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Posts Tagged ‘incontinence’

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That which associated with activity is stress incontinence and usually is corrected with surgery.

Urgency incontinence is associated with overactive bladder and this improves with diet and medicines.

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You mean the robot works on other organs?
That hurts Mr. Prostate’s feelings!

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instead of spending a lot of time explaining why you can't help the patient, spend just a little time on how you can help.... john mchugh (just made it up this week)

So back to my tooth…the saga continues…

  • several months pass and I go back to the original again because of a cracked temporary crown and in the process of fixing me a new temporary he notes that the bone structure above the tooth has not changed like one would expect if there was a deep enough crack to preclude a crown.
  • “I’d like you to see an endodontist and see if you’d be a candidate for a root canal.”
  • “What does this mean? Can the tooth be saved?”
  • “Let’s just see what he thinks. I’ll call him and his office will call you for an appointment.”
  • I go to the root canal doctor and at that visit and after my fifth set of xrays of my teeth I experience first hand the dreaded and universally feared “root canal.”
  • It was fine except for the part where a “lateral canal” did not get the effect of the lidocaine and I felt a lightening bolt that shook me to my core.
  • “Huhhh. That must be a lateral canal. I’ll put more medicine in there. You  don’t see that often.”
  • After the root canal I am advised to return to my dentist for a crown on top of that (whatever he did) in two weeks.
  • The next night while having a potato chip half of my tooth breaks off and have to spit out the chip and the tooth to keep from swallowing the fragment.
  • The next day I am at the dentist. “I was only eating a potato chip,” I said in disbelief of my predicament.
  • “John. There are some pretty tough chips out there.”
  • I get new crown. I go back to the root canal guy and we determine that all of the root may not have been reamed out and I go through a second root canal.
  • After this one I developed a sinus that is like an abscess of the gum that swells to the size of a large grape and then bursts one night in my sleep.
  • I go back to the root canal guy and does the reaming yet again and floats the thought that I may have a crack that is extending too far to fix or that there is an aberrant root he cannot get to. He calls over an associate in the office next door to explain my case and see if I am a candidate to have the rood excised through my gum…periodontist an “apicalectomy.”
  • I don’t go back for about six months until the area swells again and decide to have it checked.
  • I see the periodontist.
  • He does the apicalectomy….an incision in the gum, the offending root is then drilled and reamed out.
  • As bad as the above seems all was done professionally and I have confidence in my doctors.
  • About six stitches are placed in the gum that hang around in my mouth for about a week.
  • I am now in the waiting phase to see if it will be successful. My gum is still sore but not swollen.
  • After the apicalectomy the left side of my face “swole up” like I’d been in a fight or having had an allergic reaction to shrimp.

So what to make of this?

You have been told you have prostate cancer.

You have about six options to include doing nothing.

You read, you listen and you gravitate to a decision.

Treat it like my tooth. See the urologist, the oncologist, the radiation guy, speak to friends, get a second opinion, hell…do it all.

But don’t whine at the end of your treatment that you were forced into something because you were not given options and now you feel it was all about money. Really?

Go to all the “ists” like I did. I have no regrets. All my guys were great and made clear to me that the treatment of a “crack” is not a science but an art and a lot of wait and see. I get it. Do you?

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A question (slightly amended for privacy) from a message board.

I am so happy to report that my husband’s bone scan, x-ray and cat scan all came back negative and the doctor feels the cancer is contained to him prostate.  I understand it could actually be a bit outside which won’t show up on any of these tests, but still this is great news for us.  Have been sitting on pins and needles til these results were it.

He will start treatment in Georgia the end of this month, likely hormone therapy and radiation.

I’ve read some bad side effects from hormone therapy, anyone do the radiation without it?

Gleason 9 (5+4) psa 1.54 T2c

Good question but is it best asked of other patients on a prostate cancer message board or of this person’s doctor who recommended this form of therapy? Use all the arrows in your quiver my friend.

Here’s a google I did on this question and I got several good articles, not the least of which from the PCF’s blog that addressed the very subject. Imagine that!

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you catch more flies with honey than you do with vinegar

 

Prostate removal surgery and sex: ‘Very few men… are the same as before’

 

Incontinence, impotence two possible side effects

 
By Denise Ryan, Vancouver Sun September 30, 2010 Comments (7)
 
 
 
Francine Hardaway and her husband, the late Dr. Gerry Kaplan.
 

Francine Hardaway and her husband, the late Dr. Gerry Kaplan.

Photograph by: Courtesy, Family

VANCOUVER – Francine Hardaway, an entrepreneur and tech guru, said love came upon her powerfully and unexpectedly.

“He was my boyfriend,” she says in a phone interview from Phoenix, Ariz. Her voice bursts with pride and pleasure when she says “boyfriend,” as if he was, and is, the very first.

She was divorced, and in her late 40s. Her hairdresser introduced her to Dr. Gerry Kaplan, a radiologist.

He was 57, also divorced. Kaplan was tall, intellectual and free-spirited.

They fell wildly in love. They had sex like teenagers.

There was just one thing. “He showed up on one of our dates and said ‘I just had a biopsy’.”

He downplayed it. He’d had rising PSAs, he explained. “He had gone to a urologist friend, who had not found anything and he let it go.”

A year later his prostate-specific antigen count had doubled.

Again, he waited.

The third time a biopsy detected prostate cancer.

For her, it was simple: Get the cancer out.

“I knew that people had surgery, and that surgery could work,” Hardaway said.

She couldn’t understand why he had delayed.

Then, it came out: “I could end up not able to get an erection.”

She pleaded with him. “Think of me. Think of your children. Your work.”

In reply, Kaplan blurted out, “Marry me.”

Hardaway was taken aback. “What does that have to do with it?”

Kaplan, utterly vulnerable, replied, “You’ll go away because I’ll be impotent. I’ll be all alone.”

Hardaway didn’t hesitate. They married, and Kaplan had surgery a week later.

Prostate cancer throws mortality and sexuality in the ring together: If you win your life, you could lose your erection.

“If a man is sexually active and it’s a big part of his life, it’s critically important. It’s a big part of what we talk about,” said Dr. Larry Goldenberg, founding director of the Prostate Centre at Vancouver General Hospital.

After a prostatectomy — the complete removal of the prostate gland — Goldenberg said, “There are very few men who are the same as before.”

The effects of surgery can range from mild loss of erection and pain on orgasm, to total loss of erection and incontinence.

“It’s almost impossible to predict,” Goldenberg said.

The good news, says Goldenberg, is that advances, such as earlier diagnosis and nerve-sparing surgery, have changed outcomes for men.

“With better treatments, we have higher chances of maintaining sexual function.”

He compares the nerve-sparing surgery to peeling the skin off an onion. “We peel the nerves off the prostate, it’s very delicate. Then we remove the prostate, reconnect the urinary bladder to the urethra.”

Nerve-sparing surgery cannot be done when cancer is detected close to the nerves.

The first priority, says Goldenberg, is to get all the cancer out. The second priority is to maintain urinary function.

The third priority is to maintain sexual function.

Often it is not until after surgery that sexual function moves front and centre.

Still no erection

Glen, 64, a Vancouver computer programmer, was diagnosed four years ago with an aggressive form of prostate cancer.

Nerve-sparing surgery was out of the question, and due to complications, part of the penile shaft was removed.

“You look down and go, holy smoke. It’s short. I was left with about a half-inch of male tool,” he says. “You feel like your manhood’s gone.”

Glen was angry. His wife tried to be encouraging, but that only made things worse. “She was talking to others, telling me erections come back. That was so hard to deal with.”

What got them through, he says, was acceptance.

“Once we accepted that the erections were not going to come back, we could move on.”

Snuggling and being close has really helped, he says.

“And we use a strap-on,” he says, somewhat mischievously. “We do it that way, which is pleasing to her.”

Jeff Jarvis, renowned American author and blogger, is fully out of the closet with his prostate cancer. He will take part in a live chat today at noon at vancouversun.com.

Diagnosed a year ago, he has blogged about the indignities big and small: having a “mondo stapler shoved up my ass” during the biopsy; picking up Viagra and pads to deal with incontinence; a helpful pharmacist who yelled out across the store, “Is he gonna need the diapers, too?”

Jarvis has fearlessly opened the door to the male kitchen and invited the public in.

A year after surgery, he still has not had an erection.

Going public with his experience, he hopes, will encourage other men to get tested and stay healthy.

This is his “small mitzvah,” for the luck he has had: He has been declared “cured.”

“It is very freeing to be oneself,” Jarvis said in a phone interview from New York.

“Erections are an odd thing, especially not having them. I still don’t.”

Jarvis considers himself lucky. “My grandfather died of this disease. I can rationally remind myself of this.”

He compares looking down at his unresponsive penis as a kind of out-of-body experience.

“Some people get some action back in a few months, but I’ve had nada. Absolutely no response. It’s a bit infantilizing. The thing hasn’t been like this in 50 years.”

The only “malfunction” he’d ever had before, says Jarvis was “once in a hot tub in Montreal.”

“Here’s the full humiliation,” he added. “I got the penis pump and even that doesn’t work for me.”

Jarvis, who is married with two children, is remarkably free of embarrassment.

For him, going public has been liberating, and forced him to engage with the very meaning of what it is to be a man.

“We men spend our lives being led around by our penises,” he said. “No longer.”

Francine Hardaway said that when her husband awoke from surgery, she knew he was going to feel sexually compromised.

“I got up into his bed and did some things that were gestures of solidarity for him,” she hesitates, her voice full of emotion.

“I got into his bed and started performing fellatio. He still had the catheter in. I wanted him to see, look, I am not afraid of this. This is not going to make a difference.”

Hardaway’s gesture may seem surprising, but there is a medical, not just an emotional, reason to stimulate the penis as soon as possible after surgery.

“I operated on a man yesterday,” Goldenberg said. “I started him on Viagra last night.”

Blood flow to the penis allows oxygen into the area, keeps tissues healthy, prevents atrophy and helps men recover sexual function.

“If you don’t use it, you lose it,” Goldenberg said.

Penile rehabilitation is part of the deal.

Help is available

Shannon Griffen, a sexual health clinician, said she encourages men to bring their partners to appointments where erection enhancement is discussed.

“Some of the men I see are of the mindset that ‘It’s my problem, my concern, I’ll take care of it,’” Griffen says.

“When a couple has gone through something like this they need to be more verbal, have more communication.”

Men experiencing failure with erections may withdraw from their partners; partners not wanting to pressure their husbands may also withdraw sexually.

“Couples that have been together 35 years and want to resume their sex lives now have to ask, ‘How do we do that?’ There’s shyness and discomfort,” Griffen said.

“You learn a whole lot about sex as a result of having prostate cancer,” said Alan, who was diagnosed at the age of 62.

After surgery, he experienced a year of erectile dysfunction, bladder spasms, physical pain and inner turmoil.

“We had been screwing each other regularly and enjoying it,” he says about his relationship with his wife.

“I found myself living under a dark cloud.”

Alan regrets not getting sexual counselling more quickly, but he said, “After a diagnosis, all your psychological bearings have changed. You’re vulnerable, your future is unknown, you have choices to make but not enough information to make them.”

Attending a support group and going online helped.

Alan had a poor response to Viagra, but has had great success with intracavernosal (penile) injections.

“It used to be, ‘Get the condom out of the drawer.’ It’s changed to, ‘I’m going to do the injection now.’ At 25 this would have been a real problem. At 65 you can get used to a lot of things.”

Although sex has changed, “orgasms feel different, but they are still orgasms,” Alan said.

“If you think about sex with your wife as being able to stick it in, then you’re in trouble,” he said. “If your manhood is more broad-based and sexuality is about mutual pleasure, you’ll do better.”

Hardaway’s husband did not recover erections. They found all sorts of ways around that. “I didn’t care, but he did. He decided to get a penile implant.”

She told him it was his decision. He got the implant, which left him semi-erect all of the time, and he was happy with it.

Sadly, the cancer metastasized, and five years later, he died. Had he been more proactive and less fearful, Hardaway believes “absolutely” that the outcome would have been different.

“Jeff Jarvis is a hero,” she said. “Men man up and don’t talk.”

Her husband, she said, had that “one Achilles heel.”

“But you don’t say this sucked, because I only had it for five years.”

The words pour out of her as she recalls the love she lost too soon. “You learn from each other, you leave each other alone, you have dinner, you sleep together, you comfort each other. Some people never get that. I nearly missed it.”

dryan@vancouversun.com

  

 

 

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if you can walk with kings and not lose the common touch

Read the following comment and then my thoughts after it.  Being a doctor is a lot like a person gambling with someone else’s money. Read the comment and then I’ll explain.
 
October 08, 2010, 11:28:15 AM | Dean Hubbard

My physician and urologist recommended a biopsy when my score hit a 5 at age 55. Nothing there. Later, when my score was a 6 another biopsy was recommended. Nothing there…again. Once I had a 9.9 and two months later it was a 6. My latest score, the eighth since 2006, is a 7.3. I’m 61 yrs. old now and my prostate is sized “…between 40 and 60″. Oddly, neither of my previous two urologist EVER mentioned that a bigger prostate will produce more enzyme. So, why was I being unnecessarily frightened by the urologists while being compared to those men with a prostate size around 15g? No DRE has ever inidicated any nodules in my prostate. The PSA test is not an indication of anything other than the presence of the enzyme. A fried seafood dinner and sex the night before can elevate the score. (Unfortunately, I was not told that by any doctor.) I’m sorry, but after my second biopsy I couldn’t help but remember what caught my eye on the way out of the urologist’s office: his shiny black Porsche Carrera Turbo. After my latest score my current urologist’s nurse (by phone) has urged me in strongly worded suggestions to consider “talking to the doctors” at my earliest convenience. I’ve heard this story before and patients like myself are tired of hearing the alarm, paying the money, and suffering the biopsies, simply because the PSA chemoluminescence indicates something above a 4. Urologists need to stop frightening us by using an incredibly fallible test as a basis for doing so. Urologists need to donate a portion of their income and book sales to research that can find a better test.

My thoughts…

  • Except for the penis…size doesn’t matter. Whether a prostate is small or big it can still harbor prostate cancer. One can reason that, “my PSA is high because I have a big prostate” but the problem remains… a high PSA. So what to do? You can ignore it, repeat it, or do  biopsy. I tell folks with a high PSA, we usually repeat the value at least once because of known variations, that you  really do need to  do the biopsy at least once to  be sure there is no  cancer. Otherwise you  are  just “mentally masturbating” about whether the PSA means cancer or not.
  • Here’s the problem if you are the urologist.  Think of Will Roger’s saying, “to know or feel what a fella’s thinking, go around behind him and look out at what he’s looking at.” So you are doctor and your patient has a high PSA.  He is there for you to tell  him if he  has cancer or not. What to do? There is only one way…a biopsy. Okay…as in the situation  above, your patient returns at some point and the PSA  has gone up. Only three options, repeat the value at some point in the future, ignore  it, or do a biopsy. Hint: If you don’t do a biopsy and the patient returns a  year  later and the PSA is higher again  and you  do a biopsy  then  and it’s positive for cancer…well you are going to have a very unhappy patient and family wondering why you waited a year to make the diagnosis. If that patient has asymptomatic bone disease for metastasis (uncommon but trust me it happens) then you are at  risk for a law-suit. So in the comment above I agree with all the issues and also  feel the author is intelligent. I love that word chemolumenesicencesesssxz, but the fact remains that each  time the PSA goes up and there has been a period of time that passes, a  new decision has to made. You can’t base  a  negative biopsy four  years ago to lend  credence to  not acting on an elevated PSA today. “I’ll gladly pay you Tuesday for a hamburger today.”
  • I have a friend whose father I see. He is 78 and has a PSA of 16. I had biopsied him two times over 5 years, each negative. He comes in about four months ago and now his PSA is 19. I say, ” we have two options…one ignore the change and repeat it in few  months or so, or two repeat the biopsy.” As the doctor, it is more definitive  to do  the biopsy. His son is a friend of mine, what if  the man has cancer and I have missed it with the previous biopsies. (You only take 12 cores, so a prostate biopsy probably only samples less than 1% of the gland.) It been a  few years since the last biopsy so I lean on him to repeat the biopsy.(Ps….you notice I have not mentioned money nor  did money have anything to do with  my decision-making process.) We do the biopsy and one core  of twelve comes back  positive. Now here is the kicker. It was Gleason’s 8. That’s a bad actor. That is not  an incidental cancer that old people  get anyway. So, I send him over to the radiation therapist, and he is impressed by the Gleason score and in turn recommends radioactive seeds.
  • If you are the urologist and over your career you  have seen  things happen like, a small gland and a low PSA that had an aggressive cancer, or a big gland and low PSA and bad cancer, or normal gland and  only a slight change in  the velocity of the PSA and you find a bad cancer…and on and on….begin  to be wary  of the PSA and you do become a bit defensive. What I do is lay it out for the patient,  I try to go over the scenario’s and then  the patient decides.
  • Try this question and it is one that I have used many times….” Mr. Smith,  if you had prostate cancer would you want to know?” Think of it that way.  The  only way to know is the biopsy.  
  • “Mr. Smith, do  you want to fish or cut  bait. We are gambling with your money.”
  • In the above comment, I don’t have big problem with the fact that biopsies were done or that they were negative. There does appear to be a problem  with communication and there is never an excuse for that particularly if you have  an intelligent and motivated patient  as this.
  • Final thought…..regarding the comment and the history of this patient….we still don’t know if he cancer or not and if the PSA is on the basis of an  undiagnosed cancer or an elevated PSA because of an enlarged prostate. My feeling is that he does not have prostate cancer. If he  were my patient, and the PSA goes up again, I might recommend a  Free PSA and see if the free  portion low  or high. In my hands if the free  portion is low, I’d recommend another biopsy. I’d document that I recommended another biopsy. And  then, the patient decides, gets  a second opinion or whatever. It’s tricky….I’ve been there done that.”

Dirty little secret: you still could have undiagnosed prostate cancer and it could be an aggressive form. Unlikely yes….but remember….we’re gambling with your money. In many ways it all ends up with  what a patient can “live with.”

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My wife and daughter went to the beach recently and as my usual custom I stayed to work to pay for my many ill-advised investments. So…what to do with the pepster,(our most wonderful chocolate lab, have you by chance seen any of her pictures?). I ask one a member of my staff if she would mind going to my home mid-morning to let her out of our bedroom to go out in the backyard to run around, do her thing, and maybe throw tennis balls in the pool for her to fetch. So one my employee volunteers goes and dutifully does as I ask and lets the pompsie out and throws balls for about twenty minutes, puts her back into the bedroom, and comes back to work. ” How did the pepsi do?” I asked when she returned. ” I saw the bathroom where you filmed the legbag movie!” she said. I thought, ” That wallpaper is distinctive and dated.” I then debated telling my wife about any of it.

I had moderate obstructive voiding symptoms at the time of my diagnosis of prostate cancer. I was 52 and noticing a slower flow to my urinary stream and a little more frequency in feeling the urge to void. This was exacerbated by certain foods or drink, particularly beer.
This is key: obstructive voiding symptoms (diminished force and caliber of stream) is a sign of benign prostate enlargement. (See the diagram of the previous post). It can be a symptom of prostate cancer but only if the cancer is revealed very late. HELLO…THERE ARE NO SYMPTOMS RELATED TO PROSTATE CANCER IF IT IS DIAGNOSED EARLY. SYMPTOMS RELATED TO PROSTATE CANCER OCCUR IF THE DISEASE IS FOUND OUT LATE. IT IS USUALLY A SYMPTOM THAT GETS THE PATIENT TO THE DOCTOR BUT THAT IS WAYYYYYYYYYY TO LATE. SEE MY LETTER TO THE NYT REGARDING ABLIN’S FATHER. WE DON’T WANT THAT SCENARIO…. WE WANT EARLY AND WE WANT TO ADVOCATE AND SUPPORT EARLY DIAGNOSIS, AND AWARENESS. I SAW THIS SOMEWHERE ON THE NET…. A MAN DESERVES THE RIGHT TO KNOW IF HE HAS PROSTATE CANCER OR NOT AND HE IS GIVEN THE OPPORTUNITY TO DECIDE WHAT TO DO AND HOW AGGRESSIVE OR PROACTIVE HE WOULD WANT TO BE. FOR SOMEONE TO DECIDE NOT TO DO A PSA OR A BIOPSY BECAUSE A ” THIRD PARTY THINKS IT’S THE RIGHT THING AND MOST COST EFFECTIVE THING TO DO” IS WELL…. WELL…. WHAT IS IT….ORWELLIAN?
Anyway back to me.
I had obstructive voiding symptoms at the time of my diagnosis. Removal of the prostate would fix that but would risk stress incontinence common to surgery. Radiation would worsen my obstructive symptoms (by virtue of the inflammation of the prostatic urethra).
So here is the deal today and the poignant point of the blog ……
You absolutely need to know your current voiding pattern and the affect each of the treatments has on that baseline.
For me one of the biggest factors favoring removal was ” how I voided.”
If you are reading this and don’t have a feel for where you are now, how each treatment affects how you void… you have more work to do.
Voiding issues and patient’s difficulty in understanding them was a very large impetus for writing ” The Decision.” Most of one chapter is devoted to the males abnormal voiding patterns and how each is influenced by each treatment.
Why? It was the urologist in me…. you know…. I’m a penis machinist, a pecker checker and of course a verified member of the ” stream team.”
Tomorrow… irritative voiding symptoms and why that is important…. tease…. radiation therapy… no matter which one… think irritative. Do your homework on this and more next post….
Oh yeah… the youtube…. I had surgery so immediately post op I had total incontinence which progressed over three months to stress incontinence which progressed to continence. Do you understand continence and it’s relationship to the treatments? No? It’s in the book my friend.
The whistling is supposed to the carefree sound of one of the seven dwarfs from Snow White….carefree, happy, not a care in the world….not!

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