So if he told me to do a handstand and the splits, is he not looking out for my best interests?
Maybe he just likes to see you make a damn fool of yourself.
Hey, after the barium treatment and the time they inflated me with air so they could make some video of my YouTube, getting a pickle check is nothing.
This thread brings up an etiquette question.
My Doc of twenty some odd years has been dealing with colon cancer since last December, and he visits the office once or twice a week. I was due for my annual, and he assured me that the young female PA that he had hired, was well qualified to do my exam. All results and lab work would be reviewed by him.
Fine with me.
She was very professional, but I did notice that she spent much more time during the digital than my Doc does.
Should I have sent her flowers?
Apparently Godiva Chocolates are the preferred gesture of gratitude.
In 2001, I visited my doc for a routine physical. No symptoms of any kind. A DRE revealed a tumor on my prostate, which, had it gone unchecked for another four or five years, would have led to my demise. I underwent treatment and had assumed because my PSA levels since were consistently under 2.5 that I was well rid of any cancer. Three months ago, due to a totally unrelated illness, the docs discovered that the prostate cancer had spread to the right iliac lymph node. It is fairly benign, and since it appears to be confined, and we’re playing the “watchful waiting” game.
Go get the checkup. Especially if you are in the 50-59 age group. Prostate cancer has been shown to be more agressive in this relatively younger age group.
Pickles sounded so good that I had to run out and get a jar of 'em.
I’ll join my fellow docs in expressing some ambivalence. I don’t screen routinely; instead, I discuss it with every male of age, discuss the risks and the benefits, and make sure they’re aware of the sort of symptoms to look for. Occasionally they ask me if I’m going to have it done when I’m 50, and I say that yes I will, because I do have a family history. If I didn’t, I probably wouldn’t. (If they want it done, I do it.)
I hate awareness campaigns like this. I’m glad that they make men aware of what prostate cancer is and what can be done, but they always make it seem like it’s something men HAVE to do, and that I’m a bad doctor for not insisting on it. They never mention that the test is actually quite controversial.
I don’t know of anybody who recommends testing at age 40 for low-risk groups. The ACS doesn’t even recommend it for high-risk groups until age 45. The prevalence is just too low at that age for the test to be valuable.
You are the doctor and I’m just another guy with a prostate, but with all due respect, may I ask a follow-up question?
You just said that the prevalence is too low for a test to be valuable.
Do you consider it …what?.. abuse of health insurance, or illegitimate blood work, to draw blood for a full physical and check that little box? At least one Doper has pointed out that trending over years showed a problem, whereas the single result might not have rung a bell for even a cautious and careful MD.
Why not do the blood test starting at 40 ? If for no other reason that to start to establish a baseline.
I’m not trying to attack you personally, I just simply don’t get the logic. By that logic, no cardiologist in the world would ever recognize and openly appreciate the value of a baseline EKG performed prior to any specific cardiac event. ( A real 12-lead, not some joke two-lead strip that they run in a GP’s office ).
Or, do you also feel that the idea of a baseline EKG is not valuable? It appears from what one hears and reads that most healthcare systems are frantic to promote relatively low-cost preventative measures. The time it takes to run a 12-lead is negligible. The extra vial of blood and cost of running the PSA is (probably) just as negligible. A real cost, no doubt. But… well worth it, perhaps.
It’s not just the cost of doing the test, it’s the cost of the false positives - followup tests, followup ultrasounds, etc. Not just the money costs, either - I had a totally unnecessary lumpectomy due to routine breast cancer screening. Sure, I’m glad it wasn’t cancer, but if you send 10,000 women in for lumpectomies to catch one cancer, have you increased the overall happiness of all women? What if two or three of the 10,000 die under anesthesia? You have to run the numbers and decide how many cancers you will catch that you wouldn’t have caught otherwise, and what the costs, human and monetary, will be for everyone who undergoes the extra tests.
What ENugent said. One needs to do the test where an abnormal result actually correlates with a disease you can do something about often enough to make it worthwhile. And the benefits of the intervention need to outweigh the risks!
Otherwise you might end up doing 500 prostate biopsies (based on mild elevations of PSA) to catch 1 cancer (if you decide to screen any guy who is williing to have his PSA done). And in the course of identifying that one cancer, 15-20 guys had signficant complications from the procedure.
Lab tests are not just innocuous numbers to record in the chart for later when maybe they’ll make more sense. One must understand why one is ordering the test, what the result means for that individual with their particular risk factors, and what the implications of a positive test really are.
And do enough prostate biopsies, and eventually someone will get septic and die from the biopsy, or end up with a colostomy bag, or end up impotent. Not a fun thing to inflict on a person, especially if the actual benefit of doing the test wasn’t really clear-cut to begin with.
In rare solidarity of opinion, 3 long-time doper docs (primary care experts all) say: “Prostate screening for the masses? Eh, not so sure about that. Come talk to us about your particulars and we’ll try to figure out what’s right for you”.
I don’t get baseline EKGs on just anybody. Again, what do you do with an abnormality? Especially if you don’t know if it’s abnormal for that individual?
I get baseline EKGs on folks with high blood pressure, elevated lipids, diabetes, and anyone whose history, symptoms, and signs correlate with a significant increased risk of heart disease. Otherwise I have a whole slew of EKGs done on healthy, low risk folks, 10% of which are guaranteed to have some sort of abnormality, which the textbooks will say “often a normal variant, but on occasion has been associated with an abnormality. Suggest clinical correlation”.
Now in this age of defensive medicine, many docs will then order a stress test. If/when that ends up being abnormal or nondiagnostic, they order a nuclear stress test. No clear answer there? Take 'em to the cath lab!! No insurer will say no to a cath if the cardiologist puts down the reason as: “possible abnormal EKG and nuclear cardiac scan”!
Hey, great, they had a normal cath! But oops, a few will have complications of the cath, ranging from a day or two in the hospital for excess bleeding, to infected arteries, to fatal arrhythmias or arterial dissections. Normal heart, dead patient. Shit oh dear.
Primum non nocere! First, do no harm!!!
I find that I have much less trouble if I practice for a while before I go. 
Bob
When I go for the last pickle in the jar, I usually use a fork.
Yeesh! So that’s how it’s done with socialized medical coverage? I’ll stick wth the HMO!
Whilst I defer to the doctors posts above, I think recent research have shown that it is difficult to pinpoint, not prostate cancer, but aggressive prostate cancer. I discussed it with my specialist surgeon and he explained how it was difficult to know exactly what or how the cancer was going to develop and that a lot of invasive treatment was performed that may ultimately have made no difference. A lot of men died with prostate cancer, but not from prostate cancer.
Where does that take us- I still get checked but but with the blood profile. If prostate cancer is detected I don’t know what I’d do.
Understood, and agreed. I did not think of the potential negatives to what sounded like a fairly simple thing- PSA bloodwork and a prostate exam. Thank you for explaining it so clearly.
Here, Doc Cathode, try out these.
Yeeeeouch, those things look painful…! :eek: (I even pity the salad handled by those tongs)
…are you trying to alter his altar…? 
backs against the nearest sturdy concrete wall
“Free Prostate Massage”?!? From a male therapist? “I’ll take things that sound dirty for $1000, Alex.”
bow chika bow bow chika chika
Hey doc, what’s your hurry?
tikka tikka dow dow
Take your time. Can I call you Bill?
baddow dow dadadow
The lights, they’re a little bright. Let’s bring 'em down a bit. Maybe light some candles…
bading doo dow chicka chicka
Awwwww yeeeeeaaahhh…dat’s it Doc…
bow chika chika bow bow
What? He’s got very soft hands.