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I don't understand some doctors.

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Posted 6/15/2013 3:14 AM (GMT 0)
Meet with my URO today to go over CT scan, scan came back with nothing of concern. Good news on that, but when we were discussing treatment options he brought up:
1) Surgery (he’s a surgeon so that was expected)
2) LDR Brachy
3) Cryotherapy (W.T.F.? Is this even a viable treatment?) and I did voice my concern that he would even suggest it. I brought up Active Surveillance but he blew it off and didn’t even want to entertain it.
So towards the end of the meeting I gave him a list of documents I needed as requested by Sloan Kettering when I contacted them for an appointment, the dude seems to get an attitude, tells his nurse rather sharply to “gather the requested documents because he’s going to Sloan”. I have never in my life had a doctor cop an attitude because I was going to get a second opinion. I just don’t get it. Is this guy just looking at potential lost dollars, he does not seem to have my best interest in mind. So bottom line is I will make my appointment with Sloan and will never see this URO again. I guess he’s been fired. No offense meant to our older members of HW but I think this guy is past his prime and should get the hell out of the doctoring business.
I also had a consultation with a radiation doctor earlier this week and talk about polar opposites, this doctor gave me his views on his radiation treatment plan.
IMRT & LDR Brachy, gave me pros & cons. He also encouraged me to speak with at least a surgeon to get another opinion on my options. I also told this doctor that I was going to Sloan to get checked out and he stated that was a good idea and that he would be more than happy to treat me after I have done my research. What a pleasure dealing with a doctor who is secure enough to want you to get your ducks in a row before making a decision. The Rad Doctor said I should not feel rushed into a decision and with my stats could take a few months to decide but my URO said I should make a decision in a few weeks max. I don’t think I will take a few months to decide but I know it won’t be done in a few weeks either.
darn doctors give me a headache.
Posted 6/15/2013 4:41 AM (GMT 0)
Steven:

Read my thread about firing doctors.

Sounds like the uro I first dealt with -- and fired

Mel
Posted 6/15/2013 4:44 AM (GMT 0)
Sorry you had to deal with a wacky doctor - good plan to fire that one.

When I was going through the decision I was amazed to find a Uro who said to me, "You don't want me to do surgery, let me get the RO in here."

You're plan to get checked out at Sloan is a sensible step. If you do decide on radiation, that RO's sounds like a doctor you can work with. And that's important - a doctor that will work with you.

Hang in there, you're doing great,
Andrew
Posted 6/15/2013 4:46 AM (GMT 0)
You have just experienced the 180 that doctors can be. Your ex-uro (now) is exactly what I wouldn't tolerate in a doctor, he showed his true colors to you, and I do not believe he had your best interest in mind, rather was concerned about his interests ($$$).

You are going about your primary treatment in the right direction, please continue like this.

Even though you are a Gleason 6, you have quite a few positive cores, and even though I am a big supporter of AS, I think your numbers justify treating more than not treating.

Seeds, would be a much more less invasive way of going about it, imo.

Good luck in the steps ahead.

David
Posted 6/15/2013 5:05 AM (GMT 0)
Steven,
Sorry that you had a bad experience with an "arrogant bas---d". You are doing the right thing by getting different opinions and obviously he wasn't used to his patients doing that..Don't let him bother you! Easy to say but hard to do...Yeah, I would have run when he mentioned cryo--my facility has it and members here have played with ice balls but with your stats I don't know why he brought it up--I'm in trouble now..
No recommendations from me except the procedure you are comfortable with that has the least possibility of long lasting side effects..With your stats all of the procedures should effect a cure. All the best!
Bill
Posted 6/15/2013 5:50 AM (GMT 0)
StevenD,

Maybe he's been losing a lot of business to MSK and it struck a raw nerve. If you're in the NY area you have many of the best to choose from, so how's a poor Uro supposed to make a living? LOL

I would certainly be comfortable with AS if I had your numbers, but we all have different comfort levels. While you're exploring treatment options, another excellent RO in the NYC area is Alan Katz in Flushing. I think he's done more SBRT than any RO out there and his results are excellent.

Stereotactic body radiotherapy for localized prostate cancer: disease control and quality of life at 6 years

I hope the other docs you meet are more like the RO.

-Allen
Posted 6/15/2013 8:28 AM (GMT 0)
Side note... Best Buy for example as all but coined the phrase "Showrooming."

Shoppers pick out an item on line and then go to Best Buy to touch and feel the product - often times getting additional info from the sales people. Then they go home and buy the product on line cause its cheaper.

As you can imagine - BB feels used and abused.. Their new policy of price matching should help capture more sales.
Posted 6/15/2013 10:03 AM (GMT 0)
I my opinion, you did the right thing.  I let my first uro go as well, just didn't feel right with him.  he treated me like I was 12, and acted insulted when I asked how many DaVinici's he had performed, since that's what he was aggressivley pushing on me.  Take your time (you've got some, based on your numbers) and feel comfortable with your decision.  I've heard great things about Sloan.

Mike

Posted 6/15/2013 11:52 AM (GMT 0)
I have a big and somewhat known hospital in my town. I play tennis with one of the hospital administrators and someone on the board. I discussed with them the situation with my local urologist whom they know as he operates in the hospital.

Their take was that these local urologists get frustrated by two things:

1 - They do all the leg work, discover our cancers etc and then see us flee or get plucked by bigger more prestigious/specialized centers. I think it's fair to say that this isn't only about money. They probably genuinely feel like they get to do everything for us except the actual treatment.

2 - Because of sheer numbers and traffic alone they cannot specialize in only one procedure, surgery for PCa for instance, so they will never be able to compete with big number guys.

but prior to my surgery they both advised me to go out and find a specialist who did only this and who had a ton of experience. They reminded me that I get one shot at this. I remember thinking what great advice this must have been just by the fact that they worked for the same hospital as my local urologist and with him, yet still urged me to look elsewhere for more experience.
Posted 6/15/2013 12:23 PM (GMT 0)
Cutters CUT.... Burners BURN...
Good ones are not afraid of competition... Bad ones are, because they know you won't be back..

Gleason of 6.... most men that I know with a SIX ended up being a SEVEN after surgery.. ie.. don't trust the docs that it's " likely not too bad.."k

Saw a good doco on BBC knowledge, all about PC.. it was the first time that I saw the truth presented publicly.

Cut it out and 80% - your life will change... ED is a near certainty ... 20% chance that you will be able to perform again...
Weigh that against the reality that radiation will kill the prostate within two years...
Consider that radiation causes cancer, even if it's initially intended to cure...
Our Governments LIE to us, so why expect complete truth from the doctors..nono

It's a dark place that you have come to, but life after is not all that bad.
John Thomas is now much shorter.. the big "O" happens but it's barely worth it.

ED meds cause Tinnitus ... and they lose their effect and you get to the stage that it just does not matter..

You have CANCER, and there is a cure.. which one will cause the least long term damage.. that is the $64,000 question ...
Don't think of the next two years .. Think of the next twenty and more..

I HAD CANCER.. I had the wicked cut. I AM HERE..still.
I know friends who are not, and years ago, they had radiation...
YES , it is better today, but NOTHING will ever change what radiation does.. IMHO

I hope that your dark stay here is very short.
..
.

Post Edited (BuiDoi) : 6/15/2013 6:29:36 AM (GMT-6)

Posted 6/15/2013 12:34 PM (GMT 0)
Bui, that's not true.

ED numbers are very different to the ones you posted and differ even more based on many factors ncluding skill of surgeon.

Radiation does not result in more cancer.

Both radiation and surgery can be very effective in curing PCa if caught early enough and if performed by the right people.

The "BIG O" is actually better and more intense according to many people.
Posted 6/15/2013 2:32 PM (GMT 0)
about two years ago all my prostate troubles started when I had to go to the local ER due to sudden and complete urinary retention (couldn't pass urine at all, due to severe BPH).

After being fitted with a catheter, I was assigned to a local uro and I saw him the next day. I could have gone to him or not, but I did go. Turns out that uro was a 5-star-out-of 5 guy in all categories, and I have been with him ever since.

So sometimes it's just the luck of the draw. But if you do get one of those 1-star guys (or less), you DO have the option of firing him and getting somebody better, and doing it immediately.

Don't let somebody's "reputation" override your observation of what he is really like when looking for a doctor. For some reason, often the "big name" doctors seem to have the worst bedside manners. Check out some of Purgatory's recently posted experiences on this. He certainly knows about that.

I once did a post here about doctors sometimes being "Jekylls" and "Hydes," per the R.L. Stevenson short story. That is still the case. Sometimes you just never know what you're going to get. But always remember that THEY work for YOU. If necessary, you can always fire them any time you want.
Posted 6/15/2013 3:13 PM (GMT 0)
I was worried about bedside manner at first. Then I realized that if I was going to have surgery, I'd want the best surgeon for the one time operation regardless of his personality. I got lucky in that I got a great surgeon who also happens to be a great guy and a now a friend.
Posted 6/15/2013 8:42 PM (GMT 0)
Thanks for listening to me rant, I needed to get it off my chest.
I see I am not alone on this issue. All I'm looking for is some kind of open and frank conversation with the doctor. A doctor who at least pretends to care. Nothing more, nothing less. I'm not looking to go sailing, golfing or to spend a weekend in the Hampton's with him.
I'm not looking for a friend
Posted 6/16/2013 12:55 AM (GMT 0)

Steven D said...

I'm not looking for a friend

Exactly Mr. WW & I's thoughts about the arrogant little radiation oncologist we met. He's one of the best and we weren't looking for a friend.

To our knowledge, he got the job done with no known side effects to date.

We meet our friends on a different sort of turf. :)
Posted 6/16/2013 1:33 PM (GMT 0)
Is this guy just looking at potential lost dollars,
Yes.
You were right to fire him, Steven..been there...done that.
Posted 6/16/2013 1:55 PM (GMT 0)
BuiDoi,

I saw at least 9 things in your post that simply aren't true or accurate. You must have been very angry when you wrote it. I would love to address them one by one, but it would look like a personal attack instead of a series of corrections. So, will just have to let it pass. Perhaps you should re-read it yourself, and edit some of the obvious.

david in sc
Posted 6/16/2013 2:40 PM (GMT 0)
Bui:

>>>>>>>>>>>>>

Gleason of 6.... most men that I know with a SIX ended up being a SEVEN after surgery.. ie.. don't trust the docs that it's " likely not too bad.."k
>>>>>>>>>>>>>>>

You must know a very odd sample.

Most G6 remain a G6.

Unfortunately, there are some that do end up being a G7

The rest of your post is kind of hard to respond to.

Mel

Posted 6/16/2013 8:01 PM (GMT 0)
isn't it like 30% get upgraded?
Posted 6/16/2013 9:50 PM (GMT 0)
Davidg:

I'm too lazy to look it up. I thought maybe 30% get a change (some up, some down)

Mel

Posted 6/16/2013 10:10 PM (GMT 0)
StevenD,

I moved management of my case to Sloan nearly two years ago, and my experiences there have been excellent.  Both a medical oncologist and radiation oncologist have treated me, and staff have also been excellent.  If you do decide to go with Sloan, I suggest you sign up for their mymskcc on-line patient portal (no charge).  This will give you real time information about lab test results, appointments, and bills.  For example, I can log in and see my PSA test results within three hours of blood being drawn.  Recommend this service highly.  Best wishes!

Newspaper Lover

Age 69

11/09 DaVinci surgery upstate NY; nerve bundle taken; clean margins, clean seminal vessels, no incontinence, no erections.

06/11 PSA noted

Gleason 8

Time to recurrence 18 months

Three month doubling time (summer 2011).

PSA rose from .07 on 06/11 to .17 on 11/11.

09/11 hernia surgery to repair hernia resulting from the DaVinci

10/11 Moved management of my case to Memorial Sloan-Kettering in New York City

12/11 Started hormone therapy (Lupron/Casodex)

02/12 Began radiation (SRT), including pelvic lymph.

04/12 Finished SRT

03/12 Last Lupron shot 07/12 PSA and testosterone "undetectable" 

01/13 PSA “undetectable”; testosterone (T) level at 452 ng/dl

Next set of tests July 2013.  Currently receiving no treatment

Posted 6/16/2013 10:47 PM (GMT 0)
My urologist who did the biopsy and read my lab results to me practically had me on the operating table before I could leave the office. He wanted to give me 7 days to think about it. I said, give me three weeks. I called him a couple days later to tell him I wanted to get a second opinion and he said, "The surgeon will give you the second opinion". That made me angry as it felt like I had no other choices. That old-fashioned idea of prostatectomy still being the "gold standard" I guess is hard to shed and it tends to be an "easy answer" to give the patient. My thoughts were, "Easy for you to say -- you're not the one going through the RRP and the potential devastating after effects". I did not have to fire the guy -- he fired himself and left the group a couple of weeks later.
Posted 6/17/2013 11:07 AM (GMT 0)
Gardenz, That sounds so much like my experience that it's scary. All i want is a doctor who will listen and answer my questions. ! don't want a friend and I don't want some guy that's pushy. Anyone highly regarded would have no need to be pushy.
Posted 6/19/2013 11:46 PM (GMT 0)
What is with URO's ...... ????

My first Uro (one who I thought should have hung up his shingle when the new millenium came in) - was part of the team for my Brachytherapy in 2004. I saw him once for a post-operative check-up ... and he asked me "why are you here"? That was the last time I saw him!

My second Uro in 2010 kind of just kissed off my drastically increased PSA after the 6-month reading. Shortly after, I read in the Chicago Tribune, an article about the three highest paid (by the drug companies for their representation) surgeons in the area - and sure enough, there was only one Uro listed ... and he was mine. That is, until I read that article and realized how complacent he was about my PSA numbers.

My third Uro was contacted right after the above fiasco - and I am currently with him. I like him - great attitude - and he has competently placed or replaced a stent from my left kidney to my bladder three times now. Considering the fact that this is done thru the penis .... you just have to have a lot of confidence in your Uro!!!

By the way - is there a chance that the enormous "ego" might be a contributing factor to a Uro who won't talk about a second opinion??? 

Could be that the second opinion Uro might be your new Uro! LOL!!!

Posted 6/23/2013 12:11 AM (GMT 0)
Buidoi,

You are wise to be alert to how your doctor is acting. Get that word "acting". Lets not forget lots of these guys/gals have a huge ego and don't appreciate anyone getting in the way. A lot of them are overwhelmed, and another lot of them are very competent and maybe not so gifted in the patient/doctor interaction. You have to decide on a path that you feel confident about, and know that the treatment is going to work. Also take an unbiased look at the statistics, do your homework on the doctors and their patient outcomes, for each of these options you may consider, and once you see the plan for you, go forward and don't look back. Your mental health will be much better for it, and your healing potential will be greatly increased. Good Luck.
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