beautiful Sunday afternoon in Northeast Georgia and my wife is at the beach with my daughter Bess. I am “home alone” and that really is not good. I like being alone for about 23 hours then I don’t like it. I thought I’d like it, but then I miss all that my wife” brings to the table.” I have the dogs and “their” issues to deal with. Then it came to me. My son, Sam, who is in Savannah, let me borrow  his friend’s mother’s Flip, and it dawns on me that I could do an Amazon video for Author Central using the friend’s mother’s Flip…and I do it. So…..without further a deau…..is that the way you say or spell that….it’s okay…I am from the south and we southerner’s don’t know the sophisticated ways of the north…..and bla bla bla

Oh I forgot…surveillance. I just finished one of the requirements for the Board of Urology, it’s called MOC, or maintenance of certification. I had several disease options to choose from and you guessed it…I chose prostate cancer. The whole thing, and obviously what the board members thought was important to its member urologists, was about being sure that all the options for the treatment of prostate are given to the patient along with the risks and benefits of each. Active surveillance was listed as one of the treatment options to be offered and documented as having been discussed. (This should make those of you who think that all surgeons want to do is remove your prostate feel maybe a little bit better.)

I mention in my book that active surveillance is a bit dicey for the guy less than 60 and it is an option for a certain type of mindset. An anxious person will not go this route. I personally considered it but my mind wasn’t good with it. I had a guy “give in” to doing something (abandoned surveillance) because he knew did not want radiation and if  the disease progressed, he’d rather deal with surgery at his current age than 3-5 years down the road.

In my practice for my patients that choose surveillance, I do what they do at Johns Hopkins and that is a PSA twice a year and a biopsy yearly. The patients that I follow this way are very pleased and usually feel very comfortable with their decision.

I spent way too long on this post…but when I saw the picture of Will Rogers with Waite Phillips in the basement of Phillips’ home at Philmont and I had been hiking with kids for two weeks straight…well it did me good to remember all that and how it felt to be done and to think I was standing in a place where Rogers once was as a guest. History does me that way. It intriques me but frustrates me…I want to feel it but it is a tease…and that keeps me reading.

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