Posts Tagged ‘ga urologist’


From “101 Aphorisms, adages, and illustrations for the urological resident and nascent physician.”


The Only Thing E.N.T.
Has over Urology is Cocaine

One day in the urology clinic the intern I have previously mentioned in this book (the one that told the BS-ing older patient that he should treat his impotence by abstaining from sex for six months-that guy), was complaining of a head cold.
“I can’t breathe. This is miserable.”
I had a friend who was the chief resident on ENT and I arranged for the intern to go to their clinic. Just as an aside, this chief resident knew my older brother from twenty years ago in Columbus, Ga. He and my brother went to St. Anne-Pacelli Catholic School there. I went there until third grade. I still remember the nuns.
So the intern goes and about hour later comes back a changed person. I mean his was showing us how well he could breathe by taking long and exaggerated breaths, and moving around excitedly and “ready to get to work.”
“What in the hell did they do to you?” I asked him.
With a big smile and after another demonstrative deep breathe he says, “Cocaine my friend, cocaine.”
The ENT boys had put cocaine soaked pledgets in his nose and let it sit for a while and the stuff must have gone systemic.
“Man that was something else. Now I know why people use this stuff. I feel great!”
I had a medical school friend who was telling me about snorting cocaine and he said he’d do it before going to parties.
He says, “I’d do the coke and then go into a room full of people and I felt like King Bad. I loved it.”
Rule: If we could just invent a “cocaine soaked urethral pledget” for the penis. No that won’t work, cocaine is a vasoconstrictor. Never mind.

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true friends..."stick" together- a friend is someone who after you have made a complete fool of yourself...doesn't feel you've done a permanent job

How the free PSA helped me.

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time sets the stage, fate writes the script, only we can choose the characters-liam thomas ryder

The intrigue involved with the Lockerbie bomber has been addressed on this blog before. There are now reports that he is near death.  What I don’t understand is why it was important that Gaddafi wanted him back so badly. If he is indeed dying then the doctors that made the pronouncement that his death was pending have been vindicated. He must have been on hormone therapy and his PSA going up. In this case  you can predict  somewhat longevity  but not always.

But I digress. You’ll read below the tie in with BP and I find that very interesting, as I said before, ” the stuff movies are made of.”

The picture above is   the beach in front of a condo we have in Orange Beach, Ala. I am here in Orange Beach as I write. The heavy equipment you  see in the picture above is right out my back door. I took the picture just minutes ago. It sounds like New York City here. Back-up beeps, roaring diesel engines, horns, and the voices of the workers drowning out any chance of hearing the ocean. The last time my wife and I came here was in August. They reported that the moving of dirt to find “tar balls” behind our condo would be completed in a few days.  You guessed it, about the time we leave.

This might surprise you but I have somewhat enjoyed being at the beach when it’s cold and getting to watch the dirt moving. They dug it up, loaded it on a truck, took it to shifter, loaded it back on a truck and then took the dirt back. The funny thing  is that to my eye the beach sand is clean. There certainly is not obvious oil issues. I wonder if BP gave money for clean up and “By God we are going to spend it” mentality has kicked  in. My wife has enjoyed the drama of all the motion and figuring out the sequence of where all the equipment goes. ” John, it looks like someone is playing with toys down there.” Indeed, the equipment looks like our kids toys when viewed from the fifth floor.  The Orange Beach “Deep Clean”

So the Lockerbie bomber, BP, Orange Beach and prostate cancer. Yep, only I can pull that  one off. 

The Malaysian Insider


WikiLeaks: Gaddafi threatened UK over Lockerbie bomber

 Libyan Abdel Basset al-Megrahi (third from left) is hugged by Seif al-Islam, the son of Libyan leader Muammar Gaddafi, as he walked down the stairs upon his arrival at airport in Tripoli on August 20, 2009. ─ Reuters pic

LONDON, Dec 9 ─ Libyan leader Muammar Gaddafi threatened to cut trade with Britain and warned of “enormous repercussions” if the Lockerbie bomber died in jail, Britain’s Guardian newspaper said yesterday, citing US diplomatic cables obtained by WikiLeaks. 

Abdel Basset al-Megrahi, jailed for life for his part in blowing up Pan Am Flight 103 over Scotland in 1988, was freed by Scottish authorities in August 2009 on compassionate grounds, as he had prostate cancer and was thought to have just months to live.

The release fuelled anger in the United States, because 189 of the 270 victims were American, and the fact he remains alive today has stirred suspicion over the reason for his release.

“The Libyans have told HMG (Her Majesty’s Government) flat out that there will be ‘enormous repercussions’ for the UK-Libya bilateral relationship if Megrahi’s early release is not handled properly,” US diplomat Richard LeBaron wrote in a cable to Washington in October 2008.

Libya “convinced UK embassy officers that the consequences if Megrahi were to die in prison … would be harsh, immediate and not easily remedied,” the US. ambassador to Libya was quoted as saying in another cable in January 2009.

“Specific threats have included the immediate cessation of all UK commercial activity with Libya, a diminishment or severing of political ties, and demonstrations against official UK facilities,” said US Ambassador Gene Cretz.

Libyan officials had implied the welfare of British diplomats and citizens in Libya would be at risk. “The regime remains essentially thuggish in its approach,” he added.

The Guardian said the cables also showed Scotland’s First Minister Alex Salmond had underestimated the public outcry in the United States and Britain.

It said a British civil servant had told the US embassy that officials from Salmond’s Scottish National Party had sought to blame the British government for putting the Scots in a position to have to make a decision.

“It is clear that the Scottish government underestimated the blowback it would receive in response to Megrahi’s release and is now trying to paint itself as the victim,” wrote Louis Susman, the US ambassador in London, in a cable.

US anger over Megrahi’s release resurfaced earlier this year after suggestions British energy giant BP Plc had lobbied Scotland for Megrahi’s release. BP and Scottish ministers have denied the accusations.

Britain has always conceded that its interests would be damaged if Megrahi died in a Scottish prison.

However, speaking to BBC radio yesterday, both Salmond and former British Justice Secretary Jack Straw repeated denials that Libyan pressure had played a part in the decision to allow Megrahi to return home.

“From a Scottish government perspective ─ and incidentally, the American information bears this out ─ we weren’t interested in threats, we weren’t interested in blandishments, we were only interested in applying Scottish justice,” Salmond said.

Straw added: “Both Alex Salmond and the British government have said until they’re blue in the face what is true, that this was a decision which was made by the Scottish government and by nobody else and they did it on the basis of their law.” ─ Reuters

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it is better to be quite and appear dumb, than to speak and remove all doubt.

Why men won’t have a rectal explained with humor in a cartoon. I have personally heard these examples from patients. 

What is interesting about this study is that:

  • Older more educated men more likely to agree to get screened
  • Younger and employed men are less likely
  • Of the men who declined the rectal many would not tell why
  • Those who did say why they declined a rectal said it was “embarrassing.”
  • And finally a point that I am in total agreement about…we need to do more about getting all men recognize the importance of the “awareness of prostate cancer.” Until we do, men showing up in their fifties with prostate cancer too late to cure will continue to occur.
  • Embarrassing? Give me a break!

Why Do Men Refuse Prostate Cancer Screening? Demographic Analysis In Turkey

15 Dec 2008

UroToday.com – Prostate cancer is one of the most common cancers in men, with a high incidence rate in Turkey. However, the early detection and diagnosis rates are considerably lower among Turkish men as compared with their counterparts in Western countries. This fact reflects a lack of awareness and fear of prostate cancer as well as low participation in prevention activities. To reduce the disparities in prostate cancer survival, there is a great need to increase men’s participation in screening programs.

The present study was performed to assess why men do not seek screening or participate in screening programs, focusing on the demographics of men refusing free screening programs for prostate cancer.

The sample size (n: 747) was determined using the Systematic Random Sampling Method (95 Confidence and 2% Standard Error) among men over 40 years of age who lived in the Osmangazi region (n: 3285). All were enrolled in the study in a 20-month period and asked to complete questionnaires Then they were invited to attend a public health center to consider having a PSA test and DRE for prostate cancer. Two different questionnaire forms were applied during the study. In the first, the socio-demographic characteristics of subjects were evaluated with 23 questions. The second questionnaire was comprised of the International Prostate Symptom Score Form (IPSS form). Serum PSA level, DRE characteristic, TRUS and TRUS-guided biopsy results were recorded in a third form. Serum PSA value and DRE were used for prostate cancer screening. The screening procedure was conducted by a urologist. If the men had any abnormality on PSA value (4.0ng/mL<) and/or DRE, the results were subjected to further investigation (including TRUS and prostate biopsy). Prostate cancers were finally detected in five subjects.

Although all of men (n: 747) responded to the questionnaire forms, only 35.2% of men accepted DRE (n: 263). Subjects were divided in two groups (accepted or refused) for analysis. Participants in the 40-49 year age group were less likely to attend the screening than older ages (p<0.05), and the level of participation increased with age (p<0.05). Men graduating from high school were more likely to go for screening than men with less than a high school diploma and college and above (p<0.05). Retired men were more likely to participate than employed men (p<0.01). There were no significant differences in marital status and health insurance between refusing and attending groups. Although participation increased with the I-PSS score, there was no statistical significant association with urinary symptoms. At the end of the free prostate cancer screening program all the questionnaire forms of the participants who refused were examined from the point of view “what would make it challenging for the men to get free prostate cancer screening?”. About 51% of those who refused failed to give a reason for not participating in a free prostate cancer screening, and while 25% made an appointment, Digital Rectal Examination was not accepted. The other barriers to prostate cancer screening included embarrassment about DRE (5.8%) and other reasons.

Since this screening program was free of charge, we eliminated cost, lack of knowledge, and not having a regular doctor by free charge and informed consent. However, our findings suggested that there were some possible reasons for refusing to participate in prostate cancer screening and few barriers were reported. The current study revealed that in the 50-59 years age bracket, high school graduates and retired men were more likely to participate in prostate screening. Especially, 65.8% (n=173) of retired men participated in screening versus 34.2% (n=90) of employed men.

There are some limitations to the study. The sample was small; this being the first study related to free prostate cancer screening and barriers in Turkey.

 Future research needs to examine how we can assist men in overcoming the barriers they describe. Future efforts should be directed at increasing awareness about screening procedures for prostate cancer.

Written by Esin Ceber, MD as part of Beyond the Abstract on UroToday.com

UroToday – the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: http://www.urotoday.com

Copyright © 2008 – UroToday


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From the “Decision”-  The perfect storm.

So the perfect storm: common misconceptions that give men a false sense of security, an exam they do not want to have done, and the resultant flawed rationalization to skip a prostate evaluation. All of these factors contribute to missed opportunities for early detection.”

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a lotta shakin going on

Langston Hughes
Photo by Consuelo Kanaga

Langston Hughes
James Langston Hughes was born February 1, 1902, in Joplin, Missouri. His parents divorced when he was a small child, and his father moved to Mexico. He was raised by his grandmother until he was thirteen, when he moved to Lincoln, Illinois, to live with his mother and her husband, before the family eventually settled in Cleveland, Ohio. It was in Lincoln, Illinois, that Hughes began writing poetry. Following graduation, he spent a year in Mexico and a year at Columbia University. During these years, he held odd jobs as an assistant cook, launderer, and a busboy, and travelled to Africa and Europe working as a seaman. In November 1924, he moved to Washington, D.C. Hughes’s first book of poetry, The Weary Blues, was published by Alfred A. Knopf in 1926. He finished his college education at Lincoln University in Pennsylvania three years later. In 1930 his first novel, Not Without Laughter, won the Harmon gold medal for literature.

Hughes, who claimed Paul Lawrence Dunbar, Carl Sandburg, and Walt Whitman as his primary influences, is particularly known for his insightful, colorful portrayals of black life in America from the twenties through the sixties. He wrote novels, short stories and plays, as well as poetry, and is also known for his engagement with the world of jazz and the influence it had on his writing, as in “Montage of a Dream Deferred.” His life and work were enormously important in shaping the artistic contributions of the Harlem Renaissance of the 1920s. Unlike other notable black poets of the period—Claude McKay, Jean Toomer, and Countee Cullen—Hughes refused to differentiate between his personal experience and the common experience of black America. He wanted to tell the stories of his people in ways that reflected their actual culture, including both their suffering and their love of music, laughter, and language itself.

Langston Hughes died of complications from prostate cancer in May 22, 1967, in New York. In his memory, his residence at 20 East 127th Street in Harlem, New York City, has been given landmark status by the New York City Preservation Commission, and East 127th Street has been renamed “Langston Hughes Place.”

In addition to leaving us a large body of poetic work, Hughes wrote eleven plays and countless works of prose, including the well-known “Simple” books: Simple Speaks His Mind, Simple Stakes a Claim,Simple Takes a Wife, and Simple’s Uncle Sam. He edited the anthologies The Poetry of the Negro and The Book of Negro Folklore, wrote an acclaimed autobiography (The Big Sea) and co-wrote the play Mule Bone with Zora Neale Hurston.

A Selected Bibliography


Ask Your Mama: 12 Moods for Jazz (1961)
Collected Poems of Langston Hughes (1994)
Dear Lovely Death (1931)
Fields of Wonder (1947)
Fine Clothes to the Jew (1927)
Freedom’s Plow (1943)
Montage of a Dream Deferred (1951)
One-Way Ticket (1949)
Scottsboro Limited (1932)
Selected Poems (1959)
Shakespeare in Harlem (1942)
The Dream Keeper and Other Poems (1932)
The Panther and the Lash: Poems of Our Times (1967)
The Weary Blues (1926)


Good Morning, Revolution: Uncollected Social Protest Writings by Langston Hughes (1973)
I Wonder as I Wander (1956)
Laughing to Keep From Crying (1952)
Not Without Laughter (1930)
Remember Me to Harlem: The Letters of Langston Hughes and Carl Van Vechten, 1925-1964 (2001)
Simple Speaks His Mind (1950)
Simple Stakes a Claim (1957)
Simple Takes a Wife (1953)
Simple’s Uncle Sam (1965)
Something in Common and Other Stories (1963)
Tambourines to Glory (1958)
The Arna Bontemps-Langston Hughes Letters (1980)
The Big Sea (1940)
The Langston Hughes Reader (1958)
The Ways of White Folks (1934)


Black Nativity (1961)
Collected Works of Langston Hughes, vol. 5: The Plays to 1942: Mulatto to The Sun Do Move (2000)
Don’t You Want to Be Free? (1938)
Five Plays by Langston Hughes (1963)
Little Ham (1935)
Mulatto (1935)
Mule Bone (1930)
Simply Heavenly (1957)
Soul Gone Home (1937)
The Political Plays of Langston Hughes (2000)

Poetry in Translation

Cuba Libre (1948)
Gypsy Ballads (1951)
Selected Poems of Gabriela Mistral (1957)


Masters of the Dew (1947)

When  I was urology resident the only case that we did that was more feared than a radical cystectomy,”God did not mean for the bladder to be removed,” was a radical prostatectomy. They were hard to do, had a lot of bleeding, usually 1000-2000 cc’s, and almost always had some degree of incontinence and sexual dysfunction after math. This would have been about 20 years after Langston Hughes died of ” abdominal complications of prostate surgery.” I did see somewhere that he was in the hospital about two weeks and then succumbed to an infection. I can’t find if he had a prostatectomy or not or if the surgery was for urinary obstruction (a channel TURP not prostate removal) or if it was for something like ureteral obstruction. With the advent of the Walsh prostatectomy a urologist, like me, in a small community could perform this procedure with results unknown to Hughes’ time. Usually done in less than two hours, minimal blood loss (usually less than 500 cc’s) and a good chance of preserving sexual function and almost always preserving continence. (Mild stress incontinence can be common). Robert Frost had a prostatectomy and died a year later. This interests me. I plan to do a little research and see if I can find some of the particulars of the medical histories. That surveillance has become more and more a treatment option and not a mere ” doing nothing approach” in a way brings the treatment of prostate cancer full circle. In patients like Hughes, Frost, Bixby etc…. these were cases of late diagnosis, in other words they did not have option of surveillance. I feel folks are getting this all mixed up. You have to have the diagnosis first and the specifics of the biopsy to then make surveillance choices. See previous post on Squarl and you’ll see how some are a bit misguided. To prevent a Hughes type patient you need a reasonable awareness program, then and only then, with the diagnosis in hand with the particulars of the disease, does the discussion and decision-making process begin.

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penelope playing her stick like a Stradivarius

Distressing. Waiting on my “positive” biopsy was one of the worst times of my life. But what’s a man to do? In active surveillance there is a degree of waiting and ” not knowing.” In ” The Decision,”  I state that a lot of what men decide to do or how they react to their situation depends on their personality. They will deal with the issues surrounding the prostate cancer process the same way they deal with issues at work or at home. Here is the link to this site to show you how the h___  I waited for the results of my prostate biopsy. Distressed is not the word for it.

My ” waiting on the biopsy” experience.

Men Should Be Warned That Prostate Cancer Tests Can Be Distressing

Main Category: Prostate / Prostate Cancer Also Included In: Men’s health | Psychology / Psychiatry | Medical Devices / Diagnostics Article Date: 08 Apr 2010

Twenty per cent of men can feel distressed at the prospect of having a biopsy after finding out they have a raised PSA level, and nine per cent continue to feel this way even after being informed they don’t have cancer, concluded UK researchers who recommended doctors clearly explain the psychological effects of prostate cancer screening to their male patients and how it can lead to anxiety and distress.

You can read about the findings in a paper published online on 6 April in the British Journal of Cancer. A high level of Prostate-specific antigen (PSA) can indicate cancer, but it can also be a sign of infection, an enlarged but not cancerous prostate, or even a reaction to

recent exercise.

For up to 70 per cent of men who have a biopsy as a result of a raised PSA, the result is negative (ie the biopsy, a surgical procedure that removes small pieces of the prostate gland which are then tested for cancer cells, does not show evidence of cancer).

In the UK, men are not routinely offered a PSA test, but if they are concerned they may have prostate cancer, they can discuss the risks and benefits of having one with their GP.

Lead author Professor Kavita Vedhara from the University of Bristol told the media that:

“At the moment, doctors are asked to warn men about the difficulties of interpreting the results of a PSA test. The test misses some cases and can produce false alarms.”

“While it’s crucial that men are aware of the difficulties they may face when deciding what to do with their results, it’s also important they’re aware that they may find the whole process stressful”, she added.

Vedhara explained that in some men, the psychological effects appear to last even after they have been told they don’t have cancer, that the biopsy was benign.

“Even 12 weeks after receiving a negative biopsy result, nine per cent of men said they still felt distressed,” said Vedhara, stressing that it was important doctors know about this and fully inform their male patients about the psychological challenge of undergoing a PSA test.

For the study, Vedhara and colleagues used data on 330 men aged 50 to 69 who took part in a Cancer Research UK funded survey that is linked to the ProtecT trial, which is investigating the best ways to detect and treat prostate cancer.

The participants all had a PSA level greater than or equal to 3 ng/mL and a negative biopsy result and completed distress and negative mood measures at four points in time: two during the diagnosis phase and two after receiving a negative biopsy.

When they analysed the data the researchers found that:

Most of the men were not greatly affected by testing or a negative biopsy result. The impact on psychological health was highest at the time of biopsy, with around 20 per cent reporting high distress and tense/anxious moods.

A longitudinal analysis on 195 participants showed a significant increase in distress at biopsy time compared with PSA testing time, and these levels persisted after the negative biopsy result and 12 weeks later.

Psychological mood at the time of the PSA test predicted high levels of distress and anxiety in measures taken after that.

The researchers concluded that:

“Most men coped well with the testing process, although a minority experienced elevated distress at the time of biopsy and after a negative result.”

They recommended men be informed of the risk of distress linked to the uncertainty of diagnosis (and presumably the fact the distress could continue for months) before they agree to have the PSA test.

Martin Ledwick, head cancer information nurse at Cancer Research UK, said that for many men, an early diagnosis of prostate cancer could save their lives, but for about one in eight the test will be abnormal but not be followed by a cancer diagnosis at that time.

“Further tests and biopsies are usually needed to rule out cancer for these men,” said Ledwick, adding that this study shows “just how important it is that men in their 50s and 60s can talk to their doctor about the pros and cons of having a PSA test and only have the test if they feel it is right for them”.

“Impact of prostate cancer testing: an evaluation of the emotional consequences of a negative biopsy result.”

R C Macefield, C Metcalfe, J A Lane, J L Donovan, K N L Avery, J M Blazeby, L Down, D E Neal, F C Hamdy, K Vedhara. British Journal of Cancer, published online 6 April 2010. DOI:10.1038/sj.bjc.6605648

Source: Cancer Research UK.

Written by: Catharine Paddock, PhD Copyright: MediLexicon International Ltd

Original article posted on Medical News Today.

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