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Posts Tagged ‘new york times’

mchugh's rule for success (not that i am successful) for doctors....one wife (if possible), one city, one practice

If you see the nerves better with the robot and “you spared them” why is it then that people still have erection issues? Why is that to date there is no better success rate shown by the robot vs traditional open prostatectomy? The following is quite good.

Look at the next video…does it appear that they actually see “the nerves” or they where they would be? Can you see a “nerve.” If they think they see the nerves, then do they see the “subvisual” branches that then go to the prostate? I think not. And that is why there is so much variance in how people do after a “nerve sparing ” prostatectomy. There is still a lot we don’t understand and I am bit disappointed in surgeons that announce to their patients,” I spared your nerves.” I think it would be fairer to say, ” I feel very good about my nerve sparing technique and my dissection today. I am optimistic that we have optimized your chances of sexual recovery.” In the following video, the doctor doing the procedure has done as many as anybody in the world. He says in the video,”The path of the neurovascular bundle is clearly delineated.” That is a fair assessment of the surgery. Most commonly you see “where it should go and you spare that” not “I saw the nerves and I spared them for you. Now go and tell your friends that your “nerves were spared.” A big difference my friend.

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the only time you should look down on someone is to help them up... j. jackson

Non-Cancerous Prostate Biopsy Results:

PIN

What percent of atypia results in cancer on followup biopsy?

PIN: Prostatic Intraepithelial Neoplasm—-Most likely no big deal. Think of the actual individual prostate gland cell…the nucleus  isn’t right. For a cell to be “cancerous” it has to invade tissue. In PIN there is no  invasion, just a funny looking nucleus. In my practice, and I must have about two hundred patients I follow with PIN, it seldom progresses.  Think of it this way….If a patient has the actual diagnosis of prostate cancer and the parameters are favorable…the surveillance is an option and the likelihood is that the patients cancer won’t progress. Well then, PIN is way better situation than that…”gently keep your eye on it.”

Psychological factors in being told that your biopsy is “suspicious.”

PIN vs. Suspicious– I think suspicious trumps PIN. The studies referenced show a higher chance of a positive subsequent biopsy than I have noted in my practice.

In both cases it ain’t cancer and that’s good on a couple of fronts.

  • Bad prostate cancers, the high Gleason Scores (8-10) are easy for the pathologist to call. So if your biopsy comes back equivocal (PIN or suspicious) then you know it’s not the bad kind and if it were cancer then you know it would most probably be he good kind or low Gleason’s (6).
  • PIN and a suspicious core on a biopsy means that they patient needs to be followed more closely and the likelihood of having another biopsy to confirm the absence of cancer is greater. The period of time between follow ups also may be closer.
  • Although the chances are greater that one day a PIN or Suspicious will end up cancer, not all do.
  • I  view PIN or Suspicious as good news (better than being told you have prostate cancer )  and  I recommend maybe another biopsy once in six months to confirm, and then twice a year PSA’s and another biopsy only if there is a change in the rectal exam or a PSA velocity change.
  • If the pathologist isn’t sure the biopsy specimen has cancer and only a few of the cores are suspicious, then if one day on another biopsy shows cancer….it will be probably be low volume, probably low Gleason’s….that’s favorable and that’s a good thing.
  • I mention in my book when reflecting about how I felt the night before I got my results that I was not worried about the favorable type prostate cancer…I did not want a result with the bad or unfavorable parameters…that is what really worried me.
  • If you are here because of a suspicious or PIN biopsy, I hope the above has somewhat eased your “potential” fears but also make you diligent and follow the recommendations of your urologist.

How is golf and prostate cancer alike? A slice will listen to you, a hook won’t do a damn thing you say.  The unfavorable prostate cancer is a lot like a hook.  So…that’s the bright side of PIN and Suspicious/Atypia.

Suspicious carries more weight than PIN however both findings require a bit closer follow-up.

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it is amazing what can be accomplished if it doesn't matter who gets the credit

 

So…A dream I had as a child was a pool with a lap lane. I love to swim and when I  was younger , I was actually quite the swimmer. I rarely lost a race in any stroke. There was a boy in Columbus, Georgia who regularly beat me…but no one else. I ruled the swimming world when I was eight in Columbus, Georgia. I remember winning every event in every stroke at the Green Island Country Club on a day when there was a total eclipse. We were swimming and at the same time looking at these tin foil card board boxes that allowed one to see the eclipse without looking directly into the sun. I remember it as if it were yesterday.

So, I get to be a doctor, I chose to be a urologist and then with some success, I get to build a new house with a swimming pool with a lap lane. My dream come true…right? Well…. what if the pool turns out to look like a penis? What?  All these years and hopes and dreams and a pool that looks like a penis?  Tell me it isn’t so.

It was. A regular oblong pool with a lap lane looks like a penis and a scrotum.  We also had two dachshunds and so I became the urologist with a dick pool and two weinner dogs. Who’d thought? My kids got ribbed about it all the time. I thought I was successful but now this?

I will say I love my pool. I love my chocolate lab chasing balls and sticks in it. I love taking pictures of her chasing balls and sticks in it and swimming in it. I absolutely love my lab in the pool.

Now the question. Can a man with prostate cancer “spread something” to his wife by having sex?

No!

So….good try girls….be more creative next time…you are not getting out of it for this reason or this time…………….have at it.

Guys…You are welcome….no charge.

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orators become dumb… when beauty speaketh-shakesphere

Okay…one more time. 

  • sex drive is called libido and is dependent on testosterone
  • testosterone is not affected by removing the prostate
  • testosterone is produced by the testicles and gets into the body through the blood stream independent of the prostate
  • potency is the ability to get an erection
  • an erection after prostatectomy is a function of sparing the nerves
  • a prostatectomy does not affect the testicles or the level of the males hormones or testosterone
  • it is possible to have a very high libido and not have the ability of having an erection (which can happen after any treatment of prostate cancer)
  • fertility is the ability to have children which is unrelated to potency or libido…but will go away with a prostatectomy but may not with radiation of the prostate

So…In answer to the search question…Sex drive or libido which is hormonally driven… will not change after a prostatectomy. Now…a prostatectomy or any treatment of the prostate had an emotional hit or consequence…that too can affect libido or drive……it’s complicated……

When a man has a vasectomy or a prostatectomy his sex drive or libido, which is dependent on the male hormone testosterone, does not change. Testosterone is produced by the testicles and released into the blood stream and subsequently not affected, or its blood level diminished, by either procedure.

What is wrong with the terminology in the following urology joke? 

One of the oldest Urology jokes around involves a man coming to the Urology clinic for a vasectomy all dressed up in a tuxedo. When asked,” Why the formal attire?” he responds,” If I am going to be impotent, I’m going to look impotent.”

The answer and the  problem with this joke, as explained in the bullets above, is that a vasectomy makes you sterile (no sperm), it has no affect on potency. Potency refers to erectile function which is independent of fertility (which is what a vasectomy affects). I mention this because it is misconceptions like these which abound within the male population, and contribute to the “perfect storm” of delayed diagnosis alluded to earlier in this book. It is still a cute joke however.

 

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since then it's been a book you read in reverse, so you understand less as the pages turn.....pink bullets

And I so loved his movie and that he was singing “ The day they drove old Dixie down.”  Dana Jenning’s family and the emotion that goes with all this prostate cancer stuff. I have been there. But this?  Ted Turner and the trite old “money reference” in conjunction with the treatment of prostate cancer. Then the anecdotal patient that did well not doing ” radical treatment.” What is radical treatment? I had my prostate removed and I am doing quite well on all medical fronts. What am I missing here? A patient can be angry that he is not whole after the treatment of prostate cancer, but to blame the medical community and not the disease? What about the disease? If 50,000 prostatectomies were done and only 10,000 were necessary where does that leave us? Who are the 10,000……we don’t know. Do we throw the baby out with the bathwater ?

Low PSA and low volume on the prostate biopsy that is Gleason’s 6- the patient will do well in most cases.

High PSA, high volume on the prostate biopsy that is Gleason’s 8 will not do as well.

To lump them all together is irresponsible. To tell people you can cure if you do something, or to tell people not to do something is equally misinformed. This the problem with some of these books out there. No book or doctor can promise cure or from the get go that a patient won’t need a biopsy or a particular type of treatment. One can describe  which cancers are aggressive, which treatments are considered aggressive and then allow the patient to make decisions about treatment peculiar to him and his family. In the same way, which options are suitable for the more  favorable prostate cancers. Not all prostate cancers are alike, not all patients are alike. Treatment should be “customized” to the specifics of the disease in the context of the patient.

I am a urologist. I was diagnosed at age 52. I had favorable biopsy parameters. I was mapped for radioactive seeds and had a catheter in my penis and an ultrasound up my rectum in anticipation of that form of therapy during lunch and saw about twenty patients after that. It was a tough and trying time for me and my family.  I took three months to decide what to do. For better or worse, I had my prostate removed. I am at peace with my decision.  I made the right decision for me. My process I feel is the process each should use on that difficult journey to “his” decision. I would not advocate one type of treatment for all cancers.  One size or one treatment or one book……doesn’t fit all.

 

August 30, 2010, 5:00 pm

<!– — Updated: 5:11 pm –>A Rush to Operating Rooms That Alters Men’s Lives

By DANA JENNINGS

Jeanette Ortiz-Burnett/The New York Times

As I scuffed through the stations of the prostate-cancer cross these past two years, I sometimes wondered whether I wasn’t a dupe caught up in a Robin Cook medical thriller.

Sure, the biopsy (so I was told) showed that my prostate was cancerous. And after it was removed, the pathology report revealed that the cancer was unexpectedly aggressive, thrusting me from the relative comforts of Stage 1 to the deep woods of Stage 3.

But at least on the surface, the cancer itself never did any damage. It was the treatments that razed me — the surgery, radiation and hormones producing a catalog of miseries that included impotence, incontinence and hot flashes. And a small voice kept whispering: What if this is all a lie? A dark conspiracy of the global medical-industrial complex?

And now comes “Invasion of the Prostate Snatchers,” by Ralph H. Blum and Dr. Mark Scholz, effectively confirming my whimsical paranoia.

Mr. Blum, a cultural anthropologist and writer, has lived with prostate cancer for 20 years without radical treatment, and Dr. Scholz is an oncologist who has treated the disease exclusively since 1995.

Their book, written tag-team style, is a provocative and frank look at the bewildering world of prostate cancer, from the current state of the multibillion-dollar industry to the range of available treatments.

About 200,000 cases of prostate cancer are diagnosed each year in the United States, and the authors say nearly all of them are overtreated. Most men, they persuasively argue, would be better served having their cancer managed as a chronic condition.

Why? Because most prostate cancers are lackadaisical — the fourth-class mail of their kind. The authors say “active surveillance” is an effective initial treatment for most men.

They add that only about 1 in 7 men with newly diagnosed prostate cancer are at risk for a serious form of the disease. “Out of 50,000 radical prostatectomies performed every year in the United States alone,” Dr. Scholz writes, “more than 40,000 are unnecessary. In other words, the vast majority of men with prostate cancer would have lived just as long without any operation at all. Most did not need to have their sexuality cut out.”

A collage of photos and insights submitted by readers..

Yet radical prostatectomy is still the treatment recommended most often, even though a recent study in The New England Journal of Medicine suggested that it extended the lives of just 1 patient in 48.

And surgery, of course, is most often recommended by surgeons and urologists — who are also surgeons. Mr. Blum writes: “As one seasoned observer of the prostate cancer industry told me, ‘Your prostate is worth what Ted Turner would call serious cash money.’ ” As for patients, their rational thinking has been short-circuited by the word “cancer.” Scared, frantic and vulnerable — relying on a doctor’s insight — they are ripe to being sold on surgery as their best option. Just get it out.

Every urologist I met with after my diagnosis recommended surgery, even though it was believed then that I had a low-risk Stage 1 cancer. The best advice came from my personal urologist, who declined to do my operation because it was beyond him: “Avoid the community hospital guys who do a volume business in prostates.”

I did, but I’m still maimed. In my experience, doctors play down punishing side effects like incontinence, impotence and shrinking of the penis. Those are just words when you hear them, but beyond language when you go through them.

Despite the impression the authors give, though, judging the velocity or voraciousness of a prostate cancer can still be imprecise. I know this firsthand.

After my biopsy, it appeared that I had a Stage 1 cancer, a doddering old nag that the authors would have designated for active surveillance. As it turned out, I had an especially pure Stage 3 cancer, a real top-fuel eliminator in terms of velocity (and hunger).

I’m a wild card, the 1 man in 48 saved by surgery. Without it, my doctors wouldn’t have learned the cancer was so advanced, and wouldn’t have given me the hormones and radiation that helped keep me alive.

So yes, prostate cancer is a dark and mysterious country, and Mr. Blum and Dr. Scholz are good, levelheaded guides through these thickets. And in telling men to slow up and take a deep breath after they learn they have prostate cancer, they provide an invaluable service. I wish I had had this book back in 2008.

But all of this raises one last stark question: Was my life worth the 47 other prostatectomies that probably didn’t have to be performed?

I don’t know. I’m a man, not a statistic.

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Meaning of song
The lyrics tell of the last days of the American Civil War and its aftermath. Confederate soldier Virgil Caine “served on the Danville train,” the main supply line into the Confederate capital of Richmond, Virginia. General Robert E. Lee’s Army of Northern Virginia is holding the line at the Siege of Petersburg. As part of the offensive campaign, Union Army General George Stoneman’s forces “tore up the track again”. The siege lasted from June 1864 to April 1865, when both Petersburg and Richmond fell, and Lee’s troops were starving at the end (“We were hungry / Just barely alive”). Virgil relates and mourns the loss of his brother: “He was just eighteen, proud and brave / But a Yankee laid him in his grave.”

Ralph J. Gleason (in the review in Rolling Stone (US edition only) of October 1969) explains why this song has such an impact on listeners: “Nothing I have read … has brought home the overwhelming human sense of history that this song does. The only thing I can relate it to at all is ‘The Red Badge of Courage’. It’s a remarkable song, the rhythmic structure, the voice of Levon and the bass line with the drum accents and then the heavy close harmony of Levon, Richard and Rick in the theme, make it seem impossible that this isn’t some traditional material handed down from father to son straight from that winter of 1865 to today. It has that ring of truth and the whole aura of authenticity.”

Robertson claimed that he had the music to the song in his head but had no idea what it was to be about. “At some point [the concept] blurted out to me. Then I went and I did some research and I wrote the lyrics to the song.” Robertson continued, “When I first went down South, I remember that a quite common expression would be, ‘Well don’t worry, the South’s gonna rise again.’ At one point when I heard it I thought it was kind of a funny statement and then I heard it another time and I was really touched by it. I thought, ‘God, because I keep hearing this, there’s pain here, there is a sadness here.’ In Americana land, it’s a kind of a beautiful sadness.” [1]

[edit] Context within the album and The Band’s history
According to the liner notes to the 2000 reissue of The Band by Rob Bowman, the album, The Band, has been viewed as a concept album, with the songs focusing on peoples, places and traditions associated with an older version of Americana.

Though never a major hit, “Dixie” was the centerpiece of The Band’s self-titled second album, and, along with “The Weight” from Music From Big Pink, remains one of the songs most identified with the group.

The Band frequently performed the song in concert, and it can be found on the group’s live albums Rock of Ages (1972) and Before the Flood (1974). It was also a highlight of their “farewell” concert on Thanksgiving Day 1976, and is featured in the documentary film about the concert, The Last Waltz, as well as the soundtrack album from the film. It was #245 on Rolling Stone Magazine’s list of the 500 greatest songs of all time.[2]

The last time the song was performed by Helm was in The Last Waltz (1978). Since Robertson went to the record label and claimed that he wrote the music and lyrics, he has writing credits to the song (and most other songs by The Band, including “The Weight”). Helm, a native of Alabama, claims to have contributed significantly to the lyrics. In his 1993 book ‘This Wheel’s on Fire’, Helm writes ‘Robbie and I worked on “The Night They Drove Old Dixie Down” up in Woodstock. I remember taking him to the library so he could research the history and geography of the era and make General Robert E. Lee come out with all due respect.'”

Levon Helm refuses to play the song and it has not been heard live since 1978 even though Helm holds concerts, which he calls “Midnight Rambles”, several times a month at his private residence in Woodstock, NY.

The Night They Drove Old Dixie Down lyrics
Songwriters: Robertson, Robbie;
Virgil Caine is the name and I served on the Danville train
‘Til Stoneman’s cavalry came and tore up the tracks again
In the winter of ’65, we were hungry, just barely alive
By May the tenth, Richmond had fell
It’s a time I remember, oh so well

The night they drove old Dixie down
And the bells were ringing
The night they drove old Dixie down
And the people were singing
They went, “La, la, la”

Back with my wife in Tennessee, when one day she called to me
“Virgil, quick, come see, there go the Robert E.Lee”
Now I don’t mind choppin’ wood, and I don’t care if the money’s no good
Ya take what ya need and ya leave the rest
But they should never have taken the very best

The night they drove old Dixie down
And the bells were ringing
The night they drove old Dixie down
And all the people were singing
They went, “La, la, la”

Like my father before me, I will work the land
And like my brother above me, who took a rebel stand
He was just eighteen, proud and brave, but a Yankee laid him in his grave
I swear by the mud below my feet
You can’t raise a Caine back up when he’s in defeat

The night they drove old Dixie down
And the bells were ringing
The night they drove old Dixie down
And all the people were singing
They went, “Na, na, na”

The night they drove old Dixie down
And all the bells were ringing
The night they drove old Dixie down
And the people were singing
They went, “Na, na, na”

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I have previously posted Mr. Jennings on a link but did not see this video untill this morning. I am watching it and it’s going along and I am really enjoying it and really like this person. The part about getting a buzz-cut and then it makes him feel like, ” I’m putting on a cape or something,” I loved, I mean really loved. I liked the background of his study, his wife, (I have patients where the wife is the “note-taker”), his walks with his kids in what I presume is some acreage they have near their home. That the two teenage boys love him to death and say he loves music but can’t sing. In the scene where is singing and walking in the woods, (did you pick up on the song), I did, the boys were right, it was clear to me that he could not carry a tune. Well, the song he was singing was ” The day they tore old Dixie down” and the band would be The Band and this is the band that opened for years for Bob Dylan. The one of three 8-tracks I had the day I drove to Dahlonega, Ga to start college was one by The Band, that I stole from my brother Bob who was a big fan of theirs, and as fate would have it one was by Dan Fogelberg.(He had prostate cancer.) Well that’s the song in the video.
For me everything was going along in the video, I was intrigued by the whole thing, even beginning to think I could like someone that worked at the New York Times, when out of nowhere he can’t talk. He paused and his eyes moistened. In that instance I begin to cry. All of my mornings on the way to work, when I would be alone for first time of that day, in my car I’d cry. It would be about anything, but mostly about that I had let my family down, and that it was possible that I would not be around for something significant in the future as it might pertain to one of our children. Dana’s piece brought back to me, all of the emotions that I faced three years ago came to life and made them as real as if it were today, I mean right now. It was cathartic. My wife sitting across from me in the den asks, “Are you crying?” I am surprised she didn’t say, “Again?”
What a beautiful piece and what a beautiful man and family and I truly wish him the best.

From “The Decision”

I was a bit different in how I handled the news that I had prostate cancer compared to most patients and probably differently from you. I did not tell many people; I had emotional difficulty telling my children and did not want it announced at church, like you hear so often during prayer concerns. I personally felt that I was dealing with the diagnosis of cancer fairly well, but that retelling it to others would be difficult for me. I have been that way all my life; my aunt Betsy once said to me, “It’s a Davis family trait, John; your grandfather would cry at the drop of a hat.” I had this fear of becoming emotional in telling my children the news, so I delayed doing anything for several weeks and finally decided I’d send an email. I used as the subject line, “dad’s got a new gig.” In my email I rambled on and only implied that I had cancer (“the biopsy showed something”), but reassured them that I would be O.K. It was a very difficult time for me; I was more concerned about how they would feel about their dad having cancer than the threat that I would not do well. As I have previously mentioned, I kept having the sensation and feeling that somehow I had let all of my family down. When they called to ask what in the world I was talking about in my cryptic email, my wife did all the explaining. For about a month I did not answer the phone; the thought of telling one of my children that I had cancer was something I just could not do. It took weeks before I could talk of it without my eyes welling up. It was embarrassing. My wife was absolutely beautiful and strong through this, explaining “my situation” to all family members that would call inquiring about me as if I were not home, although I’d be there next to her in our den. I did tell a female friend, with whom I teach youth Sunday school (I have taught youth Sunday school at my church for about 20 years) about a month or so after my diagnosis. She had had breast cancer, and I felt almost guilty that I had not told her. Once she knew, she would ask each Sunday when was I going to do something about the cancer. After about two months of this questioning each Sunday, she exasperatedly said to me in the parking lot outside the church, “John, go get your prostate cancer treated; you’ll have sex again!” I thought it was an odd remark at the time, but I suppose she thought my delay in making a decision was a “male thing.” In retrospect there may have been some truth and intuition in her observation, a “woman thing.” This remark then began a new era of issues for me surrounding the misconceptions of others in their understanding of what happens to you when you’ve been treated for prostate cancer. It is a reverse misconception, so to speak, not about the male’s understanding of prostate cancer, but others’ misconceptions about someone who has been treated. I began to wonder, are she and others thinking that I will be impotent and incontinent; is this how others will view me in the future? As hard as the decision is, this added element, particularly in a relatively young man, adds to the stress of dealing with the purely medical issues of prostate cancer. This disease and associated treatment options are unusual in that concerns regarding potency and incontinence issues are often moved to the forefront and cure is placed on the back burner. In many ways the treatment of prostate cancer is a “male mastectomy.” In a female there is the emotional trauma of having breast cancer and treatments that can disfigure the body; in the male there is no disfiguration that you can see, but treatment of the prostate affects the quality of how you void and achieve erections. There is also the constant awareness that the cancer may not have been cured and “come back.” This does somewhat eat at your maleness, and knowledge of these risks complicates the decision.

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