Second Opinion

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Mackattack
Regular Member


Date Joined Jan 2011
Total Posts : 78
   Posted 2/5/2011 6:14 AM (GMT -6)   
After getting my biopsy and having a consult with my local urologist, he explained all of the options.  He also stated that he performed the open surgery.  After completing our research, I decided to have the open surgery with an out of town surgeon who I felt had a better resume. 
 
After being made aware that I needed to have the catheter in for 14 days, I called to schedule appointment for catheter removal with local urologist.  Scheduler spoke to doctor.  Doctor had questions about exactly what I was looking for.  I had the 2 doctors speak directly.
 
Now... the local urologist does not want to do the follow up!  Have any of you ever heard of this?  The local guy had encouraged me to talk to other people, but I guess he was only kidding.  I can't think of any other reason to turn down business besides a bruised ego? 
PSA 3.9 - October 2010 at annual physical
PSA 4.1 - November 2010 after a month of antibiotic, DRE Normal
Age 41 in December 2010 at Dx of 6 of 12 cores positive T1C and Gleason 3 + 3

Scheduled for open RP on 2/14/11 at Mass General

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 825
   Posted 2/5/2011 7:08 AM (GMT -6)   
I would not talk to the guy again. I really think he is violating his hypocritical oath by not helping you regardless of how treats you. I took my own cath. out per my uro. instructions after 10 days.  I had surgery by Dr. Parin at Johns Hopkins. It's their standard procedure.  Your primary care physician should be able to remove it. Its not hard. Takes about 5 seconds.
 
Dx @ 42 years old on 4/2008
Gleason 6 (50 Point Biopsy) (6 Cores positive - Small Focus Each)
open RP 10/08 Johns Hopkins
pT2 Organ Confined Gleason 6 (tertiary score 0)
PSA Since Surgery
1/15/2009 (3 Month) <.1
10/15/2009 (1 Year) <.1
10/15/2010 (2 Year) <0.03
10/15/2011 (3 Year) -

Post Edited (ChrisR) : 2/5/2011 6:12:03 AM (GMT-7)


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 2/5/2011 7:10 AM (GMT -6)   
Guessing that since your local URO doesn't have access to ANY of your other medical records he's being gun shy.
 
If at 14 days - it's too soon for the cath removal and you end up in the ER for it to be put back in - he doesn't want to take the rap. (just a guess)
 

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/5/2011 7:24 AM (GMT -6)   
Not that I recommend this but is an option, and I removed my own catheter but I never did surgery either. You cut the tube with scissors the bulb inside that keeps it tethered in there, deflates and it slips out into the toliet or floor. If you had issues at home you could go to emergency or another uro doc.

Anyway the bruised docs ego theory I have seen plenty of these on forums over the years, some docs throw a boob fit if you go to get second opinions and especially if you go on your own choices, instead of the good ole boy referral method. Some are wonderful and others are like the Soup N_zi guys, I got 8 opinions and met enough to see it more clearly.

The hypocratic oath is a theory today and not in full practice, the dollar God is alive and well. There are exceptions to this theory and we a glad of it, finding those is the harder part.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 2/5/2011 8:14 AM (GMT -6)   
This is not uncommon, my Uro encouraged me to talk to other Dr's but explained that she would work with the local rad' oncologist but if I chose to go out of town for robotic or have another Dr do the surgery she wouldn't see me for followup for one year. Bottom line is if the other surgeon hoses something up or if you have major issues it becomes a morass of who did what if she gets her fingers in there and tries to fix or treat it.

Can't really say I blame them, a friend went to Phoenix (Mayo) for the robot and had has had nothing but trouble with strictures, why should a local Dr take responsibility for fixing another Dr's surgery on a patient that didn't think enough of him/her to have them do the surgery? Our local Dr's will see a patient after one year for routine followups, if you're having prolonged issues it's the responsibility of the surgeon who did the work to treat you for those issues, except for emergencies. My friend has had local uro's place a new cath in the emergency room here but had to go back to Phoenix for most treatments. He recently did find a doctor in a closer city who would take on the extended treatments he's still undergoing for strictures. But due to the extent of his issues and the fact that none of the local doctors had anything to do with the original surgery no one locally will work with him.
Dave in Durango CO
07-06 PSA 2.5
01-08 PSA 5.5
09-09 PSA 6.5
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5
03-01-10 Age 55 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson
03-16-10 Path' G-8 (4+4+5) Bilateral involving 21% of left lobe, 3% of right lobe, SVI, Focal positive margin, pT3b NO MX

All PSA as of 1-25-11 <0.04

Post Edited (daveshan) : 2/5/2011 7:17:47 AM (GMT-7)


Mackattack
Regular Member


Date Joined Jan 2011
Total Posts : 78
   Posted 2/5/2011 8:53 AM (GMT -6)   
I found another local uro who is willing to do catheter removal and other followup.  I met him yesterday.  I gave him my biopsy and history and explained that I was having surgery on Feb 14.  I had to laugh that he wanted to perform the 5th DRE on my me since October.  I don't  think that these uros know how to have a patient appointment with out sticking their hand up your arse.  If he does it again when I go back for the catheter removal, I will know there is a problem.
PSA 3.9 - October 2010 at annual physical
PSA 4.1 - November 2010 after a month of antibiotic, DRE Normal
Age 41 in December 2010 at Dx of 6 of 12 cores positive T1C and Gleason 3 + 3

Scheduled for open RP on 2/14/11 at Mass General

Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 2/5/2011 9:09 AM (GMT -6)   
My guess is, He is not being a jerk but Cath removal is really considered part of the surgery process and inseparable for most insurance companies.  He is taking too big a risk by involving himself that early in recovery. It's just not worth the worst case scenario. What if he ended up repairing a botched job by some other surgeon? All that legal stuff those doctors have to consider these days. Kinda sad.
 
point of interest - I have talked to several doctors where insurance companies do not pay your surgeon for any appointment for 90 days after surgery.  They consider all that care to be part of the surgery.  Fair or not, it will certainly affect a lot of decisions.
 
Paul
 
 

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 2/5/2011 9:19 AM (GMT -6)   
Mack, DRE's, even after surgery is common place and most doc's will want to continue to do them. So we might as well accept them as a fact of life. There's some good reasons why they continue to be important- feeling for abnormal growth in the ex-prostate bed, still useful in colon and rectal exam health, etc.

Actually, I personally would ask my doctor why he wouldn't continue them, considering that I just completed some reallly serious surgery for a big, nasty disease. Od course, I'm a little different, as that is the closest I get to extra-maritial sex now, so I am grateful for the attention.... devil blush cool
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 01/11-.09
ED-total-Bimix 30cc

Mackattack
Regular Member


Date Joined Jan 2011
Total Posts : 78
   Posted 2/5/2011 9:32 AM (GMT -6)   
Thanks James. I did not know that. I thought that would be one of the "bright side of things" after surgery. Cancer - free will be enough for me.
PSA 3.9 - October 2010 at annual physical
PSA 4.1 - November 2010 after a month of antibiotic, DRE Normal
Age 41 in December 2010 at Dx of 6 of 12 cores positive T1C and Gleason 3 + 3

Scheduled for open RP on 2/14/11 at Mass General

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 2/5/2011 10:16 AM (GMT -6)   
Yes, I experienced that, only more so.
 
When I first had a rising PSA, I was referred to a local urologist. When I saw him, he had already scheduled me for a biopsy. That rubbed me the wrong way. I was also squeamish about the pain of a biopsy and he brushed me off (no big deal yada yada yada).
 
I then decided to consult with Umichn and have my biopsy there as they understood my emotions and were willing to do it under twilight sleep. When I mentioned that to my urologist he blew up on me and also said that if he doesn't do my surgery then "what do I need him for?"
 
At that point, I agreed and found another excellent local urologist who was willing to do any needed follow-up.
 
In retrospect, I shoild have ran from the first guy as soon as he scheduled a biopsy before seeing me. I was just a big $$$$ to him.
 
Mel

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/5/2011 10:44 AM (GMT -6)   
You cant have your cake and eat it too. I don't blame the other doctor for not helping. There is a lot of liability issues. Now if you needed to see the urologist for a new urinary related problem, he would probably be willing to see you.

I think its real bad advice telling someone, or hinting, to remove their own cath after surgery. Of my 21 catheters I had, only 2 were allowed to be removed at home, per doctors instructions, by my wife, whom the doctor knew was a qualified nurse.

There is a lot of complicated sutures inside and around the bladder neck, and it helps if the person removing it after surgery knows the unique quirks inside before they pull out the cath. If all the fluid is not fully removed from the balloon end of the catheter, you could cause pain and/or actually hurt yourself or do damage to the surgical area.

Also, the inlet on the inside side of the cath can poke or tear things as the cath is being pulled out.

For those that go out of town for their surgeries, they shouldnt be surprised that the local docs they turn down aren't real favorable about helping them after the fact.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

billye
Regular Member


Date Joined Nov 2009
Total Posts : 24
   Posted 2/5/2011 2:34 PM (GMT -6)   
the surgeon follows the patient. w

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 2/5/2011 2:54 PM (GMT -6)   
billye, I note that you have just started posting here and in Heart Forum. Could you share a little of your Journey so far. Have you been diagnosed with Prostate Cancer, if so what treatment, if any, have you had? What was the results? I'm curious as to your story so far. Care to join in and share?
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 01/11-.09
ED-total-Bimix 30cc
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