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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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it is better to look at where you slipped than where you fell- african proverb

A popular search that ends  up on my site is “condom catheter.”  Here’s a primer and then a story about my experience with one.

 A condom catheter is a condom like device that is more sturdy  than a regular condom and has a spout at the tip that in turn  can be attached to  a bag, usually a leg bag that can  be strapped to one’s leg. The  advantage of a condom  catheter is that you don’t have to  wear  diapers. If a  post prostatectomy patient leaks only a small  amount then  the diaper is the better option. If there is profuse  leakage in which the patient is changing diapers often then sometimes the condom cath is better. For me my incontinence was profuse and diapers did not lend itself to working. I tried it but, changing diapers all  day became old quickly. Dr.   Patrick Walsh states in his  book that using a  condom catheter makes one lazy. That you become dependent on just catching the urine  and not actively using your sphincter  muscles, Kegeling, etc. I am not of that camp. I think that the return to continence has no rhyme or reason. Your  body just has to  figure  it out ,i.e.” Okay external sphincter, the prostate is now gone and you have to man  up and begin  puckering more  now…you have a more important and emphasised role  in me being dry. Get to  work.” Just like children, sometimes they listen  and sometimes they don’t. And as  always they  do  it on their timetable not yours.

  • Not everybody can wear one. If the male has a  prominent suprapubic  fat  pad…a good seal that the part closest to the abdomen is not possible and the condom will just roll up and slip off.
  • There are several  kinds.  In the old days the condom would roll on and then one would wrap a tape like strap at the base to hold it on. These were problematic because  the only thing holding the condom on is at the base and you would have to  do the strap so tight that it either was uncomfortable or might restrict blood supply. (I saw a  male patient this past week who was a  paraplegic and had used this type for years. The reason I saw him was for necrosis of the  skin  of the penis beyond the strap  he  was using. This is uncommon but does happen. He  will need  skin grafting the entire penis  circumferentially.)
  • Probably the best one out today is the one that the entire  inside of the condom  is sticky, so there is adhesion to the skin of the penis throughout its entire length and is no strap. You put it on and then  squeeze the entire thing and it seals.  This is the kind I used and it worked out quite  well.
  • They come  in  different sizes, mostly a diameter or girth  thing not a  length  thing, and this is important in the condom working well without leaking. Length is important in that this helps the condom stay on, i.e. there is more area for the condom’s adhesive to stick.
  • A thin person, no suprapubic fat  pad and a penis with some length works better for a  condom catheter than an obese patient with a  penis with little  length. The condom  catheter is very discriminating my friend.
  • They can be expensive as you would use one to three per day dependent on showers, etc.
  • I would take my off for sleep, because a lot of incontinence stress  in nature. By that I mean it is worse when  you are upright and moving around.
  • Whether a condom cath is best for you will depend on what you can tolerate, the degree of your leakage, your anatomy, if your skin can tolerate the glue that is used, and your attitude and  preferences about the management of leaking urine.

From “The Decision”

I was totally incontinent for about three months. I initially thought that diapers would manage the problem, but even the most absorbent brand would last only 45 minutes without getting heavy and beginning to sag down between my legs. I went back to work with a full patient load 11 days after my surgery. It quickly became apparent that a diaper alone would not work. Going back and forth to the restroom in between every four or five patients got old very quickly. I then tried the technique of adding an absorbent liner inside the diaper and only changing that, but the liner was cumbersome as well, and still I had to dispose of and replace it several times a morning. I soon found that the only thing that would let me have freedom from all the paraphernalia related to diapers was a condom catheter. We used to joke as urology residents, saying, “I’m going to go empty my leg bag,” instead of saying we were going to go to the restroom. There were residents who would take condom catheters from the urology clinic and put them on at baseball games so they could drink beer without the inconvenience of going to the stadium restroom. I ordered several types to try out (I won’t tell which size I ultimately used) and actually got along quite well with them. The ones I used were like a condom with sticky glue on the inner surface. As you roll it on, it sticks to the skin and forms a water-tight seal; the end of it has a spout that connects to a tube and a bag that attaches to a leg, hence the term “leg bag.” I could wear this under my scrubs and no one knew I had it on. I worked in the office, operated, and even taught youth Sunday school with this set-up undetected. This system malfunctioned and popped open only once. This soaked the pant leg of the scrubs I was wearing, but no one saw it and I was able to correct that quickly with a new pair of scrub bottoms. There was an ever-present fear that it might leak at an inopportune time, but that never happened. I had told very few people that I had had my prostate removed, so hardly anyone knew that I had a “leakage” issue and was wearing a leg bag. I would be speaking to a patient about what they should do for their prostate and answering questions about incontinence, all the while wearing my leg bag. It was an odd time; I elected not to tell patients about my situation. I bet in those three months of wearing protection that I must have treated hundreds of patients with prostate issues. “What would you do if it were you?” they would ask as I could feel my leg bag filling up. The bag holds about a pint, so I could feel it getting heavy and bulging the scrubs at the calf level of my leg. If you let the bag get too full, then it begins to pull down on the tubing, which in turns pulls down on the condom, which pulls down on the… You get the picture. With time, as I am sure it is with most inconveniences that patients endure, all of the issues associated with the condom catheter became second nature, just part of my life.


I would take off the condom before my shower and then jump around to see if the leaking had improved, and each morning for those three months, I was disappointed. Following the shower, I would dry the area to perfection and then carefully roll on my condom catheter and begin the process of hooking everything up. I had a routine that took about 15 minutes. On one particular morning, some of the skin of my “you know what” was very irritated and little blisters were all over the skin, particularly where urine would contact inside the condom. The condom catheter’s glue made taking off the condom a very unpleasant experience, as it would pull at the irritated areas of skin and open the blisters as well. It was very painful to take off the old and miserable to then put on the new. I remember being quite depressed by my situation that morning, more so than usual. As if it were not bad enough to be leaking all the time, now my system for dealing with it was also problematic. The thought of wearing this contraption all day, considering all the movement and discomfort that this entailed, also added to my despondency. The other issue was that if the skin kept getting irritated, I would not be able to use the condom catheter and would have to go back to diapers. I was pondering my plight and was just about “situated” when my wife entered our master bath. I was stooped over in order to connect the rubber straps of the bag to my calf and looked up at her. She looked at me oddly and with what I perceived as a look of concern. I thought that maybe she had detected my frustration and slight depression. I remember being disappointed that my true feelings might have been revealed, as I had been trying to down-play to my family the pathetic “urinary” situation that had become my life. By the way she peered down at me I was sure she was going to ask, “Is everything O.K?” She then said,” John, I think I see a black hair on the tip of your nose.” Somewhat relieved, as I connected the last leg strap, I said, “Thank you dear.”



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Doctor Settles For $600,000 For Not Informing Man Tests Suggested He May Have Prostate Cancer- By: Joseph Hernandez

Description : Men often possess a scant understanding of prostate cancer, their own chances for the cancer, and the methods available for detecting if they have prostate cancer. Many men have limited, if any, understanding of the value of screening for prostate cancer or of the guidelines for when they should start testing, how frequently to screen, and how to interpret the test results. Unfortunately doctors sometimes fail to screen male patients or do not order diagnostic testing given an abnormal result from a screening test.

Delayed diagnosis of prostate cancer cases are all too common. This article will consider the following pattern: the doctor (1) actually screens the patient for prostate cancer by keeping track of the level of PSA (Prostate Specific Antigen) in his bloodstream, (2) discovers that the patient has a high PSA level, however (3) does not notify the patient, fails to refer the patient to a specialist, and fails to order a biopsy to determine if the elevated PSA is due to prostate cancer. The case below is an example of this situation.

A doctor, an internist, found out that his male patient had a PSA of 8. (a level above a 4.0 is generally viewed as high). The physician said nothing to the patient. The physician failed to refer the patient to a specialist. The physician did not order a biopsy. Two years later the doctor repeated the PSA test. This time the PSA level had gone up to 13.6. Once again, the doctor said nothing to the patient. Again, the doctor did not refer the patient to a urologist. And again, the physician did not order a biopsy. Two years later the physician repeated the PSA test. It was not until three years after first learning of the patient’s raised PSA level that the doctor finally advised him that he probably had cancer. More testing uncovered that at this point the patient had advanced prostate cancer. A prostatectomy was no longer an option. Treating physicians alternatively advised radiation therapy and hormone therapy. Neither of these would eliminate the cancer but they might decrease the cancer’s progress and additional spread. The law firm that handled this matter reported that they took the lawsuit to mediation where they achieved a settlement of $600,000.

If they do not do anything in the presence of abnormal test results and the man later learns that he had prostate cancer and that the lapse of time lead to it spreading beyond the prostate gland therefore decreasing treatment alternatives and lowering his possibility of surviving the cancer, the person may have a claim for malpractice against the doctor.

At a minimum they ought to inform the patient that the results of the screening tests are abnormal and refer the person to a urologist. In addition, the doctor can recommend diagnostic testing, like a biopsy.

As the above claim illustrates physicians sometimes comply with the guidelines by performing screening for prostate cancer but if the test results are abnormal they do not follow through.

Article Source : http://www.articlehealthandfitness.com/

Author Resource : As an attorney Joseph Hernandez accepts medical malpractice matters. Visit his website to learn more about advanced prostate cancer cases visit the website at for a free attorney consultation with a cancer lawyerDistributed by ContentCrooner.com

This is the problem with everybody, doctors and patients, reading headlines about not ordering PSA’s on patients over a certain age and as well high false positive PSA patient’s having a negative biopsy or diagnosing a cancer that doesn’t need to be treated. If you read the previous post then the doctor did the patient a favor by not subjecting him to the inconvenience of a referral to a urologist, a biopsy, and the potential for a life-altering treatment. You can’t have it both ways. For better or worse, the best we have is a PSA and high values have to be thoroughly vetted with options for subsequent management. I would imagine you could be sued for not ordering a PSA in the first place. Ps… how about the last line about a “consultation with a cancer lawyer.” How appropriate. The American Cancer Society’s recent update on PSA could have been  used in the defense here. I’ll ask Mr. PSA’s spokesperson Pepe the Prostate at the next interview.  

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Sexual Function Does Not Continuously Decline After Radiation Therapy Treatments For Prostate Cancer

07 Jan 2010

Sexual function in prostate cancer patients receiving external beam radiation therapy (EBRT) decreases within the first two years after treatment but then stabilizes and does not continuously decline as was previously thought, according to a study in the January 1 issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Radiation Oncology (ASTRO).

Prostate cancer is the most common male cancer other than skin cancer. It can be effectively treated using multiple methods, including prostatectomy, brachytherapy and EBRT, so the long-term side effects are often used by patients and doctors as deciding factors when choosing a treatment.

Changes in sexual function are some of the more common side effects from prostate cancer treatments, but the degree to which EBRT affects function varies widely, depending on the study.

In a first of its kind study, researchers at the Jefferson Medical College of Thomas Jefferson University in Philadelphia, the Thomas Jefferson University Hospital Department of Radiation Oncology in Philadelphia and the University of California, Davis, School of Medicine Department of Radiation Oncology in Sacramento, Calif., evaluated 143 prostate cancer patients receiving EBRT who completed baseline data on sexual function before treatment and at follow-up visits.

Patients were analyzed on sexual drive, erectile function, ejaculatory function and overall satisfaction for a median time of about four years. The study authors found that the strongest predictor of sexual function after treatment was sexual function before treatment and the only statistically significant decrease in function occurred in the first two years after treatment and then stabilized with no significant changes thereafter.

“Treatment-related side effects, especially sexual function, have a significant effect on a patient’s quality of life and satisfaction with their overall outcome,” Richard Valicenti, M.D., M.A., senior author on the study and professor and chair of radiation oncology at the University of California, Davis, School of Medicine. “The results of this study allow patients and their partners to have a fuller understanding of the long-term sexual side effects of EBRT and what they can expect after treatment, which should aid in deciding on a treatment course.”

Beth Bukata
American Society for Radiation Oncology

My thoughts-

This is a good article but not for the reason that it was written. The deal is that patients are very much aware of the potential for sexual dysfunction as a result of surgery, but often don’t consider it an issue if they choose radiation. Brachytherapy (seeds) affects sexual function more than external beam and of course combination therapy of external and brachytherapy affect erections more than either alone. In the decision making process it is very important for the newly diagnosed patient to consider the ramifications of all treatments on erectile function.  As it pertains to the quality of your erections and how you void after the treatment of prostate cancer, there is “no free ride.” This issue is addressed in my book “The Decision: Your prostate biopsy shows cancer. Now what?”

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When we came up with idea of the doctor as a patient illustrated by  a doctor with the tubing coming out of a lab jacket and into a bedside bed, the issue then became how to make the fluid look like urine. The photographer Travis Massey suggested apple juice, ” Just bring the bag. I’ll fill it up when you get here.” He filled it to full capacity in order to get some of the apple juice into the bag and the tubing. This in turn made the bag much too full and prompted several funny remarks from people that saw the picture.”Man, John. You must have had a real full bladder.” “You must have really needed to go!” Placing the bag in the foreground further made the bag look big and full. Several weeks later at 7 am., and prior to surgery one morning, I went over to Travis’s studio and in his parking lot filled a second bag with one can of Icehouse beer and one can of Bud Light. We did not worry about the tubing this time and only filled the bag half full;  better representing a  more real situation. This is the bag that is on the cover of the book. Travis took pictures of the new bag on an associate and then pasted it onto the original picture you see here for the final outcome. If you are wondering why the beer looks so much like urine, it goes back to the addage,” You don’t buy beer, you rent it.”


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