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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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a little knowledge is a dangerous thing....

There is no debate that men who have urinary symptoms, such as frequent or difficult urination, a weak stream, etc., ought to be getting exams including PSA tests. That is not screening; screening is testing asymptomatic men for signs of cancer. Men who have symptoms should be getting tests.  Otis Brawley- March 2009  

What is breath-taking about the above remark by the person who would become the point man M.D. of the American Cancer Society is that symptoms of prostate cancer to which he refers occur late in the diagnosis and too late to cure. He should know that. He is either disingenuous on the one hand or misinformed on the other. 

The whole point of screening, awareness, and the PSA is to find men before they have symptoms. You have to trust me on this…If I make the diagnosis in a loved one of yours because he is having voiding symptoms, his prognosis is less than ideal and has been made too late. 

Before the PSA test, about the time I started my urology practice circa 1986, we did yearly rectal exams and a biopsy on a prostate that had a palpable nodule. If that biopsy showed cancer, it most always had some degree of capsular extension i.e. cancer had spread to the outer layer of the prostate. That model of management found the cancer too late. (To make the cost conscience more happy-there is a higher rate of positive biopsies if you only biopsy a hard nodule of the prostate…but that is later in the disease than is preferred.) So along comes the PSA and now there are more biopsies being done, more that are negative and more found at an earlier stage. Another nuance about this is that the PSA made M.D.’s and the male patient more aware of prostate cancer and the need for testing. (This is not emphasized enough in my opinion-men don’t like rectals but they will easily submit to a blood test.) So the result is that the cost per diagnosis went up and that is the issue with the likes of Dr. Brawley, he is a study guy i.e. is it cost-effective? But there is more to it than that…hint… read about his remarks about someone making money on the PSA reagent and the reference to the Tuskegee experiment. Now are we talking about an inference to race, politics and money? If you look at Dr. Brawley’s work history you’ll find he has been on a lot of government panels and this and that institutes. Doctors that work for the government( who pays the doctors that work for the National Cancer Institute… I don’t know?) or other similar entities are of a different mindset than the practicing doctor. They tend to think in terms of cost and the masses… your family doctor is thinking about you, and is  responsible and at risk for….you. That’s a big difference. 

So this is part one…I had been intrigued about the AMA endorsing National Healthcare and the ACS dissing the PSA and I did not get it. Brawley may be the key. This interview from 2000 I think gives us the answer to what intrigued me and also why Ph.D. Albin and the ASC are on the same page. Verrrrrrrrrrrrry interesting……  

Tuskegee syphilis experiment-To you…is this the same as having a PSA done?   

Prostate Cancer Planner Never Takes PSA Test

Compares Prostate Screening to Tuskegee Experiment

Opposes Prostate Cancer Awareness Stamp, Says Post Office Should Deliver Mail, Not “Misleading Advice”

By Jacqueline Strax (Psa-rising.com)  

Otis W. Brawley M.D. in the year 2000 was Director of the Office of Special Populations Research and Assistant Director, Office of Science Policy at the National Cancer Institute. When he worked at the Division of Cancer Prevention and Control (DCPC) at the National Cancer Institute, he was part of a team that developed and launched the Prostate Cancer Prevention Trial, an 18,000 man trial looking at screening and epidemiology of prostate cancer and at prevention of benign prostatic hyperplasia and prostate cancer. He also served as chief of the NCI intramural prostate cancer clinic.
This interview, conducted by E-mail January 29 and February 1, 2000, was arranged in Q & A format and edited for length.  

PSA Rising: Dr. Brawley, do you know what your own PSA is? If so, at what age did you start taking PSA tests? If you have ever had PSA drawn, how much information were you given before doing so about risks and benefits, and did you feel you needed more?  

Otis Brawley: I have never had a PSA and do not desire one. I have had relatives with the disease. I just do not believe it saves that many lives. SEER data show that a large proportion of so called early detected patients with pathologically localized disease (the best prognosis one can have) ultimately relapse by PSA. This means they really had distant disease at diagnosis.  

PSA Rising: In view of Dr. Gabriel Feldman’s resignation from his post looking after colon and prostate cancer at ACS, your name has come up in several places as candidate for that job. Is this true? Has ACS approached you and are you interested?  

Otis Brawley: I cannot imagine that the American Cancer Society would consider me for the job you are referring to. As things go, most would consider my current job a bit better than any job the ACS could offer.  

PSA Rising: We don’t know where this rumor arose, we figured we needed to get the facts straight. Can you in any event please give a brief outline of your views on priorities for prostate cancer research and services for patients?  

Otis Brawley: My views on prostate cancer research are in http://www.nci.nih.gov/prostateplan4.html#1-3-3 and http://wwwosp.nci.nih.gov/planning/prg/toc.htm.
These are NCI documents that I helped prepare.  

PSA Rising: One specific question has bothered us for some time. In December 1997 or maybe Jan 1998, the American Cancer Society (ACS) made a press release on what they characterized as the “disgraceful tragedy” of prostate cancer especially in African American men. At the time, we put a report based closely on that release on line; we have maintained the page (“African American Prostate Cancer Crisis – Disgraceful Tragedy“) ever since, tying our coverage of African American prostate cancer research news to it.  

That press release quotes Charles J. MacDonald, MD, head of ACS, and John R. Kelly, an ACS board member. They urged grassroots action, more research and early detection from age 40 up. How did that press release, that policy, get made? What was the process by which, under Dr. Feldman, it was so drastically revised as to be rescinded? The public needs to know this after having been told at the time what Dr. MacDonald and Mr. Kelly said.  

Otis Brawley: I can make no statements about the ACS and their inner workings. I can only vouch for the fact I did attend a series of meetings in 1997 when the ACS gathered fifty leading cancer specialists (epidemiologists and treaters) to re-evaluate their screening recommendation. This meeting led to the ACS repealing their recommendation that all men over fifty get screened and instituting a recommendation that men be offered the test and informed of potential risks and benefits. This latter recommendation was adopted in June 1997.  

PSA-Rising: From your article in JAMA and elsewhere it’s evident that you oppose screening. What are your current views on early detection of prostate cancer?  

Otis Brawley: It is unfortunate that you have interpreted my writings as against screening. Indeed if you carefully review them, I am against misleading people by saying it clearly saves lives and there are minimal downsides. I have been fortunate in that I have had the opportunity to publicly express my views on many occasions and have published it in several articles. For example, in the journal CANCER in 1997. There I call for informed consent of the risks and benefits and say no one should criticize a man who decides to get screened.  

I reiterated this stand in: Brawley O: Prostate Cancer and Black Men. Seminars in Urologic Oncology. 16:184-186, 1998.  

If a man is truly informed and chooses to be screened I have no difficulty with it. I am against those who oppose informed education about the screening issue.  

Many of my views about ethics and misleading people about what is scientifically known and what is not known and distinguishing it from what is believed come from my experiences in working in the aftermath of the Tuskegee Syphilis Study. The tragedy was initiated and prolonged because well meaning folks who did not understand, supported the trial and actually conveyed untruths to men participating in the trial often in an effort not to worry them with something too complicated. I wrote about this in:  

Brawley OW: The study of untreated syphilis in the Negro male: Modern lessons of the Tuskegee Syphilis Study. International Journal of Radiation Oncology, Biology and Physics, 40:5-8, 1998.  

I should note that I am aware of twenty three different organizations of experts in screening around the world who have considered the question and all have chosen not to make the blanket statement that screening saves lives and men should be screened. Most actually recommend men not get the test because it is not proven effective.  

PSA-Rising: I think we do understand about Tuskegee. Some degree of that same risk applies today to recruitment of minorities into clinical trials at a time when several major trials, badly run, have been halted for their disarray. And men going into clinical trials often include men who were not diagnosed early enough to have currently curable disease.  

Otis Brawley: The Tuskegee issue goes far beyond clinical trials and misleading people in clinical trials. My point is that when twenty-three organizations of experts from the Canadian Urology Association to the American College of Physicians to the U.S. Preventive Services Task Force recommend against screening and men are encouraged to get and not told that the predominance of professional expert opinion is that it is unproven and should not be done then they are being misled and misinformed just as the men in the Tuskegee trial were lied to.  

This again is not to say that a man cannot still legitimately decide to get screened. The prostate cancer screening question is far more complex than just doing the test and diagnosing cancer. There are a number of issues such as diagnosis of lesions of no clinical significance and the resultant unnecessary treatment. Indeed there are now several studies that suggest that perhaps a third of all men diagnosed by PSA and quote “cured” would never have been bothered by their disease without our current screening technologies. They would have lived long not knowing they had prostate cancer and ultimately died of something unrelated.  

There is also the issue that nearly 40% of men diagnosed and “cured” with radical prostatectomy ultimately relapse with metastatic prostate cancer. For most of these men early detection (no matter how early) would not save their lives.  

Now the above are the known proven facts. There is reason to believe and I do believe that some men’s lives are saved by screening but I must stress no one knows for sure.  

I far rather tell men that the test exists and it may save lives, it may not, than twenty years from now find out that it is like lung cancer screening and the misleading of men has caused more harm than good.  

I have also been very outspoken about the ethics of private industry which stands to gain from prostate cancer screening advocating it so heavily. In reality I know private industry benefits from prostate cancer screening, I do not know that the men who are screened benefit.  

I have also been critical of physicians who get into the business of giving screening advice but cannot define for me the basic principles of screening such as defining length bias or lead time bias. You see many physicians who advise prostate cancer screening [who are] ignorant of the discipline of screening.  

By the way the money to be made is not through selling drugs or through treatment of cancer. If you like money you want a piece of PSA reagent sales.  

PSA Rising: Do you oppose the Prostate Cancer Awareness stamp?  

Otis Brawley: Given these facts I believe any awareness campaign for prostate cancer screening must stress what is known, and what is not known and what is believed. Given this, my personal belief is the U.S. Postal Service should stick to trying to deliver mail rather than publishing stamps that give misleading advice. They should not have a stamp advocating early detection and suggesting that it saves lives when this is a significant area of debate among experts.  

I am committed to continue unearthing all the data for or against prostate cancer screening so that we can finally have an answer to this very important question.  

PSA Rising: A lot to follow up here. We will continue to do our best to give coverage to the issue. With that in mind, I would like to check in with you from time to time to bounce some opinions and ideas and get facts straight.  

Otis Brawley: An NCI screening statement on PDQ really sums up my position better than I ever could put it in words:  

No trial of prostate cancer screening where the intervention arms were analyzed as randomized (analogous to an “intention to treat” analysis in a treatment trial) has been reported. There is, therefore, insufficient evidence on which to decide the efficacy of transrectal ultrasound and serum tumor markers (including PSA) for routine screening in asymptomatic men. While awaiting results of these studies, physicians and men (and their partners) are faced with the dilemma of whether or not to recommend or request a screening test. A qualitative study undertaken on focus groups of men, physician experts, and couples with screened and unscreened men has explored what information may help to inform a man undertaking a decision regarding PSA screening. At a minimum, men should be informed about the possibility that false positive or false negative test results can occur, that it is not known whether regular screening will reduce deaths from prostate cancer, and, among experts, the recommendation to screen is controversial.  

   


References

Back to article!Cancer, 80:1857-1863, 1997 Prostate carcinoma incidence and patient mortality. The Effects of Screening and Early Detection. Brawley OW.  

Semin Urol Oncol 1998 Nov;16(4):184-6 Prostate cancer and black men Brawley OW  

Int J Radiat Oncol Biol Phys 1998 Jan 1;40(1):5-8 The study of untreated syphilis in the negro male. Brawley OW Office of Special Populations Research, National Cancer Institute, Bethesda, MD 20892, USA.  

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to really know why someone acts or thinks the way they do, you have to go behind them and look at what they are looking at. Will Rogers

American Cancer Society Got it Wrong: Study Confirms Prostate Cancer Test Saves Lives

Jul 2, 2010

American Cancer Society Got it Wrong: Study Confirms Prostate Cancer Test Saves Lives

PR Newswire

WASHINGTON, July 2

ZERO Demands ACS Apology to All American Families About Prostate Cancer Testing as New Proof Emerges on the Effectiveness of the PSA Test

WASHINGTON, July 2 /PRNewswire-USNewswire/ — With a new study showing the PSA test reduces the prostate cancer death rate by 44 percent, ZERO – The Project to End Prostate Cancer demands an apology for all at risk of the disease from the American Cancer Society, which has long discounted the importance of prostate cancer testing.

“It’s time to ‘Man Up’ and admit they were wrong,” said ZERO CEO Skip Lockwood. “This new study clearly shows the PSA test does save lives, even though the American Cancer Society and its chief medical officer, Dr. Otis Brawley, have long disregarded scientific data and the advice of 17,000 urologists across the U.S. that this test reduces the prostate cancer death rate.”

The new study out of Sweden, based on a 14-year review of 20,000 men between the ages 50 to 65, found that PSA testing reduced the prostate cancer death rate by 44 percent. These results were published June 30 in the Lancet Oncology medical journal.

“With 2010 statistics predicting a 17 percent jump in prostate cancer deaths – the largest in more than a decade – the ACS should be encouraging men to take control of their lives and get tested,” Lockwood said. “Instead, ACS is more concerned about sexual side effects rather than saving men’s lives – though it quickly changed its tune when it said the same thing last year about women getting a mammogram.”

ACS became embroiled in a firestorm of controversy last October by seeking to change its guidelines that women did not need an annual mammogram until age 50, instead of 40. ACS quickly backed off after an outcry from the public and health and government officials. ACS says men should consider getting the PSA test at the age of 50, or age 40 or 45 depending on one’s family history with the disease.

“Like the mammogram, we acknowledge the PSA test is not perfect – it cannot distinguish slow-growing tumors from rapidly growing ones – but until new methods for testing are developed, it’s still the best tool available for early detection and prompt treatment of prostate cancer,” Lockwood said.

While the new report says 12 men need to be diagnosed in order to prevent one cancer death, Swedish scientists say they found that the risk of over-diagnosis was not as high as previously thought, and that “the benefit of prostate cancer screening compares favorably to other cancer screening programs.”

Despite the lack of support from ACS, the value of early detection through PSA testing is supported by more than a dozen leading U.S. organizations. This includes the American Urological Association, National Comprehensive Cancer Network, Prostate Cancer Foundation, Prostate Cancer Research Institute, Malecare Prostate Cancer Support, Men’s Health Network, National Alliance of State Prostate Cancer Coalitions, Prostate Cancer International, Prostate Conditions Education Council, Prostate Health Education Network, The Prostate Net, Us TOO International Prostate Cancer Education and Support Network, and Women Against Prostate Cancer.

“The only difference between the PSA test and mammograms is there aren’t millions of men who will stand up to the claims being peddled by Brawley and the American Cancer Society,” Lockwood said.

About Prostate Cancer …

1 in every 6 men will get prostate cancer sometime in his life. More than 217,000 cases are expected in 2010 – on par with breast cancer.

There are no noticeable symptoms of prostate cancer while it is still in its early stages. This is why getting tested is so critical.

African Americans and men with a family history of the disease are at a higher risk for developing prostate cancer.

Nearly 100-percent of patients survive at least five years if prostate cancer is detected early (i.e. cancer still contained within the prostate).

About ZERO – The Project to End Prostate Cancer (ZeroCancer.org)

Zero prostate cancer deaths. Zero prostate cancer cases and, for those with prostate cancer, it means a zero PSA. Our name conveys what we stand for – zero tolerance for prostate cancer. At ZERO, we commit ourselves not only to reduce prostate cancer or alleviate the pain from the disease, but to end it. We see a future where all men who have been diagnosed with prostate cancer will be cured or manage their illness with good quality of life, with the support they need to minimize physical and emotional suffering, and to cope effectively throughout their cancer journey.

To accomplish our goal, we provide comprehensive treatment information to patients, education to those at risk and conduct free prostate cancer testing throughout the country. We increase research funds from the federal government to find new treatments and we fund local grants to end the disease.

SOURCE ZERO – The Project to End Prostate Cancer

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