Are you smarter than a 6th grader?

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Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 5/20/2010 2:42 PM (GMT -6)   

Were you smart enough to ask:

a.      What is your biochemical reoccurrence rate

b.      What is you positive surgical margin rate

c.       What is your post operative infection rate

d.      What is your percentage of compliance to CMS core measures initiative

e.      What is your percentage of patients that require blood transfusion

f.        What is your percentage of patients that require hospitalization greater than normal

Which is defined as the average length of stay by diagnosis (LOS), All hospitals can provide that.  

g.      What percentage of your patients require intensive care post-op

h.      What is your age adjusted mortality rate

i.         What is your average operative time

j.        What percentage of the operation do you actually execute

k.       What percentage of your biopsy patients get septic

l.         What percentage of your patients suffer an iatrogenic injury during surgery

m.     What percentage of your patients suffer thrombosis as a complication of surgery

n.      What percentage of you patients have normal  continence (how do you define that)

o.      What percentage of your patients have a colostomy as a result of the surgery

p.      What percentage of your patients have post operative pneumonia

q.      What percentage of your patients have normal sexual function (how to define that)

r.        What percentage of your patients required an unexpected return to surgery

s.       Have you ever had a “never event” (google it)

 

 

In a few days you should be able to go from no knowledge to knowledgeable with a modest amount of effort. With a little more effort and time you can become an expert. If you don’t participate in your health care “you get what you get”. After all, it is a physician / patient relationship…Both have a responsibility.  As I said earlier some individuals will know enough about the various flat screen TV’s to be considered an expert, and yet...some of the same, just assume that it’s all the Dr’s responsibility when it comes to a health care.   

 

No disrespect intended...Just my Perspective.

 

Hero

 


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09 Non-Nerve Sparing on Rt.
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate involving 20% of the Gland. Surgical Margins Free of Tumor,
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. Extracapsular extension is absent Perineural Invasion is Identified, Vascular Invasion is not identified.
Post-op PSA 12/10/2009, Undetectable  <0.01
Post-op PSA 05/03/2010, Undetectable  <0.01
I hate this crap
Moved by individuals like Living1963

 


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/20/2010 3:16 PM (GMT -6)   

Instead of asking "Are you smarter than a 6th grader?", maybe the correct question is, "How anal are you?"

  • If you didn't ask any of these questions, you need to be more involved.
  • If you asked all these questions, you are off-the-charts anal.

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3741
   Posted 5/20/2010 8:14 PM (GMT -6)   
  • 1)And what would you do with the data?
  • 2)Would you interview (and pay) 50 docs until you found the one who said his XYZ rate was 0.001?
  • 3)Do you expect the docs to have that data at their fingertips during the 30 minutes you are spending with them?
  • 4)Would you rather the doc was concentrating on the DRE instead of discussing all the statistical what ifs that might not apply to someone with your build and condition?
  • 5)Could you even trust the doc to tell you the honest answer?
  • 6)How would you verify the numbers?
  • 7)Would you second guess yourself to death waiting/searching for the doc who could answers all the questions (honestly or not) to your satisfaction?

I guess I am just not smarter than a 6th grader. I certainly can't pee like one.
Jeff (the leaking one)
Married 34 years, DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 6=3+3. Bone and C/T scans neg.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next See Uro 1/22/10 Trimix #1. Try 0.08- 25%, 0.12-25%, 2/26/10 try 0.16 First Success! 90%.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day. Try controlling fluids.
12/11/09 5 months: 3 pads per day, 400-450ml/day
02/26/10 7 months: 3 pads but leak is now 320 ml (5 day avg.)
03/22/10 8 months: 3 pads per day, 280 ml/day (5 day avg.) PT says all muscles are tight and working properly. There must be another issue. Uro mtg 4/23. Did I waste 9 months? Mtg 5/22.
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05, 4/14 9 months - 0.04 and <0.01 with ECLIA.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/20/2010 8:18 PM (GMT -6)   
worried jeff: a most excellent answer. most dr's dont have the time for such an intensive interogation session from a prospective patient.
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
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 5/21/2010 6:21 AM (GMT -6)   
I didn't ask all of them but wish I had. The one that bugs me isn't up there. How many lympnodes do you take out? My doctor did have time for the questions had I known to ask. I am into lists and I wish I had taken a full list with me.
 
Age 48 at diagnosis
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
22 month  PSA <.04
continent at 10 weeks (no pads!)
ED is still an issue


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 5/21/2010 7:50 AM (GMT -6)   
hero, meant to ask about your brother. How is he doing post surgery.
 
Age 48 at diagnosis
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
22 month  PSA <.04
continent at 10 weeks (no pads!)
ED is still an issue


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 5/21/2010 12:40 PM (GMT -6)   

I was playing off of the tudpock's message.  My point is if you really want to be super informed that you should be aware of all of theses and other questions.  The onus (in my opinion) is on you the patient, not just the physician and medical staff. If you look at tud’s list, and this list, and you see a bunch of questions that are completely new, then you haven’t done enough research; or……Perhaps you’re a person who doesn’t care to reasearch, Which could be completely normal…not everybody wants to be so informed and nobody should throw any rocks at anyone.  One of my best friends had a significant Colon cancer and he never made any independent effort at education and had surgery by a physician recommended to him by his Family Physician and all is wonderful.  Individuality is what makes this a great place… don’t stop the candid conversation!

Again no disrespect to anybody!

 

Rob, Brother is back to work. He looks great.  He had a positive surgical margin with high volume prostate cancer (middle brother had a completely negative biopsy) much like mine.  He is in the process of doing the second round of consultations regarding options…The positive margin question is a sticky thing.  His first post-op PSA was <0.01...Thanks for asking.

Hero


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09 Non-Nerve Sparing on Rt.
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate involving 20% of the Gland. Surgical Margins Free of Tumor,
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. Extracapsular extension is absent Perineural Invasion is Identified, Vascular Invasion is not identified.
Post-op PSA 12/10/2009, Undetectable  <0.01
Post-op PSA 05/03/2010, Undetectable  <0.01
I hate this crap
Moved by individuals like Living1963

 


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 5/21/2010 1:27 PM (GMT -6)   
Guys & Gals, Ladies and Gentlemen, Boys and Girls,

These recent threads by older hands that are listing loads of important questions are not actually being 100% sensible as they may be giving new people the idea that the second you get PCa you have to take on board a hundred questions to which you instantly have to get a hundred answers from a hundred doctors, whereas we should remember a bit more about what the time frame was when we first encountered the problem.
We should thus all continue to emphasise the truer nature of the PCa journey where it all happens fairly slowly and that as each day ends we have added one or two more pieces to the jigsaw puzzle. Getting all the answers in one go after asking a string of questions would be too much for most of us to deal with.

Whatever it was my first uro said on the day he saw me and told me I had PCa must have been the right way, or more specifically the right way for me, as I feel that I have been lead through this maze/nightmare in an eminently satisfactory manner. And all he really said was: "You don't have to rush into making any decisions. My opinion is that, given your age, you should have surgery, but your age is relevant in another way, as because you are young there are major quality of life issues for you that will need a lot of thought. There are a number of ways to deal with this: AS, Surgery, and External or Internal RT, so I suggest you investigate this for a couple of weeks and we'll meet up again after that to see how you feel and talk about any questions you've got. And if you want to see me sooner then fine and if you want more time then that's fine too."

I did masses of research and got informed so that I felt like I had enough knowledge to make the decision I made, and more importantly and relevantly I still do.

When I went to see the rad doc I had prepared a list of questions, but asked almost none of them. I told the doc I had the list but that I would wait to see what he told me and then see what had not been answered.

Now with my RT half finished and the (small) possibility that I might need HT at some point I am just starting to slowly gather in info about HT from many sources so that if it happens I am already on the ball.

yes ask the questions, but get the pace right.

Alfred
Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc.
Nov 17th 2009 PSA = 0.1
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3741
   Posted 5/21/2010 4:04 PM (GMT -6)   
My concern about the questions was the inability for us to easily check the veracity of the answers.
If I need a plumber I can go to Angie's List and look up the plumbers in my area. But, if I need a roto-rooter job on my sphincter I have to rely on word of mouth and/or the recommendation from another doc who might have some strong financial interest in the outcome.
I consider this on par with the commandment: "Go with a Uro who has done more than 500 DaVinci's". Where is that score posted? I came up with a number by surreptitiously determining how many the uro scheduled per week and then doing a multiplication. Most people don't have the time to do that.
I'd like to the data made readily available, and while we're dreaming, I'd include surgeon pricing as well.
I would gladly have paid a subscription service for a couple of months of access.

Hey, Computer data geeks- are you listening?
Jeff

Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 5/22/2010 10:18 AM (GMT -6)   
Obviously the proper road lies between the two extremes of:

1. Placing yourself in the hands of your local doctor because he/she is friendly and always available - even though the situation calls out for another doctor, perhaps a regional or even national expert; and

2. Going through dozens of doctors armed with a lengthy master list of questions, looking for the semi-mythical doctor who can answer every question on the list "correctly" within the pre-determined time limit.

The road between these extremes (which are not intended to depict any actual person, living or dead, in case you didn't pick up on that) is broad and can easily accommodate a variety of personal styles. Some key points are: (i) do not be rushed; (ii) do not accept anything that anyone in a white coat tells you without checking it; (iii) do your own research (or have someone you trust do it for you); (iv) armed with a good medical dictionary (perhaps an online dictionary), go heavy on the medical literature, light on the Internet, advocacy groups, and what happened to your brother-in-law's friend - the gold standard is randomized, double-blind long-term studies [you'll find few, if any, of them for prostate cancer but get as close as you can]; and (v) there is no "one size fits all" correct answer - PCa truth is existential.

And good luck to all.

Zen9
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