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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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the tree exposed most to the wind has the strongest wood

 
Men prefer large breasts to enlarged prostates.
 
 
 

Movember

A new study has indicated that despite 1 in 6 men being diagnosed with prostate cancer in their lifetimes, men know less about how to monitor and prevent this condition than they know about what women should do to protect themselves from breast cancer.

Dr. Cason, who conducted the research, put this down to a number of factors. “Firstly, men seem to be generally more interested in breasts than prostates,” he observed. “When shown a set of slides, men demonstrated a marked preference for large breasts vs. enlarged prostates, and expressed much more interest in a model demonstrating a breast exam than a male nurse demonstrating a prostate exam.

When filling in questionnaires, 24 out of the 25 men said they would willingly assist a female friend or spouse to examine her breasts and 15 reported having done so in the last month. By contrast, only 1 out of the 25 reported a willingness to help a male friend examine his prostate. Out of the 25 men, 24 also reported owning or having owned breast orientated artwork, posters or magazines. Again, only one subject admitted to possessing prostate orientated material of an equivalent nature. “That was an interesting fellow” observed Dr. Cason gravely.

Secondly, familiarity with breasts vs. prostates seems to be a factor. “Breasts are far easier to view casually than prostates” observed Dr. Cason, “A great deal of clothing is designed to accentuate the breasts, while there has not been a single item of clothing designed to draw attention to the prostate since Pre-Revolutionary France.” Of the 25 men, 22 expressed dire confusion when shown pictures of the prostate and only 14 were able to correctly describe its location. 5 participants believed it was part of the brain and 3 claimed that they had had theirs removed in their early teens. “I believe they were confusing the prostate with their tonsils” suggested Dr. Cason.

“The distressing thing is that prostate cancer is something men need to be aware of. Detecting prostate cancer early dramatically increases chances of recovery, but detection depends on regular testing. The most treatable early stages seldom show symptoms.”

The Prostate Cancer Foundation shares Dr. Cason’s concerns and hopes that as many men as possible will join the “Grow Your MO'” campaign. When asked if he would be growing a Mo’ for September, Dr. Cason admitted to putting aside 40mins a day for mental preparation. “When that bad boy grows in, I am going to need a stick to beat the women off me!” he said, as he high-fived the Grow Your MO’ correspondent.

     
 
   
 
 
 
     

 

     
Not everyone who is awesome has a moustache, but everyone who has a moustache is awesome.
– Plato

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Perspectives

Nature Reviews Cancer, advance online publication, Published online 11 February 2010 | doi:10.1038/nrc2795

 

Opinion: Breast and prostate cancer: more similar than different

Gail P. Risbridger1, Ian D. Davis2, Stephen N. Birrell3 & Wayne D. Tilley3 

Abstract

Breast cancer and prostate cancer are the two most common invasive cancers in women and men, respectively. Although these cancers arise in organs that are different in terms of anatomy and physiological function both organs require gonadal steroids for their development, and tumours that arise from them are typically hormone-dependent and have remarkable underlying biological similarities. Many of the recent advances in understanding the pathophysiology of breast and prostate cancers have paved the way for new treatment strategies. In this Opinion article we discuss some key issues common to breast and prostate cancer and how new insights into these cancers could improve patient outcomes.

My thoughts-

In addition to the points made in a medical perspective in the story above, I see similarities as well in the emotional consequences of both diseases. It is well known that the journey of the women with breast cancer is tough. Just the mention of it conjures thoughts and visions of the disfiguring surgery, potential for chemotherapy and the subsequent loss of hair. I think everybody has a feel of the magnitude of the emotional rollercoaster that the woman and family of the woman must endure.

For the male and prostate cancer, all the treatments can adversely affect how you urinate and your sexual function. Both issues strike right at the heart of the man’s ego, pride, and “malehood.” But here’s the thing, you can’t see the prostate, you can’t see the erection problem, you can’t see the diapers and worse yet most men will not discuss those issues with his loved ones. For most, they carry the weight of the aftermath of the treatment not only silently but… invisibly. I asked a female coworker why there was not more national attention and fundraisers for men like there is for women. “Men won’t walk”, she said.  All the reader has to do is join a prostate cancer support group discussion board and you’ll see the extent of the issues out there. My hat is off to the prostate cancer male. I think they go through a lot. I am noting that there are more “women for prostate cancer” type organizations being formed. It may be that this is what it will take to the get the prostate “the rodney dangerfield of organs” on the same plane as the breast.

What you can’t see won’t hurt you-or as it pertains to the prostate-can it?

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This  recent “episode” of me exploring the discussion boards pertaining to prostate cancer has been quite revealing. It has been a learning experience both from the standpoint of a doctor and as a patient. I mention in my book that I thought I was a very sensitive and intuitive doctor with my patients before I was treated for prostate cancer. Then I realized that I had a lot to learn about my patients and that having been one I was a better doctor. That was about three years ago. I write the book and make the point that I have been a patient, that I was a “urologist with his own” disease. I began to think that I had it all as a doctor relating to patients; I treat the disease, I have had the disease, now I’m ready to be the consummate urologist. An then the discussion boards and my discovery of them come along. At first I was very intrigued by the threads,(a list of questions or comments that in turn are in turn commented on by other participants). First of all, I knew all the answers, that was neat. Then I noticed that everyone was brutally honest about their particular problem and that everyone was sincerely trying to be supportive. I read some pretty shocking stories about what the what the prostate cancer patient goes through. There is a adage that urologists use to tell parents of bed-wetters, to make sure that they do not punish their children for wetting the bed. It goes, “even the lowest of creatures will not urinate where they sleep.” The point is that sleeping in urine, urine in general on your clothes and skin is universally agreed upon to be pretty much despicable. It’s gross, it smells and if you were once a proud alpha male and have been treated for prostate cancer and you are now wearing diapers, well it “don’t get no worse than that.” So back to the discussion boards. I note that several questions are going along in the wrong direction. A responder to a thread tells another that they are experiencing a particular disorder and that he should go to webmd to a link he provided to help him understand and solve the problem. Well what he mentioned was a well know disorder of voiding that is most commonly seen in females. I comment that what the guy is experiencing is something else ,recommend an over the counter med and mention the drugs that his doctor could consider to correct the problem. That’s where I went wrong, there and the fact that I referenced something on my website( a link to an article) that I thought would be helpful. I was cognizant that I mentioned my site and book, but in the process I was, I thought, being helpful and correcting advice that was clearly wrong and not helpful. So I get kicked off the site. In inquiring what the issue is I learn the rub. These are peer to peer sites, they don’t want doctors and discourage medical advice. It has to do with being supportive and probably legal issues of issuing medical advice over the internet. I have talked to all involved and am going to try again to offer comments but solely as a patient. I am Okay with that and I still think I can be helpful and serve a purpose. I’ll be a “smart” patient. But all this is the set up for what I want to post today.

A couple of things. My wife: she agreed that there should be sites without doctors. She has said to me in the past that the maddest she is at me is when I have a solution to her problem right about the time she starts to explain the problem. “John, you don’t listen, you jump to the answer before you have heard the problem. You are soooo smart aren’t you.” This usually happened with children issues and no other issue has trouble my marriage through the years than this fault. Maybe its a doctor thing, maybe this is why they don’t want on these sites. So my wife agrees, keep the smart ass know it all doctors with their arrogance and their fancy education off the sites with patients needing support not lectures. Damn her…. why is she always right?

The other pertains  to me telling this story to doctors about my being kicked off of these sites because of  mentioning my book and being a doctor offering “expert” commentary. ( I will say that the stuff I commented on was right on and well spoken). The universal response of all and I mean all of the  doctors to a person was one of disgust. They all had an issue with patients, particularly two types of patients. The know it all patient, the internet patient that would not listen to advice and was more interested in telling the doctor what he had learned than what the doctor had to say. An then the patient that listens to another patient with the same problem and relates the other patients history to the doctor. In other words ,”My friend’s doctor did recommended this.” Or, “My friend did this.” The doctors I spoke to felt that discussion boards represent the very essence of what should not happen in the care of patients. To a person they said sarcastically, “Why in the world would you want a person who is a expert in his field to comment on these boards?” Each had a story about the type of patient that they just could not talk to, wouldn’t listen, and what they were told was then perceived and then related to family members incorrectly. One surgeon who deals a lot with women with breast cancer said,” The first thing I tell my breast cancer patients is that they are not allowed to speak to another breast cancer patient. All they do is confuse the issue. There are numerous scenarios regarding the management of breast cancer so what relevance does cousin Betty’s breast cancer have to do with my patient? But I have to spend fifteen minutes listening to Betty’s story and Betty’s doctor when it has no similarities to the person in front of me. I have to say I am your doctor, I know about “your” breast cancer.” Talking about a sore point that got everyone fired up , this was one.

So, what do we make of this? Discussion board patients need someone to listen and support and stay away from offering medical advice. Doctors should listen more and stay away from support groups and let patients vent with each other. I have been thinking about the perfect site, or scenario. Doctors as a rule don’t want to be on a discussion site, and doctors don’t have the time in daily schedule to adequately listen and be supportive. It’s an imperfect system. The support sites evolved for a reason. It filled a void not filled by the doctor and that it became into being is a good thing. Both sides can learn from this, I have.

I may stick to my one and only other  discussion board site….a georgia trout fishing group.

Rainbow trout, flyrod, self-tied wolly bugger, Soque river just outside Clarksville, Ga.

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