Thursday, January 7, 2010
7 jan 10 @ 6:22 pm
Tuesday, January 5, 2010
If it is one in a hundred and it happens to you, then you are 100%
http://www.medwire-news.md/46/85879/Oncology/PSA_screening_may_be_unnecessary_in_certain_men_over_75_years.htmlThe 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
Saturday, January 2, 2010
2 jan 10 @ 6:04 pm
Main Entry: tri·fec·ta
Pronunciation: \trī-ˈfek-tə, ˈtrī-ˌ\
tri- + perfecta
: 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.
Sunday, December 20, 2009
God's sense of humor
20 dec 09 @ 3:29 pm
The male's prostate after the child bearing days are over provides no necessary function, much like an appendix.
All it does is cause trouble for the aging male. It is something the male does not need, yet it continues to enlarge. The
very part of the male anatomy he cannot see and does not need grows, while another part his anatomy that he would prefer to
grow, not only doesn't but slowly loses the ability to function.
Saturday, December 12, 2009
A significant event occurred about ten days ago......tootsie passed away. Tootsie was a small dog that was always hungry.Always hungry.She was the daughter of Oscar
who mated our next door neighbor's Dachshund Penney. Our children went over to examine the litter and chose her because she
was the "smallest one." She also was always getting into trouble. One time she went under the house at the lake
and got trapped under the kitchen floor chasing a rat. We had to saw a hole in the flooring to get her out. On a another occasion
she got into a fight with a Doberman Pinscher. The humongous dog lifted tootsie up and shook her and then just
tossed her about twenty feet. Chloe had uncharacteristically started the fight by barking at the dog and making him
mad. In the process bite ripped about twenty holes into her side and abdomen. Blood pouring and her lifeless,
witnessing the whole thing. was one of the most dramatic and horrifying things I have ever seen. I had a rake that I
was working with at the time, and I hit at the big dog until he left. I gathered up tootsie and Chloe in my truck with blood
soaking my v-neck t-shirt and made my way to the vet's office , calling on the way. It was a Sunday I was listening to the
Atlanta Falcons on the radio while I was working at the lake. The Vet met me there and I helped him sew up Puddlin Pie ( we
had about sixty names for the pudster.) As it turned out she had no serious injuries. The bowel, a kiss of death had
it been lacerated, is surrounded by fat and fat was weeping out of all the cuts but had protected the intestines. It was a
two hour surgery, about a hundred stitches and she was back at home in about three days. The day she came home, I was holding
her in my arms with my wife observing and decided to give her a little kiss on the nose. ( I had saved her life and loved
her more than life itself, all of my family did.) Pueeet out of nowhere snaps at me and digs her teeth in my nose. Out of
self defense I drop her to the floor. my nose bleeding with a deep cut. Pud goes running to my wife, who is now laughing at
me as I go to the mirror to see how deep my injury is. Karen could not stop laughing. Such was Pud, her own woman and always
hungry and eating the cat's food and scooting around the empty cat cans in the garage; acquiescing to no one. Over the last
month of her life her hearing , sight and control of her bowels deteriorated to the point that it became a daily ritual for
my wife to clean all of our walk ways with a water hose. The night before she died, I found her walking in circles in the
front yard, a week before she rolled down a hill by our house and only by luck was discovered and rescued by Karen. We think
she had a stroke because she was always tilting to the left when she walked with her ear down as if it had a weight in it.
Two days before she died Karen, gave her a bath and rocked her on the porch for about two hours. We discussed what we should
do. She did not seem to be in pain, it seemed too early to put her down, but she was not living a meaningful life; her appetite
was good, we reasoned for leaving her be. Fifteen years, we'd loved her for fifteen years.
12 dec 09 @ 5:36 pm
I had gone to surgery
early on a Tuesday morning, rainy and cold, and Karen called me to say, between tears, that she could not find Tuuet. We spoke
about three times before noon, and then after that I decided I would not subject myself or Karen to her telling me that she
had not found her. It was a cold and rainy day and the thought of a dog that we had had for fifteen years out in the cold
alone and not well just killed us both. It was nauseating. When I got home that evening, at the door to our kitchen was a
pair of soaking wet tennis shoes, an umbrella and a flash light. Karen had searched for Pud for six hours without success
in ice cold rain. When I entered the house she had been crying all day during the search and her eye looked like she'd been
in a fight. The picture above is when Pud had had a good bath, and Karen was rocking her on the porch a day and a half before
she died. I was taking alot of pictures, we both sensed that the end was near.Karen told me later that evening that
she had told Tootsie while rocking her, "Just die now, while I'm holding you." Now we were both crying and Oh how
much better it would have been for the Puddson Pie to have died in Karen's loving arms. I still have a scar on my nose, it's
Thursday, November 12, 2009
Is that you on the cover?
This past weekend, I was entering my book into a national site which will make my title, The Decision,
recognizable to various book outlets. In one of the pages related to this, there was a box that asked the question,"
How much does your book weigh?" Since I had been formulating the website, theprostatedecision.com, weeks before the actual
manuscript was put into book form, I did not know the weight of my book until I got my book back in proof form this past week.
On Saturday past, I went with my book proof to a local UPS store but they had closed at noon. I went to my office, with my
little Clompie Miester, and after getting some Johnny's Bar-b-que, but forgot to weight the book on our stamp machine.
So, what to do? Going back to the lake with the pomps de la chompie... I see a pharmacy that has a sign that says, " We
ship UPS." Me and the Chomy pull in, and I go into the pharmacy with my book in hand hoping to be "weighed."
I walk in and go to the pharmacist counter ,and the pharmacist's assistant quickly refers me to the "Gift and
shipping section of the pharmacy.(My grandfather was a pharmacist in LaGrange, Georgia. My grandmother, whom I adored, always
told me that, " A pharmatist's life, John, is a hard life.") In the gift section and dressed in my usual Saturday
attire; a V-neck t-shirt from Wal-mart and some clean but stained kakai's, I ask the lady in the gift and shipping area, if
she would mind, " Weighing this book for me?" At this point, she reaches underneath the counter, and pulls out
bathroom scale. By the color of it, a soft pastel yellow, I am thinking it was circa 1960's. This lady,
who was in her late sixties and very delightful and attractive, says to me after placing my book on the bathroom scales,"
It weighs a bit less than a pound." I look at the scales. The increments were in quarter pounds, and my confidence
that this assesment of weight will stand the scrutiny of UPS is suspect. After a pause and seeing my book on the bathroom
scales, the vision of the naked people from who knows where or when had stood on those scales, and that I would be soon
holding and touching that book that had contacted those scales, and that the exactness of the weight is suspect as well, is
all flowing through my mind. The lady then says, " Is this your book? Is that you on the cover?" "Yes
mam." "Congratualtions, wow, congratualtions!" I, at that point ,did not mind the rudimentary weighing system.
I had gotten from that "shipping area" everything that I had needed.
12 nov 09 @ 7:18 pm
Monday, November 9, 2009
the $3000.00 visit
9 nov 09 @ 8:06 am
My wife as well looked forward to my daughter's visit, from Bozeman, Montanna, because she wanted to show Charlie
and her the island. Karen walks the island several times a week with Penelope and just knew that Bess and Charlie would enjoy
it too. The added treat of the two water loving dogs, running along in and out of the water, chasing squirrels and sticks
would just be the icing on the cake. No sooner do they arrive at the island trail, Charlie bounds out ( I've seen him jump
into or out of a car window without a second thought or a seconds notice) and starts galloping beside Penelope. They disappear
into the woods of the island. As Bess and Karen begin the walk, Peneolpe comes limping back drenched in blood. Her back right
leg had what appeared to be a foot long laceration, and blood was just pouring. They were hysterical, and in
addition there was the fear that she might bleed to death, and the logistics of getting her into the car and then calling
the Vet. It was after five, so the office message system informed them to go to an animal emergency clinic about 15 minutes
away. They try to reach me, but I did not have my phone with me (which is by design). When I did meet up with my phone,
there were about five frantic messages about Penelope having been "Cut very badly". The Vet put in about thirty
staples, put a big lamp shade on her head, and that is how I found her upon returning home that evening. No one could figure
out what happened. We did not feel that she and Charlie had a fight. I felt that in the process of galloping together, that
Charlie nudged her into a sharp branch of a tree or something. A few days later the wound started draining and several staples
came out , reopening the laceration. Karen and I took her back to the emergency clinic. They reoperated on her
and put in more staples, and cut off skin that had died. The resultant skin was pulled together very tightly and was as my
brother Rushton would say,"tighter than Dick's hat band." Bess goes back to Bozeman, the new staple line
,too, opens and we take her back to the regular Vet. They keep Penelope for about five days in which time the entire
wound opens, they remove all the remainding staples and the decision is made to just let it heal "on its own."
This took about two months. It was a pitiful process to watch; a beautiful dog with this large shaved area on back hind quarter,
a $3000.00 surgery bill, and a large scar to remember Bess and Charlie's visit. The very thing that Pepi
and I loved the most, our pool game and retrieving sticks at the lake and the Chattahoochee river, was taken
away from us in the height of the summer because the vet admonished, "Keep her away from water." Thanks
Bess and Charlie. Yall come again won't you? Not really. I am just kidding... Love you Bessie! Charlie...
We ain't kin!
Saturday, November 7, 2009
My daughter Bess and her boyfriend visited this past summer from Bozeman, Montanna. They drove and brought
with them Charlie, a humane society border collie. I love dogs and my wife and I immediately fell in love with Charlie, that
is until he took over our home. The problem started when it became apparent that he was a bully and he immediately started
bullying Penelope. Outside in backyard, where ever Penelopee ran, Charlie ran, or I should say galloped beside her, intimidating
her. Albeit playfully. But what got me the most was the pool. Penelope and I had practiced all summer on a pool trick to do
when Bess came home. I was so excited about acting it out that I even had my wife video me doing the trick. I would get on
one side of the pool and Pepsi would get on the other. I then would throw a tennis ball half way and the two of us then would
swim as fast as we could to see who would get it first. I let her win each time, but the funny part was that she used her
tail as a rudder to quickly turn around and then swim back. Her motions were frantic as I chased her to the steps, with each
time her getting out of the pool just in time to evade my grasp. I then swam back to my side, she'd bring me the ball and
then shake, then go back to her side to repeat the game. It was exhausting for me and she loved it. I mention the steps because
Pomps de la poops always acts like the lady she is and uses the pool steps to get into the pool. Back to Charlie. I get in
the pool with the tennis ball to "show off" our trick and no sooner am I in the pool than Charlie leaps like a mad
man and takes my tennis ball. He dominated the pool the whole visit, as if he was marking his territory. Penelope was afraid
to get in the pool and was relagated to just watching, and me both in awe of the aggressive diving of Charlie in the pool(the
hell with the steps for him) and just "telling " about Peppi's trick. This picture shows Charlie "taking over"
and poor little Pommpiii having to just watch and wait for this half breed holligan gun slinging varmint from the west to
go home. On the next post I'll explain how the much anticipated visit gets worse.
7 nov 09 @ 6:27 pm
Thursday, November 5, 2009
John, it's snowing.
When I began writing The Decision, I changed my routine at the
lake. I used to go out there and cut grass, work in the garden, blow leaves. fish a bit, fill up gas containers, and go to
Walmart. With the book on my mind, I changed to taking the dogs, Chloe and the puppy, Penelope, working on building flyrods and writing the book while listening to Pandora.com on the Steely Dan/The Shins/Modest
Mouse/Beatles/Sinatra station I created. I was out there one day this past winter, when my wife called to ask,"John
have you seen the snow?" I looked up from typing and sure enough it was snowing, I had not noticed. She said, "You
need to take the dogs outside, they'll love it." I put on my jacket and went out with the dogs and saw the largest snow
flakes I had ever seen. In Northeast Georgia, snow is uncommon, we usually get one good snow a year. This was different, the
snow flakes were huge, I mean large and fluffy. The dogs went crazy. They began running all around wildly amoungst and in
between the snow flakes. I had just gotten a used, but very nice, Nikon camera for Christmas, and began taking pictures of
the dogs in the snow. Chloe would be running and Penelope would run beside her teasing her. On one occasion, Chloe snapped
back playfully at the teasing and this picture captured that moment. Two things: Over the next few months, several older patients
of mine told me they remember that day vividly as the day of the "largest snow flakes I have ever seen in my memory",
and several people have commented to me that animals love to play when it snow. (How did Karen know that and I didn't?) I
think the picture reflects both.(Penelope is the one that is surpirsed by the playful yet dramatic response of her older mentor,the
5 nov 09 @ 6:26 pm
Monday, November 2, 2009
Put a scotch on it.
One of my favorite and longtime patients was in the office this past week.
He is in his late seventies and he and I were discussing his prostate cancer. His PSA was very slowly rising after about
15 years after I had removed his prostate. He was very hesitant to do anything, such as radiation, that might alter his otherwise
excellent quality of live. We mutally agreed that at his age, we would just watch his PSA every three months and do something
if the change in the value occurred more rapidly. He said,"Dr. McHugh if it keeps going up we'll just put a scotch on
it." This remark took me aback for a minute considering his age and what I knew about him. I from time to time enjoy
scotch and began to think that many times I too had "put a scotch on it" in certain situations in the past. "Really,
Mr. Taylor? What kind of scotch do you like?" Puzzeled he said,"I don't drink, Dr. McHugh. I said put a scotch on
it. Like putting a block on a car wheel on hill to keep it from moving." He, his wife and I took a good laugh, but I
felt I had disclosed a little bit more about myself to them than I preferred. I love sayings and never heard that one. It
originated with railroad tracks and placing a "scotch" to keep the railroad car from moving.
2 nov 09 @ 6:46 pm
Saturday, October 31, 2009
It all started with Chloe visiting Savannah- Chloe and her abductor at Forsyth Park in Savannah
My youngest son Sam needed my help moving to another apartment in Savannah, so Chloe and I went down to assist in the moving
and bring excess furniture back. I should have never fell for it. Once Chloe was exposed to the smells of all those old parks
in Savannah, she longed to return. Since Sam was to be living by himself, it was a natural fit for Chloe to move to Savannah.
When I started The Decision there was no such thing as our other dog, Penelopee. Chloe and Penelopee became close
friends, my wife and I fell in love with the Lab, and that's when my son strategically asked,"Can Chole come to visit
me in Savannah? She can stay with me until I come home for my birthday." That was about the last we've seen of the Chlomiester.
"She loves long walks on the beach at Hilton Head", he tells us. "Girls love her", he tells us. Meanwhile
all of our attention is now directed at the Pompie and I don't know if we will ever get Chloe back or for that matter, if
Chloe will ever want to come back. So...all the stuff I was doing with Chloe in the book, I am now doing with Peppi; a Chloe
clone so to speak.
31 oct 09 @ 12:53 pm
Thursday, October 29, 2009
A "good fit"
29 oct 09 @ 7:26 am
A urologist is examining a male patient and much to his surprise sees that the man has five "you know whats."
"My goodness Sir. In my many years of practicing Urology, I don't believe I have seen ever anything like this!
It must be a problem getting clothing for your particular anatomy. I am curious, for instance, how do your pants fit?"
patient replies with a smile,"Like a Glove!"
Monday, October 26, 2009
26 oct 09 @ 6:38 pm
A lady with a dead rabbit asks the Vet," Is my rabbit dead?"
says. It is dead. That will be $20.00."
did not do anything. How do you know he's dead?"
you like me to do some tests?"
"Why yes. I love this
rabbit. I want to be sure."
The Vet brings in a cat that
sniffs the rabbit, and then leaves.
The Vet brings in
a Chocolate Lab and she also sniffs the rabbit and leaves.
Vet then says, "Your rabbit is dead! That will be $120.00 dollars!"
"$120.00? Are you kidding? For what?"
Vet responds,"For the Cat scan and Lab tests I had to do."
For two weekends,
I took our Chocolate Lab Penelopee to my office for a picture to accompany this joke. It took about twenty shots and several
cans of Alpo to get the picture seen here. Patients have loved the picture and the joke, and each time ask for the picture
so they can tell the joke later with the "prop" and then take the picture away with them, necessitating me to print
off another Cat scan and Lab test picture. Isn't she's so pretty.......
On a later blog,
I'll explain why people are asking "Where's Chloe?" She's fine. I just don't have her anymore...for now...
Sunday, October 25, 2009
My wife and I went to a wedding last p.m. and at the reception were talking
to two friends. At one point in the conversation, the wife of this couple said that she had heard I was writing
a book. "What is it about John?" Responding with a remark and a technique I call "shock humor" I
say with all seriousness, "Penile enlargement." At first taken aback but then finding the reponse very funny, she
began to laugh. As we are laughing, the husband leans forward to discern why all the laughter, and asks, "Allen who?"
I said, " P. Allen Largeman. You wouldn't know him."
25 oct 09 @ 7:53 am
Saturday, October 24, 2009
The Big Bag
When we came up with idea of the doctor as a patient illustrated by
a doctor with the tubing coming out of a lab jacket and into a bedside bed, the issue then became how to make the fluid look
like urine. The photographer Travis Massey suggested apple juice, " Just bring the bag. I'll fill it up when you get
here." He filled it to full capacity in order to get some of the apple juice into the bag and the tubing. This in turn
made the bag much too full and prompted several funny remarks from people that saw the picture."Man, John. You must have
had a real full bladder." "You must have really needed to go!" Placing the bag in the foreground further made
the bag look big and full. Several weeks later at 7 am., and prior to surgery one morning, I went over to Travis's studio
and in his parking lot filled a second bag with one can of Icehouse beer and one can of Bud Light. We did not worry about
the tubing this time and only filled the bag half full; better representing a more real situation. This is the
bag that is on the cover of the book. Travis took pictures of the new bag on an associate and then pasted it onto the original
picture you see here for the final outcome. If you are wondering why the beer looks so much like urine, it goes back to the
addage," You don't buy beer, you rent it."
24 oct 09 @ 5:44 pm