Why is color Doppler ultrasound available in so few places?

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nodaker
Regular Member


Date Joined Dec 2008
Total Posts : 22
   Posted 10/9/2009 7:34 AM (GMT -6)   
Both my husband and I have been wondering why color Doppler ultrasound isn't done at more places around the country -- esp. noted medical centers like Mayo and Johns Hopkins?  We are going to (Rochester) near Detroit soon as my husband has an appointment with Dr. Lee there, but it is just surprising to us that this tool is not available much closer, i.e., Mayo and in many more places -- especially if it is so valuable in finding and mapping prostate cancer. 
 
Any insight as to why it is so sparsely available ??
 
Deb

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/9/2009 8:30 AM (GMT -6)   
One reason, the machine (hardware) cost is so high, requires special training, another big expense, and probably factored agaisnt how few patients would actually use it, or should I say have their doctors order it as a test. Still comes down to cost effectivieness.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4225
   Posted 10/9/2009 10:06 AM (GMT -6)   
It's a skill based procedure and the skill of the operator is more important than the machine. The places I know that give color doppler are Lee, Bahn, and Dattoli in Fla and Bard in NYC. Everyone of these is a trained radiologist. Dr Sholtz, an oncologist, in marina Del Rey uses color doppler to identify suspicious areas, but won't do biopsies because he says Dr Bahn is much better than he is.
You have to do a lot of color dopplers, 1-4 a day, to gain experience in what you are looking at. It's like a weekend fisherman looking at his deph finder. he can identify the bottom and the fish that swims by, but the charter captain who uses it every day in his work can tell you what kind of bottem it is, sandy, mud, rock, and the exact type of fish.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


nodaker
Regular Member


Date Joined Dec 2008
Total Posts : 22
   Posted 10/9/2009 11:31 AM (GMT -6)   
It sounds like my husband will be going to one of the best then.  Dr. Lee's office staff is certainly very helpful, informative, and friendly.

Deb

nodaker
Regular Member


Date Joined Dec 2008
Total Posts : 22
   Posted 10/9/2009 3:04 PM (GMT -6)   
Thank you OhioState. LOL, the procedure will be absolutely painless for me ;) , but my husband does have his doubts about no anesthetic and pressure point pain management only that Dr. Lee uses. He has had three biopsies -- two saturated and has tolerated them well -- but he was numbed up too. I will tell Ingrid 'hi from some guy in Ohio." Good idea about the tape recorder.

I would think that I won't be in the room with him. Does Dr. Lee take photos so I can see what they looked at?

Deb

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4225
   Posted 10/9/2009 5:10 PM (GMT -6)   
Deb,
My wife was in the room for 12 of my 13 biopsies. I have never had a problem when I asked the doctor if she could be present. My last biopsy from Dr Bahn was the least painful of all biopsies and there was no anesthetic at all. At most 6 cores will be taken and that is much better than most biopsies as they really start to hurt after 8 or 10 cores.
You can also remember things that your husband may not remember or think is important. The brain reverts to its reptilian stage when confronted with a trauma or a difficult situation like being diagonosed with cancer or getting fired. It just can't process information, so it's always better to have someone else along who can remember the important stuff.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

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