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The Chattahoochee in the fall- Cherokee for " river of painted rock"

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Thursday, January 7, 2010

Diaper Diaries

From now on my blog will be through WordPress so please follow this link to view. 


7 jan 10 @ 6:22 pm          Comments

Tuesday, January 5, 2010

If it is one in a hundred and it happens to you, then you are 100%

The interesting thing about this article has to do with something that happened to me about a month ago. I have been treating an elderly male for symptoms of an enlarged prostate. He was on two medicine for that and was getting along quite well. I had examined his prostate about two years ago, he was 82 at the time, and it was mildly asymmetrical but for his age unremarkable. He, a friend of his, and I all agreed that because of his age and other medical problems that we would stop getting PSA's and doing rectal exams. Recently he was in the hospital for a heart condition and on chest xray was noted to have an abnormality of his ribs. This prompted
a bone scan revealing wide spread metastatic bone disease. A PSA was obtained by the cardiologist and the value was over 1300. His daughter calls me to tell me that her father that has been under the care of a "urologist" for two years has widespread metastatic prostate cancer. So. These studies and others that you may read that may regard to other various medical topics have to be taken with a grain of salt. I personally will continue do rectals and occasional PSA's on my older healthy patients. I can quote all the studies I want to this family, but they feel that I allowed prostate cancer to progress in a loved one under my care. This type of stuff happens all the time in medicine and again showing why the practice of medicine, "is an art and not a  science."
5 jan 10 @ 7:42 am          Comments

Saturday, January 2, 2010


Main Entry: tri·fec·ta
Pronunciation: \trī-ˈfek-tə, ˈtrī-ˌ\
Function: noun
Etymology: tri- + perfecta
Date: 1974

1 : a variation of the perfecta in which a bettor wins by selecting the first three finishers of a race in the correct order of finish.

This is a relatively new term to me. I have seen reference to it as it regards to prostate cancer in increasing frequency over the last several months. It is not a bad analogy. It refers to the three most important aspects of determining the outcome for the treatment chosen by the male to treat his cancer. It pertains to continence, potency and cure. The reason I like it and its use is that it very nicely clarifies the issues regarding "The Decision." If a trifecta is your goal of treatment, each of these issues is a long term issue and at this point in time there is no benefit of the robotic prostatectomy over the traditional open method. As I have said in the book,"I'd rather have my prostate removed by an experienced robotic surgeon than an inexperienced open surgeon, and as important, vice versa." The advantages of the robotic method at this time, as it concerns the trifecta, offers no benefit to the patient. I am not condoning one method over the other, just that the "decision" is made for the right reasons and with appropriate expectations.

2 jan 10 @ 6:04 pm          Comments

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