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Medical Forum / Diseases and Disorders / Prostate Cancer / November 2006Is it really necessary for patient ?
My father is 70 years old, about a month ago he accept Radical prostatectomy because of prostate cancer. The surgery was successful ,but recently his doctor ask him to take some Viagra, and watch some porn image to prevent the atrophy of sexual organs. But My father didn't have sex life long time ago, Is it really necessary? I really feel embarrassment for this things. > My father is 70 years old, about a month ago he accept Radical > prostatectomy because of prostate cancer. The surgery was successful > ,but recently his doctor ask him to take some Viagra, and watch some > porn image to prevent the atrophy of sexual organs. > But My father didn't have sex life long time ago, Is it really > necessary? I really feel embarrassment for this things. Orion, There are a couple of good reasons, physically and psychologically, that your father should do as told by his physician. Yet, I cannot think of one that would make it your decision. I recommend you support him in all facets of beating this disease and don't concern yourself with his sex life. Maybe because I'm Asian, I don't feel comfortable about finding porn for my father. Maybe It’s my own problem, I don’t know how to say it. ^^ But what will happen if he won't watch the porn? It still sound a little rediculos to me. Steve Kramer 寫道： > > My father is 70 years old, about a month ago he accept Radical > > prostatectomy because of prostate cancer. The surgery was successful [quoted text clipped - 9 lines] > that would make it your decision. I recommend you support him in all facets > of beating this disease and don't concern yourself with his sex life. Maybe because I'm Asian, I don't feel comfortable about finding porn for my father. Maybe It's my own problem, I don't know how to say it. ^^ But what will happen if he won't watch the porn? It still sound a little rediculos to me. The concept here is called "use it or lose it". It is similar to not using one's arm for 2 years. It's possible that you will never have use of that arm in the future. Same goes for all the nerves, muscles, etc. that cause erections and climaxes (which may be unrelated). I will concede that maybe, because I am not Asian, I do not understand the relationship with parents. I was more respectful of my father.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum Maybe because I'm Asian, I don't feel comfortable about finding porn for my father. Maybe It’s my own problem, I don’t know how to say it. ^^ But what will happen if he won't watch the porn? It still sound a little rediculos to me. Steve Kramer 寫道： > > My father is 70 years old, about a month ago he accept Radical > > prostatectomy because of prostate cancer. The surgery was successful [quoted text clipped - 9 lines] > that would make it your decision. I recommend you support him in all facets > of beating this disease and don't concern yourself with his sex life. Maybe because I'm Asian, I don't feel comfortable about finding porn for my father. Maybe It’s my own problem, I don’t know how to say it. ^^ But what will happen if he won't watch the porn? It still sound a little rediculus to me. Steve Kramer 寫道： > > My father is 70 years old, about a month ago he accept Radical > > prostatectomy because of prostate cancer. The surgery was successful [quoted text clipped - 9 lines] > that would make it your decision. I recommend you support him in all facets > of beating this disease and don't concern yourself with his sex life. >> My father is 70 years old, about a month ago he accept Radical >> prostatectomy because of prostate cancer. The surgery was successful [quoted text clipped - 10 lines] > facets of beating this disease and don't concern yourself with his sex > life. Well said. Children of any age don't like parents taking an interest in their sex life, it should work the other way too. Mary > > There are a couple of good reasons, physically and psychologically, that > > your father should do as told by his physician.... I just come onto this thread, and I wonder how come the responders are not sticking to the thread topic. So what are the GOOD REASONS you are talking about? I aam a newly DXed PCa victim, so any USEFUL info, if you know it for a fact should be the answer to this posting. >> > There are a couple of good reasons, physically and psychologically, >> > that [quoted text clipped - 4 lines] > talking about? I aam a newly DXed PCa victim, so any USEFUL info, if > you know it for a fact should be the answer to this posting. The problem, Commander, is that there are a few people crossposting into our NG. It probably won't last much longer. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum "to prevent the atrophy of sexual organs." Did the doctor really say "atrophy?" There has been some discussion here over the years re "using it or losing it" but I don't think anyone has actually ever suggested or cited any data to the effect that that should be taken literally. I have never heard that not "using it" would actually lead to physical atrophy of the sexual organs. If that is the case then why don't elderly men who don't "use it" lose theirs? If he has no interest in "using it" then I see no reason why he should have to exercise it. I suspect the doctor is just assuming that he would want to maintain his sexual potential and prescribing therapy for it. Bill Denton RP 2/12/02 PSA .96 Memphis > "to prevent the atrophy of sexual organs." > [quoted text clipped - 7 lines] > to exercise it. I suspect the doctor is just assuming that he would > want to maintain his sexual potential and prescribing therapy for it. I thihnk the doctor was wise. If the patient wanted to keep going he was being helped, it wasn't just assumed that he wasn't interested. I think a lot of men would be flattered. Mary Sorry,I live in Taiwan ,Doctor speak Chinese,"atrophy" is just my translation. It mean "pennis 'll be much shorter than before". My english isn't very well,I think It's a misunderstanding. And I'm sure My father didn't have sex life anymore. He is old,It's quite normal for Chinese people. Bill 寫道： > "to prevent the atrophy of sexual organs." > [quoted text clipped - 12 lines] > PSA .96 > Memphis > Sorry,I live in Taiwan ,Doctor speak Chinese,"atrophy" is just my > translation. > It mean "pennis 'll be much shorter than before". That's a different story. A prostatectomy shortens the penis anyway, but not significantly, I don't think. But sex -- solo or with a partner (and get back to us when you reach 70 and tell us you don't have sex any more, at least with yourself) -- is greatly assisted by any degree of erection. Just tell tell your father that if he doesn't do his homework he'll start failing his tests. He'll get the message. I.P. > Just tell tell your father that if he doesn't do his homework he'll start failing his tests. It's interesting how most of the responses have addressed some aspect of sexual life, rather than the actual health of the penis. Fathers of boys may recall that erections occur from birth. Nocturnal erections are with us throughout life, unless the testosterone fails or PC treatment messes up the works. The fact is, erections, while necessary for an ideal sexual life, are essential for penile health. If PC treatment destroys the ability to have an erection, regular massage may nonetheless get sufficient blood into the penis to keep the tissue healthy. It is, of course, possible to enjoy a diminished orgasm without an erection, but I expect that "atrophy" refers to the penis itself, rather than a loss of sexuality. When erections do not occur, there is no particular desire for sex. I suspect that for most men, pornography is the best way to get through the sorry business of post-PC penile manintenance. -Patrick > It is, of course, possible to enjoy a diminished > orgasm without an erection Or a better one, according to several guys here. , but I expect that "atrophy" refers to the > penis itself, rather than a loss of sexuality. The literature and my uro say both length and erectile function are involved. > When erections do not occur, there is no particular desire for sex. Are you kidding me? > I > suspect that for most men, pornography is the best way to get through > the sorry business of post-PC penile manintenance. Patrick, do you have any ED? These things you're saying contradict MANY tenets stated in this forum and in the literature. I.P. > "to prevent the atrophy of sexual organs." > [quoted text clipped - 6 lines] > has no interest in "using it" then I see no reason why he should have > to exercise it. We're not talking about penis or testicles disappearing; the issue is the atrophy of the less obvious components of an erection . . . the nerves, chambers, valves, etc. Their various functions and capabilities decline -- "atrophy" -- if not exercised. But if the pt doesn't care, who does? I.P. Bill, what would happen if you sat in a chair day in and day out and took great efforts not to walk...... ? Of course, little by little, blood would cease to flow, capillaries would closed, and perhaps gangrene would set in or the very least yours legs would become useless and of know necessity. > "to prevent the atrophy of sexual organs." > [quoted text clipped - 12 lines] > PSA .96 > Memphis "Of course, little by little, blood would cease to flow, capillaries would closed, and perhaps gangrene would set in or the very least yours legs would become useless and of know necessity." Give me a break. I acknowledged the "use it or lose it" maxim, meaning that a person not using a sex organ (or leg) might eventually lose the use of it, but "atrophy" has dire connotations - as evidenced by your mention of gangrene in this context. My intent was simply to ensure that no one equated not "using it" w/ actual physical loss of tissue w/ other possible health consequences. I think we have all come to the concusion here that frequent exercise after Tx is helpful if you want to regain/maintain erectile function - but it is not necessary otherwise. Bill Denton RP 2/12/02 PSA .96 Memphis > I think we have all come to the > concusion here that frequent exercise after Tx is helpful if you want > to regain/maintain erectile function - but it is not necessary > otherwise. Now, that's what Orion wanted to know, and it's what you and I THINK. But what are the facts, or at least the professionals' opinions, as represented in the literature? I.P. I believe there is a moral dimension to the use of porn that is hard to ignore. If our sexual function is intended to enhance our relationship with our spouse and, when we were younger, to bear children with our spouse, then any images that suggest a relationship with another person violate that intention. To allow oneself to become sexually aroused by images of another person who is not ones spouse, I believe, is a violation of the purpose for which one was given the gift of sexuality. Another somewhat tangential issue is whether it is appropriate to turn women into sex objects as pornography does. I believe that demeans them. Michael > My father is 70 years old, about a month ago he accept Radical > prostatectomy because of prostate cancer. The surgery was successful > ,but recently his doctor ask him to take some Viagra, and watch some > porn image to prevent the atrophy of sexual organs. > But My father didn't have sex life long time ago, Is it really > necessary? I really feel embarrassment for this things. > I believe there is a moral dimension to the use of porn that is hard to > ignore. If our sexual function is intended to enhance our relationship with [quoted text clipped - 6 lines] > Another somewhat tangential issue is whether it is appropriate to turn women > into sex objects as pornography does. I believe that demeans them. Whatever it takes to get it off, dude, after surviving prostate cancer. If using porn offends you, try Popular Sheepherding. I hear it has some great pictures. I suspect that 99.9% of us cast our opinions of women in concrete by middle age. I.P. >I believe there is a moral dimension to the use of porn that is hard to >ignore. If our sexual function is intended to enhance our relationship with [quoted text clipped - 8 lines] > > Michael I agree with all of that. Mary Sex has one purpose and one purpose only - to bear offspring to continue the species. Dogs, fish, monkeys, and people all do it for the same reason and the fact that it is pleasurable guarantees that it be done. Morality and enhanced relationship with spouse are creations of our culture and not all cultures view these things the same way. Dave Perry > I believe there is a moral dimension to the use of porn that is hard to > ignore. If our sexual function is intended to enhance our relationship with [quoted text clipped - 15 lines] > > But My father didn't have sex life long time ago, Is it really > > necessary? I really feel embarrassment for this things. > Sex has one purpose and one purpose only - to bear offspring to > continue the species. What a sad way to look at a beautiful, dual-purpose fact of life. I.P. Nuthin' sad about it. I've basked in the afterglow all snuggled up to someone who in those moments means more to me than anything in the world. That's a nice side effect of our sexual experience but to say that the PURPOSE of the sex act is anything but to keep our sorry butts, generation after generation, on this planet is nonsense. Dave Perry > > Sex has one purpose and one purpose only - to bear offspring to > > continue the species. > > What a sad way to look at a beautiful, dual-purpose fact of life. > > I.P. > Nuthin' sad about it. I've basked in the afterglow EXACTLY! Isn't it sad that some people claim that's not a valid reason for sex, that procreation is its only purpose? all snuggled up to > someone who in those moments means more to me than anything in the > world. That's a nice side effect of our sexual experience but to say [quoted text clipped - 6 lines] >> >> I.P. > Sex has one purpose and one purpose only - to bear offspring to > continue the species. Dogs, fish, monkeys, and people all do it for > the same reason and the fact that it is pleasurable guarantees that it > be done. Morality and enhanced relationship with spouse are creations > of our culture and not all cultures view these things the same way. > Dave Perry When you ascribe a purpose to sex, you are confusing intention with function. From the point of view of evolutionary biology, sex is the mechanism whereby most species propagate. But some species propagate asexually. the evolutionary 'purpose' of sex is still not entirely clear. There are various theories about it, and most of them icorporate the fact that sex allows variation in the genetic character of offspring, so they combine aspects of both parents. But evolution is not a conscious creature which has a purpose in the sense that a human being does, so it is misleading to use terms appropriate for conscious aware agents in this context. Generally, we have sex for the same reason we eat. We have an appetite for it. That appetite is built into our biology. While at certain times people do have sex explicitly in order to bear children, that is not generally why we want it. And the appetite is not turned off when there is no longer the possibility of reproduction. similarly, we don't eat to sustain ourselves, but because we are hungry. Eating of course does function to sustain us, and having sex is the mechanism whereby the species is propagated. But neither operates primarily through higher brain function where the concept of intention or purpose is a meaningful concept. You are certainly right that culture determines to some extent what we consider appropriate or moral. There do appear to be some universals, but even those may take different forms in different societies. Attitudes towards sex vary widely across different cultures and have varied significantly historically with cultures. Even within current American culture, there is a wide divergence of belief about sexual morality. For example, most of us believe in monagamy---more accurately serial monogamy---but there are still a few holdouts for polygamy as the way of God. > > Sex has one purpose and one purpose only - to bear offspring to > > continue the species. Dogs, fish, monkeys, and people all do it for [quoted text clipped - 13 lines] > being does, so it is misleading to use terms appropriate for conscious > aware agents in this context. [Please forgive the off-topic nature of this post. I love to talk about topics like this but it's not often that I find anyone who wants to hear me ramble on. Maybe not this time either but, hey, what's a little digression among friends?] The use of the word "purpose" when discussing evolution is, perhaps, a metaphor. But it's an apt metaphor, one that I think evolutionary biologists often use. It seems like a reasonable use of the term to say that the purpose of a bird's wings it to enable it to fly, the purpose of a fish's fins is to enable it to swim, the purpose of hunger pangs is to stimulate us to eat, and the purpose of sexual desire is to motivate us to procreate. These are "purposes" in the sense that the antecedent evolved _because_ it tended to produce the consequent. When we get right down to the molecular biology of what it means for a person to purposely do something, the same problems occur with the word that occur when talking about evolution. "I get in my car for the purpose of going to work" is, in some sense, a shorthand for a chemical process that occurs in my brain and body which could, in theory, be described entirely in terms of biochemistry. But "purpose" turns out to be a tremendously useful and enlightening way to describe the process. So too, it turns out to be a tremendously useful and enlightening way to describe the tendencies of evolution - even if it is stretching a term that was originally only used to describe actions by people. At least that's my view of the semantics involved here. > Generally, we have sex for the same reason we eat. We have an appetite > for it. That appetite is built into our biology. While at certain [quoted text clipped - 4 lines] > does function to sustain us, and having sex is the mechanism whereby the > species is propagated. I'd like to put another horse before this cart. There is a sense in which it is true that we eat because we are hungry rather than to sustain ourselves. But from a biological and evolutionary point of view, the reason we are hungry is because we need to sustain ourselves. We pull our hand away from a fire because it hurts, not because it's burning our flesh. But the reason it hurts is because it's burning our flesh. > ... But neither operates primarily through higher > brain function where the concept of intention or purpose is a meaningful > concept. It is indeed true that the words "purpose" and "intention" arose in our language to describe something that we most often attribute to "higher brain function". But even before evolution was discovered I think we frequently applied the term to other areas. I'm sure we can find pre-evolution literature that speaks of the purpose of a tree's height being to get it up into the light, the purpose of an ant's foraging being to find food for the colony, or the purpose of the showy display and sweet smell of a flower being to attract a honey bee. Applying the term "purpose" to these examples doesn't seem to me to be a stretch. Part of my point here is just semantics. But, if people will forgive my use of a technical term, part is epistemology. "Purpose" turns out to be a highly useful and even indispensable concept in understanding evolution - so long as we don't confuse it with "conscious intent". > You are certainly right that culture determines to some extent what we > consider appropriate or moral. There do appear to be some universals, [quoted text clipped - 5 lines] > serial monogamy---but there are still a few holdouts for polygamy as the > way of God. >I believe there is a moral dimension to the use of porn that is hard to >ignore. If our sexual function is intended to enhance our relationship with [quoted text clipped - 6 lines] > Another somewhat tangential issue is whether it is appropriate to turn > women into sex objects as pornography does. I believe that demeans them. This is an interesting example of morality in conflict with religion. If one believes in an onmiscient, omnipotent God, then one must assume God had a pretty clear idea of the consequences of giving us the equipment and impulses we have. For example, God did not equip us with wings or a prehensile tail, so most of us don't have the urge to jump off a roof or swing from a tree limb. And God clearly knew how to time-limit our capabilities, as is evidenced by the the fact that childbearing is not possible before puberty or after menopause. But both men and women have strong sexual urges before, during, after and outside of marriage. We (both men and women, and both gay and straight) react instinctively to pornography, to attractive nudes painted and sculpted by the Masters, and to hot-looking folks we happen to see. If God wanted to circumscribe those urges so they were directed only to one's spouse and solely for the purposes of producing offspring, my guess is that we'd have been programmed to behave that way. Otherwise we have to believe that God got up one day, saw a Neanderthal's erotic drawing on a cave wall and slapped Him/Herself on the head, saying, "Porn! Darn, I forgot to prevent that!" I think it's a bit presumptuous for any of us to declare that we know what God had in mind. (I'm still trying to figure out what divine design gave us the prostate and the appendix, not to mention cancer, schizophrenia, hydrocephaly, Alzheimer's...) Alex >>I believe there is a moral dimension to the use of porn that is hard to >>ignore. If our sexual function is intended to enhance our relationship [quoted text clipped - 11 lines] > had a pretty clear idea of the consequences of giving us the equipment and > impulses we have. Wot's it to do with a god? > I think it's a bit presumptuous for any of us to declare that we know what > God had in mind. So why are you talking about it? > (I'm still trying to figure out what divine design gave us the prostate > and the appendix, not to mention cancer, schizophrenia, hydrocephaly, > Alzheimer's...) Why bother? Mary > Alex >I believe there is a moral dimension to the use of porn that is hard to >ignore. If our sexual function is intended to enhance our relationship with [quoted text clipped - 6 lines] > Another somewhat tangential issue is whether it is appropriate to turn > women into sex objects as pornography does. I believe that demeans them. You are correct, Michael. However, you'll not find here much support for the "if it causes you to sin, cut it off" argument. Some do not believe at all and will not tolerate your beliefs. Some here do believe, but when it comes to sexual function will ignore the Bible and go on to the tried and true, "do not judge, lest you be judged" argument. As for me, I have learned to allow them their path and almost had forgotten my own. Thanks for reminding me. Funny thing is, I'm in the "don't use it and will likely lose it" category because of my fidelity to a woman who could care less. Oh well. He didn't say it would be easy. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum > "Michael Kiely" <wrote. >> To allow oneself to become sexually aroused by images of >> another person who is not ones spouse, I believe, is a violation of the >> purpose for which one was given the gift of sexuality. Ummm, hmmm. And just whom do we fantasize about when masturbating, or maybe even when having sex with our spouse? I.P. What Mr. Kielly forgets is that the design pre-seeds the "fall". All adaptations of species come after the ideal at the time of creation. We live in a fallen world. Cancer is part of that fallenness. The Porn response is a result of the need to be attracted to a desireable mates who can successfully provide successful offspring that are able to have successful children; other wise we become extinct and fail is our assigned task to "be fruitful and multiply". Now having said that I can't explain young men are having sex with fat pigs who live on welfare!! B > I believe there is a moral dimension to the use of porn that is hard to > ignore. If our sexual function is intended to enhance our relationship with [quoted text clipped - 8 lines] > > Michael > My father is 70 years old, about a month ago he accept Radical > prostatectomy because of prostate cancer. The surgery was successful > ,but recently his doctor ask him to take some Viagra, and watch some > porn image to prevent the atrophy of sexual organs. > But My father didn't have sex life long time ago, Is it really > necessary? I really feel embarrassment for this things. It sounds like the doctor failed to ask the most basic questions: 1. How's your sex life? 2. Do you give a damn? I.P. Once again I.P. very succinctly hits the nail on the head. -Gordy > > My father is 70 years old, about a month ago he accept Radical > > prostatectomy because of prostate cancer. The surgery was successful [quoted text clipped - 6 lines] > > I.P. >> My father is 70 years old, about a month ago he accept Radical >> prostatectomy because of prostate cancer. The surgery was successful [quoted text clipped - 6 lines] > 1. How's your sex life? > 2. Do you give a damn? It's not up to the doctor to ask that, it might embarrass the patient and that's not good care. Mary >>> My father is 70 years old, about a month ago he accept Radical >>> prostatectomy because of prostate cancer. The surgery was successful [quoted text clipped - 11 lines] > > Mary I certainly beg to differ on that. It's one of the most important issues urologists deal with, and therefore an extremely important question to ask. Really no different than asking, are you able to hold your urine and do you want to pursue some treatment options. (Mary, I'm sorry I sent this inadvertently to your email address. My response was meant to go only here.) >>>> My father is 70 years old, about a month ago he accept Radical >>>> prostatectomy because of prostate cancer. The surgery was successful [quoted text clipped - 20 lines] > inadvertently to your email address. My response was meant to go only > here.) LOL! It doesn't matter, I hold by what I said in my reply to you :-) Mary Claude, I have to agree with you and I.P. on this one, if the Dr. doesn't ask, he's not doing a thorough job. Just think of the men who do develop ED and want to continue their sex lives, but write it off as a by-product of old age and are too shy to ask questions. Any Urologist who deals with mens issues, deals with ED an a regular basis and should be comfortable discussing the issue with the patient. Tom >>>> My father is 70 years old, about a month ago he accept Radical >>>> prostatectomy because of prostate cancer. The surgery was successful [quoted text clipped - 20 lines] > inadvertently to your email address. My response was meant to go only > here.) > It's not up to the doctor to ask that, it might embarrass the patient and > that's not good care. I'm just stunned. I'm speechless (fortunately, my fingers still work.) Tripping over my lower jaw. Shaking my head. And trying to avoid saying what I really think about that statement. But I WILL avoid it, because I'm CERTAIN not one other person on the entire internet agrees with it, so it doesn't need discussion. I.P. >> My father is 70 years old, about a month ago he accept Radical >> prostatectomy because of prostate cancer. The surgery was successful [quoted text clipped - 6 lines] > 1. How's your sex life? > 2. Do you give a damn? I think you're missing an apparent intrusion the resulted in the finding of pornography and the father feeling that, for some reason, he had to explain it to his offspring. There is no evidence that the doctor made and medical mistakes. >> It sounds like the doctor failed to ask the most basic questions: >> 1. How's your sex life? >> 2. Do you give a damn? > > There is no evidence that the doctor made and medical mistakes. If the patient couldn't care less about his sex life, why a) make him worry about it and b) prescribe a med with ANY significant potential SEs that c) costs so much and d) is not covered under all health plans? My uro has mentioned Viagra only as a sex aid and a means of reviving and maintaining the erectile system. i.e., if we don't care about erections, V is moot. I may have overlooked the issue in the literature, but I haven't seen any other reason to push erections on patients. If someone can provide that reason, this thread would be back on topic. I.P. >>> It sounds like the doctor failed to ask the most basic questions: >>> 1. How's your sex life? [quoted text clipped - 5 lines] > worry about it and b) prescribe a med with ANY significant potential SEs > that c) costs so much and d) is not covered under all health plans? I agree 100%. What I am trying to point out to you is that we have no such allegation against the doctor. We have an offspring who is questioning what his father's doctor said to his father. By all known accounts, the doctor did just what you would have him do; prescribe porn and pills. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum A. >> If the patient couldn't care less about his sex life, why a) make him >> worry about it and b) prescribe a med with ANY significant potential SEs >> that c) costs so much and d) is not covered under all health plans? B. > I agree 100%. C. > What I am trying to point out to you is that we have no such > allegation against the doctor. We have an offspring who is questioning what > his father's doctor said to his father. By all known accounts, the doctor > did just what you would have him do; prescribe porn and pills. B and C seem diametrically opposed to me. I.P. > A. >> If the patient couldn't care less about his sex life, why a) make > him [quoted text clipped - 10 lines] > > I.P. I'll try one more time. Nobody said that the patient couldn't care less about his sex life. The man's son or daughter (Orion) is the one that is worried about his or her father's sexuality. But, if the patient did not care about his present and future sexlife, then I agree with b), c) and d). > Nobody said that the patient couldn't care less about his sex life. I beg to differ. Quoting Orion's opening post: "But My father didn't have sex life long time ago". Later he repeated it with emphasis: "I'm sure My father didn't have sex life anymore. He is old,It's quite normal for Chinese people. And we know that PC tx does not improve potence. Aside from all that, my point is that the doctor (apparently) never even asked the pt the all-important questions I opened with. Thus, why fix something that ain't broke? IOW, the doctor should have asked the pt what HE wanted before trying to treat him; that strikes me as *THE* most important step in any doctor-pt relationship. It goes back to one of this forum's most basic tenets: only the pt is qualified to select his PC treatment (in cases that offer options). I can't think of ANY more basic starting point in all of medicine than, "What does the (rational) *P*A*T*I*E*N*T* want?" I.P. >> Nobody said that the patient couldn't care less about his sex life. > [quoted text clipped - 4 lines] > "I'm sure My father didn't have sex life anymore. > He is old,It's quite normal for Chinese people. Okay. It's not an important point. If you want to believe Orion that his father cashed in all his chips "long time" before he turned 70, then believe his doctor is incompetent. But, I think most of the 65 and 70-year-olds here are on my side. > If you want to believe Orion that his > father cashed in all his chips "long time" before he turned 70, then believe > his doctor is incompetent. > > But, I think most of the 65 and 70-year-olds here are on my side. The medical issue is not whether Orion's dad wants boners. The issue, and I consider it vital to this doctor's right to practice medicine, is that he (apparently) didn't ask what the pt wanted. I would not only "fire" a doctor like that, but would also report him to a medical board. If, for example, I took my bx to a rad onc who just said, "You need RT; let's do it" rather than "I recommend RT, but you should consult a uro onc and a med onc and read these two books first so you can weigh all the options", and I was left with long-term bowel complications from the radiation, I'd do everything in my power to own that rad onc's home, summer home, Greek villa, yacht, wife, first born, and dog . . . all because he prescribed and executed a treatment without first asking me a few basic questions about my choices among potential benefits and SEs. Where the HELL does any physician get the right to unilaterally dictate any rational pt's future from a menu of choices without asking the pt what he wants? Do you want your doctor to choose which of your crushed hands to save without asking you whether you're right or left handed? Whether to save your eye or your hand without asking if that eye even has vision? Choose between wife and unborn full-term child? Maximum longevity vs QOL? Whether you want to risk headaches to get an erection? And back to this thread's basic issue, even though several people have correctly pointed out that no one has provided any evidence whether erections are important to Orion's dad's health, that fact remains. Has no one seen any studies on that issue? I.P. >> If you want to believe Orion that his father cashed in all his chips >> "long time" before he turned 70, then believe his doctor is incompetent. [quoted text clipped - 4 lines] > I consider it vital to this doctor's right to practice medicine, is that > he (apparently) didn't ask what the pt wanted. Okay. I don't think he said that, but if that's your perception, I agree with your statement. >> The medical issue is not whether Orion's dad wants boners. The issue, and >> I consider it vital to this doctor's right to practice medicine, is that >> he (apparently) didn't ask what the pt wanted. > > Okay. I don't think he said that, but if that's your perception, I agree > with your statement. Regardless of what Orion actually meant, or whether he was right about his dad, I was using this thread mainly as a springboard, an example, for pointing out the obligation providers have to understand patients' wishes. They're the very reason for the existence -- and illustrate the importance to each of us -- of our Durable Power of Attorney for Health Care and our Living Will. That reminds me . . . I need to further research mine, have them legally blessed, and file it with several facilities. I believe that's vital to all of us, especially for our survivors. I apologize to Orion for using his situation to make a universal point, but it is still valid to his case as a means of evaluating his dad's care. I.P. > Regardless of what Orion actually meant, or whether he was right about his > dad, I was using this thread mainly as a springboard, an example, for [quoted text clipped - 6 lines] > blessed, and file it with several facilities. I believe that's vital to > all of us, especially for our survivors. Yeah, I think I can concur with that. I've changed the subject to reflect our consensus. :-) SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum >> Regardless of what Orion actually meant, or whether he was right about his >> dad, I was using this thread mainly as a springboard, an example, for [quoted text clipped - 9 lines] > Yeah, I think I can concur with that. I've changed the subject to reflect > our consensus. :-) Many treatment decisions are medically no-brainers which patients shouldn't question significantly, but most long-term diseases are sufficiently complex that pt preferences must play a strong part in choosing from the options. I.P. > My father is 70 years old, about a month ago he accept Radical > prostatectomy because of prostate cancer. The surgery was successful > ,but recently his doctor ask him to take some Viagra, and watch some > porn image to prevent the atrophy of sexual organs. > But My father didn't have sex life long time ago, Is it really > necessary? I really feel embarrassment for Folks-- You don't have to be solomon to resolve this one. Ask yourself: would I prefer to: (a) suffer a little embarrassment and maintain my penis in the best condition I can OR (b) experience zero embarrassment and end up with a a desiccated organ. What do you think, Gentlemen? I think it is not just optional but INCUMBENT upon any surgeon to advise every post-RP patient about penile "maintenance" and "rehab." It is a crime not to, but it happens all the time. I know my husband's doctor dealt with this subject, if at all, in a very cursory fashion (meaning in about a minute's time). Believe me, what dr scardino refers to as changes in the genital's shape does occur because I've seen it firsthand and I've heard it from men in these groups. Scardino discusses this (THe Prostate Book pp. 364-36) under the topic, "Penis size and shape", expounds on this: (In fact, I believe many men (and their partners) wonder if their anatomy is any different from pre-surgery and so I suggest taking pictures and measurements of the genitals BEFORE so that most men can be assured that their equipment hasn't shrun in fact. Seriously.) "While the mechanism remains a mystery , in some cases the delicate vascular channels of the penis ATROPHY (emph. mine) and become fibrotic -- hard and inelastic. Fibrous tissue does not expand when the penis fills with blood so the organ remains shorter and erections may be not be as firm. Some men report curvature of the penis. . ." (p. 365) Then dr scardino goes on to discuss "penile rehabilitation." He recommends the "early, regular" use of injections two to three tx/wk nightly for six months or a dose of Vit. V (50 or 100mg) nightly for nine months. (p. 366). (Maybe both?) Scardino tells men to use "any effective means to have regular, frequent erections after surgery." He does acknowledge, though, that "more intensive research is needed to confirm whether penile rehab. really promotes recovery of erections." As far as penile "maintenance" this is what happened in our case: My husband had a RLRP and was put on viagra right away but it took him a couple of months to figure out that he had ED anyway. So then he called the surgeon who referred him to an "ED specialist." It seems the specialist was very busy because he scheduled Jonathan's appointments 4-6 weeks apart. And he said he needed three visits to do a proper diagnosis. This dragged on for so long that I got fed up and went to the library, looked in castle-connolly-NY and found some other ED doctors. On the 3rd try Jon saw one (Arnold Melman) that he liked who happens to be head of Uro dep. at major teaching Hosp. in NYC. Dr. A told J. that in his opinion he didn't need diagnostic ultrasound (for impotence) and that Vit. V .is not effective in penile rehab (his exact words: taking Viagra is a gift to the drug co). (I know his opinion is not infallible, I wonder about it) Dr. A recommended trimix for impotency and presented my husb. with a readymade injection kit (dr melman compounds the stuff himself) and J. didn't even have to send me to the pharm. to pick it. (Though he was too embarr. to buy the syringes; i had to). In any case the doctor gave us injections for the purpose of restoring our sex life and "penile rehab" wasn't even brought up in the conversation. Anyway, a full ten months had passed between the time of J.'s surgery and when he first injected himself . To me this time lapse was a missed opportunity. I sometimes ask myself, "what if things had been otherwise." bec. I don't have to tell you how imp. EF if for a man. I only recentlyI tried to research the issue of "penile rehabilitation" and found almost nothing. But one article that looked reliable said the jury was out about Vit. V and company's effectiveness in maintaining EF post RP-- maybe it helps some men or none at all (the only comp. study was done my Pfizer, mfr. of Viagra so personally i don't take it seriously).. I don't see much of a downside in taking Viagra bec. you can order it online for peanuts. Based on the article I read and postings from people like you I suggested to J. that he might want to try Cialis and in fact he was very enthusiastic and it happens that a shipment of Vit. C+ is on its way from canada (via india) right now. Based on what I've learned over the last year I would have preferred that Jon be given injections immediately after the surgery because there's enough evidence that they do work but you have to start the regimen early. Now I ask you: Why didn't my husband's doctor say to him, " jonathan, I suggest that to improve the chances of good EF in the long term you should take Cialis (bec. it seems to work best anecdotally and in studies) and begin intracavernosal injections ASAP. The reason Doc didn't mention the above is that he is a surgeon and they don't really consider erectile function to be their department. So it ends up being nobody's job until problems arise. I think Orion's father was fortunate to have a doctor who brought up this subject and gave the patient suggestions, as embarrassing as it may have been. Let's keep in mind that we got O's story secondhand and in translation. We don't know what really happened between her father and the doc. (although i'm sure everything orion said was in good faith) I suspect the doctor was more gentle and civil than he is made to .sound . And, has it occurred to anyone besides SK and me that Orion is very likely a WOMAN? Daughters are more likely to take their elderly fathers to the doctor than sons and being female might explain O's excruciating embarrassment at the thought of her father watching porn. So I will speculatively refer to O as "she". The wackiest thing I every read is that O implies this situation is special because she's asian. I have had asian students as guests and happened to watch a taiwanese movie (Yi-yi) last night and believe me asians have bought into our culture IMO. So to all you brits, canadians, scandinavians, etc. that participate here rest assured that I believe you are all decent people who have a normal sense of modesty and privacy and are respectful toward your parents (SK: did you actually say this humbly) and you don't need to be asian to feel embarrassed in this situation! I'm sorry for going on so long but i trying to work on this verbosity. I happen to have plenty more to say on this topic but my husband just walked in and so i have to go. Briefly, 2 pts. 1) pornography is used medicinally for a number of purposes. Forex, my husband banked his sperm before surgery and what do you think they do at the sperm bank to induce a response? Put the person in a room full of adult material, that's what (It's not much different than Times Square). Also in other areas, such as fertility treatment, men are required to submit sperm samples and they use the same means to achieve the desired end. I admire your position on this issue, Mr. Kiely; it is very idealistic. Personally I hate adult movies bec. they are so bad artistically and movies are my favorite thing in life. The problem with porn is that it is so accessible right now to anybody via internet. (Speaking of which, we just got a phone msg. from Robert DeNiro on the ans. machine. He is urging us to vote for Hilary. I like him and it was nice to hear his voice!) Finally, who would even Presume to Know what their parents do in the sex department. It is utterly ridiculous. It sounds to me that O's father is without a partner, maybe, but for her to assume that he is completely abstinent is unreasonable. You just have to admit there is a lot you don't know. I am 46 yrs. old and have just found out that I don't know everything, forex, that men masturbate in the shower (including my husb). I just never knew this little factoid (and wish i hadn't found out because i feel squeamish in the shower! ) Also, I learned from these groups that men are interested in sex (and capable of doing it) far longer than I ever imagined. So O. is wrong to write off her father's sex life. How could she possibly know what he does in the privacy of his own bed, bathroom, shower? What the doctor should have done IMO was explain to the patient that he might experience genital atrophy and to suggest that he "exercise" in order to prevent it and considering his age use porn as a way to get stimulated easier. The hardest experience for me in this past year has been watching Jonathan's testicles shrink! So this is an important issue not just physiologically but psych. as well. for both man and partner, if any. Best wishes to you all. Leah |
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