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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2008Biopsy?
Larry wrote and asked: > I'm 51 y/o with history of chronic prostatitis. Just had an increase > in PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I > asked him why not repeat PSA, just in case? He said the labs don't > make mistakes. Should I push him on this or just accept the biopsy? That's less than double in one year, and you have a history of other problems that could have boosted it just at the time the PSA blood draw was done. Someone recently wrote that a second PSA in 6 months should be performed before any biopsy. He lied to you. Labs do make mistakes. He lied to you. Do you still trust him enough for a biopsy? Find a doctor for a second opinion. Your insurance should cover that if only to avoid a "minor surgery" billing from that onager who lied to you and wants to rush you into a biopsy. ___ Blue Wave/QWK v2.12 I will definitely consider it. Thanks! > Larry wrote and asked: > [quoted text clipped - 19 lines] > > ___ Blue Wave/QWK v2.12 Actually, I double-checked it. It went from 1 to 1.6 in 13 months and then from 1.6 to 1.8 over the next 11 months. I.E. 1 to 1.8 over 24 months. Larry > Larry wrote and asked: > [quoted text clipped - 19 lines] > > ___ Blue Wave/QWK v2.12 > ... > Someone recently wrote that a second PSA in 6 months should be > performed before any biopsy. I think there must be times when there is good reason to do a biopsy right away. If the PSA is relatively high (not true in this case) or has gone up quickly (seemingly true in this case), and if there is a very suspicious digital rectal exam (questionable in this case), I wouldn't want to wait six months. > He lied to you. Labs do make mistakes. > > He lied to you. Do you still trust him enough for a biopsy? Well ... I'm not sure I want to go so far as to say that the doctor lied. In the first place, he may believe exactly what he said. He may have never seen a clear case of a mistake in a PSA report. He may believe that the odds are so small that they shouldn't be considered. If he believed that the odds of a mistake are, say, one in a thousand, do we really want to call him a liar? Also, sometimes a doctor (or anyone else) will exaggerate a statement in order to make a point. Sometimes people do that for the good of the person they are talking to. For example, when a doctor says to a patient - "You're going to have a heart attack if you don't stop smoking and eating like a pig" - is he lying? Strictly speaking, he should have said, your risk of a heart attack is increased by N percent. But he might be trying to motivate this obese smoker by exaggerating the point. Scaring the patient might be crucial to saving his life. So I don't want to be too quick to judge. > Find a doctor for a second opinion. Your insurance should cover > that ... Excellent advice. Alan Alan, Very sensible words. I did speak to him again. He feels that the PSA shouldn't have risen that much over 24 months, but he also feels that there's a 3 out of 4 chance that it's not PCa. I am going for a 2nd opinion before I agree to the biopsy. And he insists that his patients do not complain of pain during biopsy. Larry >>... >>Someone recently wrote that a second PSA in 6 months should be [quoted text clipped - 36 lines] > > Alan > Alan, > [quoted text clipped - 3 lines] > opinion before I agree to the biopsy. And he insists that his patients do > not complain of pain during biopsy. There is absolutely no reason to have pain. Tell him to give you the happy juice. You may have pain, but you'll never remember it. > There is absolutely no reason to have pain. Tell him to give you the happy > juice. You may have pain, but you'll never remember it. Once again, however, since it's been a while, let me remind readers that anesthesia has pitfalls. The certain one is that one cannot legally drive for the rest of the day. Less distinct but common is reduced mental capacity, which matters if one needs a clear head; we FEEL fine after modern happy juice wears off, but then "feeling fine" is its *purpose*, isn't it? Then there are the rarer but much more serious incidences of lingering confusion lasting days to months. The UK cited those when banning systemic drugs such as laughing gas for minor dental work. Personally, I'm not generally willing to sacrifice a day of constraints on my mental or physical acuity just to escape a little fleeting irritation like a prostate biopsy or a bigger but even more fleeting irritation like a colonoscopy. But then I don't drink alcohol partly for the same reason, so maybe my priorities are not mainstream. I.P. > Personally, I'm not generally willing to sacrifice a day of constraints on > my mental or physical acuity just to escape a little fleeting irritation > like a prostate biopsy or a bigger but even more fleeting irritation like > a colonoscopy. I would concur that I am not generally willing to sacrifice a day of constraints on my mental or physical acuity just to escape a little fleeting irritation. However, prostate biopsies cause some men fleeting irritations and other horrendous pain. The rest fall in between. I will sacrifice a little wooziness (it was nowhere near a day) to assure I'm not one of those in the horrendous category.  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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08 Non Illegitimi Carborundum On April 30, Steve Kramer replied to Mike: > I would concur that I am not generally willing to sacrifice a day of > constraints on my mental or physical acuity just to escape a little fleeting [quoted text clipped - 3 lines] > I will sacrifice a little wooziness (it was nowhere near a day) to assure > I'm not one of those in the horrendous category. Well, Steve K, I think we all understand that Mike advises everyone, regardless of individual differences. Everyone is the same: subject to his horrors. Regards, Steve J > I will sacrifice a little wooziness (it was nowhere near a day) to assure > I'm not one of those in the horrendous category. Woozy isn't the issue; the lingering effect isn't obvious, which is why it's so insidious if one goes back to a mentally challenging task. And DUI arrests are never much fun. I.P. >> I will sacrifice a little wooziness (it was nowhere near a day) to assure >> I'm not one of those in the horrendous category. > > Woozy isn't the issue; the lingering effect isn't obvious, which is why > it's so insidious if one goes back to a mentally challenging task. And DUI > arrests are never much fun. I'm thinking no one, anywhere has ever had a DUI arrest under those circumstances. Sir, have you been drinking? No. I'm going to put you on a breathalyzer. Okay. 0.000 Sir, I'm going to take blood. Okay. 0.000 Officer, do I understand that he tested negative for alcohol? Yes, your honor...... >>> I will sacrifice a little wooziness (it was nowhere near a day) to assure >>> I'm not one of those in the horrendous category. [quoted text clipped - 4 lines] > I'm thinking no one, anywhere has ever had a DUI arrest under those > circumstances. The issue of the advisability of driving after taking Benadryl the night before was debated at length on another forum. It was settled when a DA posted that police are taught to look for any signs of impairment due to legal prescription or OTC drugs ... a bottle, a pill, pupils, a receipt, maybe a Walgreen's bag ... *anything* that may implicate their involvement and trigger closer examination. If a person had a serious accident that triggered any sort of investigation, his hospital visit that AM might well show up, in which case the doctor will truthfully say s/he warned the patient that he was by law chargeable with DUI if he drove that day after any form of systemic anesthesia, from Benadryl to morphine. You take your chances with public safety and your driving record, I'll take mine. I.P. >>>> I will sacrifice a little wooziness (it was nowhere near a day) to assure >>>> I'm not one of those in the horrendous category. [quoted text clipped - 21 lines] > >I.P. Honestly, I.P., have you EVER had a doctor warn you that you "would be chargeable with DUI if you drove that day........"? I've had to have someone wait for me and drive me home after colonoscopies; but, I've never had the warning you describe from any doctor. Personally, I'm more concerned about driving after having my eyes dialated and my vision is seriously impaired, but no one seems to be too concerned about that, either. Burney RP in 1995 (age 52) RT in 2000 ADT (Casodex) 10/06 - 8/07 Latest PSA - 0.18 > Honestly, I.P., have you EVER had a doctor warn you that you "would be > chargeable with DUI if you drove that day........"? With absolutely no doubt or exceptions, EVERY single doctor who has administered ANY systemic drug that may impair driving has not only merely advised me not to drive until the next day but emphasized it very strongly and repeatedly. Their paranoia is universal and almost comic. > Personally, I'm more concerned about driving after having my eyes > dialated and my vision is seriously impaired, but no one seems to be > too concerned about that, either. My eye docs always tell me to bring very dark shades, they always administer dilation antidotes after the exam, and some have offered dark shades. I.P. > The issue of the advisability of driving after taking Benadryl the night > before was debated at length on another forum. It was settled when a DA > posted that police are taught to look for any signs of impairment due to > legal prescription or OTC drugs ... a bottle, a pill, pupils, a receipt, > maybe a Walgreen's bag ... Benadryl? Yeah, I will agree with that. >>> I will sacrifice a little wooziness (it was nowhere near a day) to >>> assure I'm not one of those in the horrendous category. [quoted text clipped - 17 lines] > Officer, do I understand that he tested negative for alcohol? > Yes, your honor...... Glad you played that one out. I have never heard of anything so bloody ridiculous in my life as a DUI from anaesthesia or benadryl. I would love to see the Crown Attorney try and make that one stick. ROFL!!!! On May first (May Day to the Lefties) Heather replied to Steve K's post upthread: > Glad you played that one out. I have never heard of anything so bloody > ridiculous in my life as a DUI from anaesthesia or benadryl. I would > love to see the Crown Attorney try and make that one stick. ROFL!!!! Well, playing Devil's Advocate, (No! You, Steve J, Devil's Advocate? It is to laugh!) the "I" is "Influence." And that Influence might be from any drug that impairs one's ability to manage machinery such as an automobile. Leave aside the matter of impairment of so many who aren't under the influence of any drug, just stupid.... Anecdote: A few weeks ago, I underwent a biopsy (bx) of my third thoracic vertebra (T3) to check for mets. In preparation, I was sedated with Fentanyl and Versed, (this can be dangerous) and monitored by a dedicated individual via BP, O2 saturation, and cardiac rate and rhythm. Because I live alone, there was a huge debate over whether I should be *permitted* to go home alone (while the medic and I waited with whatever patience we could muster). I was making noises about signing out "against advice" which is an option. Ended with the Risk Management folks approving my discharge if and only if I was held for at least two hours post-procedure to recover. No one raised this issue until they had me disrobed & in a gown. AND: all this despite the fact that I was prepared to come & go via very expensive taxi (>$50 round trip). They claimed that I was at risk if there was no one at home to keep an eye on me.... It was enough to P O the Pope. Was I sufficiently alert to drive myself home (~12 miles)? I think that I was, but I was unwilling to expose the rest of the world to the possibility that I was not. Next time, if I'm unlucky enough to be in a similar situation, things might be different. But I cannot blame the hospital. If they had sent me out the door without covering their corporate backside and I had destroyed someone en route home, they could very well have been in legal trouble. Regards, Steve J > Was I sufficiently alert to drive myself home (~12 miles)? I think that I > was, but I was unwilling to expose the rest of the world to the > possibility that I was not. For clarification, I agree with that. Driving home from the hospital is bordering on the insane (and illegal). We were talking about, or at least I think we were talking about, after you get home, a few hours later, you feel good and ready to drive. The effects of the drug are gone from your system; as is likely the drug. >> Was I sufficiently alert to drive myself home (~12 miles)? I think that I >> was, but I was unwilling to expose the rest of the world to the [quoted text clipped - 5 lines] > good and ready to drive. The effects of the drug are gone from your system; > as is likely the drug. Steve, the links I posted refute that very strongly. I've cited a small smattering of my evidence. Yours? I.P. >>> Was I sufficiently alert to drive myself home (~12 miles)? I think that >>> I was, but I was unwilling to expose the rest of the world to the [quoted text clipped - 8 lines] > Steve, the links I posted refute that very strongly. I've cited a small > smattering of my evidence. Sorry, I didn't see a link. What did say? > Sorry, I didn't see a link. What did say? Heather wrote: > I have never heard of anything so bloody ridiculous in my life as a DUI from anaesthesia or benadryl. I would love to see the Crown Attorney try and make that one stick. ROFL!!!! The DA I mentioned expressly stated that Bendryl would definitely qualify a driver for a DUI. Here are just a small percentage of the drugs tested for in tox screens performed by law firms specializing in DUI/DWI cases. See http://www.dui-expert.com/drugs.php?nav=drugs Allegra® Fexofenadine Antihistamine, relief from allergies *Benedryl® Diphenhydramine Antihistamine* Benzedrine® Amphetamine Stimulant Claritin® Loratadine Antihistamine Codeine Codeine Narcotic analgesic Darvocet® Propoxyphene Mild narcotic analgesic Darvon® Propoxyphene Mild narcotic analgesic Demerol® Mepridine Synthetic narcotic analgesic Dimetane Brompheniramine Antihistamine Motrin® Ibuprofen Non-narcotic analgesic Paxil® Paroxetine Antidepressant Percocet® Oxycodone Semi-synthetic narcotic analgesic Percodan® Oxycodone Semi-synthetic narcotic analgesic Prozac® Fluoxetine Antidepressant Sudafed® Pseudoephedrine Nasal decongestant, bronchodilator Tagamet® Cimetidine Treatment for duodenal ulcers Tylenol®with Codeine Acetaminophen, Codeine Pain relief Wellbutrin® Bupropion Antidepressant Xanax® Alprazolam Antidepressant, panic/phobia disorders Zantac® Ranitidine Inhibits gastric acid secretion Zoloft® Sertraline Mental depression Or consider this from https://webapp.walgreens.com/cePharmacy/programsHTML/transportation-pharm.pdf The principal conclusions in the Weiler et al. (2000) report were that subjects were better able to match the speed of the car ahead, drove farther behind that car, and had better steering control after taking alcohol or fexofenadine than after taking diphenhydramine. Alcohol impaired the secondary tasks, especially response time to the blocking vehicle, but overall driving performance was poorest among the study participants who took the diphenhydramine. Self-reports of drowsiness were not a good predictor of impairment on the primary or secondary tasks in this study, suggesting that “drivers cannot use drowsiness to indicate when they should not drive.” Based on these results, the report authors issue a special caution regarding the use of “firstgeneration” (sedating) antihistamines, suggesting that they “… may have an even greater impact than does alcohol on the complex task of operating an automobile.” Or check out the Missouri Highway Patrol site at http://www.mshp.dps.missouri.gov/MSHPWeb/PatrolDivisions/CLD/Toxicology/toxicolo gy.html ; it expressly lists Benedryl (diphenhydramine). From http://www.cmecorner.com/macmcm/aapa/aapa2002_06.htm Sedating Properties of Antihistaminics and Their Legal Implications Weiler and colleagues compared the effects of fexofenadine, diphenhydramine, alcohol, and placebo in the highly controlled environment of the Iowa driving simulator (Weiler JM et al. Ann Int Med 2000;132:354). This double-blind, four-treatment, four-period crossover study involved 40 patients with active seasonal allergic rhinitis. Following a series of tests involving both objective (e.g., following distance, lane maintenance, reaction time, steering instability) and subjective performance outcomes, the investigators concluded that diphenhydramine has a sedating profile similar to that of a blood alcohol level of 0.9%. (Twenty-five states have a 0.08 blood-alcohol level standard for driver intoxication). The effects of fexofenadine approximated those of placebo. Based on evidence of this kind, 32 states plus the District of Columbia now restrict driving while impaired by medication. Penalties for violation include fines of up to $8,000, revocation or suspension of license to drive ranging from 1 month to 2 years, and imprisonment for 1 day to 2 years. Motor vehicle accidents comprise the fifth leading cause of death in the United States. The use of sedating antihistamines increases the risk of accident by a factor of six, contrasted with the four-fold risk increase associated with driving while talking on a phone. From 1% to 3% of highway accidents per year in the United States are attributed to driver sleepiness alone, resulting in 600 to 1,200 out of a total of 41,500 fatalities. And on and on and on and on and on from Google. You guys may some day realize that I usually do my homework before shooting my mouth off. Now let's modify that encounter with Offisa Pupp: "What's that bottle in your shirt pocket, sir?" "Just Benedryl, Officer. I have nasty hay fever." "Would you step out real quick and put your hands behind your back for me?" I.P. >> Sorry, I didn't see a link. What did say? > http://www.dui-expert.com/drugs.php?nav=drugs Oh, the Benedryle tabs. Yeah, I've already agreed with that. >>> Sorry, I didn't see a link. What did say? > >> http://www.dui-expert.com/drugs.php?nav=drugs > > Oh, the Benedryle tabs. Yeah, I've already agreed with that. Yes, plus scores of other common drugs. I.P. > I have never heard of anything so bloody > ridiculous in my life as a DUI from anaesthesia or benadryl. I would > love to see the Crown Attorney try and make that one stick. ROFL!!!! The DA I mentioned expressly stated that Bendryl would definitely qualify a driver for a DUI. Here are just a small percentage of the drugs tested for in tox screens performed by law firms specializing in DUI/DWI cases. See http://www.dui-expert.com/drugs.php?nav=drugs Allegra® Fexofenadine Antihistamine, relief from allergies *Benedryl® Diphenhydramine Antihistamine* Benzedrine® Amphetamine Stimulant Claritin® Loratadine Antihistamine Codeine Codeine Narcotic analgesic Darvocet® Propoxyphene Mild narcotic analgesic Darvon® Propoxyphene Mild narcotic analgesic Demerol® Mepridine Synthetic narcotic analgesic Dimetane Brompheniramine Antihistamine Motrin® Ibuprofen Non-narcotic analgesic Paxil® Paroxetine Antidepressant Percocet® Oxycodone Semi-synthetic narcotic analgesic Percodan® Oxycodone Semi-synthetic narcotic analgesic Prozac® Fluoxetine Antidepressant Sudafed® Pseudoephedrine Nasal decongestant, bronchodilator Tagamet® Cimetidine Treatment for duodenal ulcers Tylenol®with Codeine Acetaminophen, Codeine Pain relief Wellbutrin® Bupropion Antidepressant Xanax® Alprazolam Antidepressant, panic/phobia disorders Zantac® Ranitidine Inhibits gastric acid secretion Zoloft® Sertraline Mental depression Or consider this from https://webapp.walgreens.com/cePharmacy/programsHTML/transportation-pharm.pdf The principal conclusions in the Weiler et al. (2000) report were that subjects were better able to match the speed of the car ahead, drove farther behind that car, and had better steering control after taking alcohol or fexofenadine than after taking diphenhydramine. Alcohol impaired the secondary tasks, especially response time to the blocking vehicle, but overall driving performance was poorest among the study participants who took the diphenhydramine. Self-reports of drowsiness were not a good predictor of impairment on the primary or secondary tasks in this study, suggesting that “drivers cannot use drowsiness to indicate when they should not drive.” Based on these results, the report authors issue a special caution regarding the use of “firstgeneration” (sedating) antihistamines, suggesting that they “… may have an even greater impact than does alcohol on the complex task of operating an automobile.” Or check out the Missouri Highway Patrol site at http://www.mshp.dps.missouri.gov/MSHPWeb/PatrolDivisions/CLD/Toxicology/toxicolo gy.html ; it expressly lists Benedryl (diphenhydramine). From http://www.cmecorner.com/macmcm/aapa/aapa2002_06.htm Sedating Properties of Antihistaminics and Their Legal Implications Weiler and colleagues compared the effects of fexofenadine, diphenhydramine, alcohol, and placebo in the highly controlled environment of the Iowa driving simulator (Weiler JM et al. Ann Int Med 2000;132:354). This double-blind, four-treatment, four-period crossover study involved 40 patients with active seasonal allergic rhinitis. Following a series of tests involving both objective (e.g., following distance, lane maintenance, reaction time, steering instability) and subjective performance outcomes, the investigators concluded that diphenhydramine has a sedating profile similar to that of a blood alcohol level of 0.9%. (Twenty-five states have a 0.08 blood-alcohol level standard for driver intoxication). The effects of fexofenadine approximated those of placebo. Based on evidence of this kind, 32 states plus the District of Columbia now restrict driving while impaired by medication. Penalties for violation include fines of up to $8,000, revocation or suspension of license to drive ranging from 1 month to 2 years, and imprisonment for 1 day to 2 years. Motor vehicle accidents comprise the fifth leading cause of death in the United States. The use of sedating antihistamines increases the risk of accident by a factor of six, contrasted with the four-fold risk increase associated with driving while talking on a phone. From 1% to 3% of highway accidents per year in the United States are attributed to driver sleepiness alone, resulting in 600 to 1,200 out of a total of 41,500 fatalities. And on and on and on and on and on from Google. You guys may some day realize that I usually do my homework before shooting my mouth off. Now let's modify that encounter with Offisa Pupp: "What's that bottle in your shirt pocket, sir?" "Just Benedryl, Officer. I have nasty hay fever." "Would you step out real quick and put your hands behind your back for me?" I.P. >> Sir, have you been drinking? >> No. [quoted text clipped - 11 lines] > ridiculous in my life as a DUI from anaesthesia or benadryl. I would > love to see the Crown Attorney try and make that one stick. ROFL!!!! Heather (LOL), who used to serve coffee (ROFL) in a law office 80 years ago (LOL) and now claims (ROFL) to understand law (grin) has never heard anything so bloody ridiculous (ROFL) as DUI from aneasthesia. Maybe Heather LOL) should take a look at the statute before venting her stupidity: Criminal Code PART VIII: OFFENCES AGAINST THE PERSON AND REPUTATION Motor Vehicles, Vessels and Aircraft Operation while impaired 253. Every one commits an offence who operates a motor vehicle or vessel or operates or assists in the operation of an aircraft or of railway equipment or has the care or control of a motor vehicle, vessel, aircraft or railway equipment, whether it is in motion or not, (a) while the person’s ability to operate the vehicle, vessel, aircraft or railway equipment is impaired by alcohol or a drug; or (b) having consumed alcohol in such a quantity that the concentration in the person’s blood exceeds eighty milligrams of alcohol in one hundred millilitres of blood. >> There is absolutely no reason to have pain. Tell him to give you the happy >> juice. You may have pain, but you'll never remember it. [quoted text clipped - 4 lines] > >I.P. I.P., after having the biopsy done, and peeing blood, how much driving would you want to do, and to where? Get someone to drive you home and take it easy! And, on the topic of a colonoscopy without anesthesia, if you prefer to tough that out, you're welcome to it. A sigmoidoscopy is one thing, but a colonoscopy without anesthesia???? BS! Burney RP in 1995 (age 52) RT in 2000 ADT (Casodex) 10/06 - 8/07 Latest PSA - 0.18 > I.P., after having the biopsy done Less bothersome than most tooth cleanings. > and peeing blood It's just another liquid until ya looks. > how much driving would you want to do, and to where? 70 miles each day to go windsurfing. > Get someone to drive you home The bx pt ahead of me rode his bike to and from his bx. > and take it easy! I get bored real fast taking it easy. > And, on the topic of a colonoscopy without anesthesia, if you prefer > to tough that out, you're welcome to it. ... a colonoscopy without > anesthesia???? BS! I've done three now sans anything more than anal lubricant. If they're done right, all we get is an occasional momentary gas pain ... no more than the average burrito might give. The live TV show is interesting, I gain a lucid day I'd lose otherwise, and I can drive anywhere and do anything I like afterwards. My proctologists say a fair number of pts go it cold turkey, with the IV and anesthesiologist in place in case they're needed. I.P. I.P., you're a legend in the making... BH >> I.P., after having the biopsy done > [quoted text clipped - 29 lines] > >I.P. RP in 1995 (age 52) RT in 2000 ADT (Casodex) 10/06 - 8/07 Latest PSA - 0.18 >I've done three now sans anything more than anal lubricant. If they're >done right, all we get is an occasional momentary gas pain .. ...let's be cautious about using the 'we'.... On April 29, Alan Meyer wrote, in pertinent part: (snip) Quoting El Jefe de California: >> He lied to you. Labs do make mistakes. >> [quoted text clipped - 7 lines] > mistake are, say, one in a thousand, do we really want to call > him a liar? Only if he knew the truth and elected not to tell it. BUT: to make the unequivocal statement that labs *never make mistakes* is simply false, whatever the medic believed. So the medic may have believed that he was telling the truth, notwithstanding the facts. think about what this suggests about his knowledge of medical science. > Also, sometimes a doctor (or anyone else) will exaggerate a > statement in order to make a point. Sometimes people do that for > the good of the person they are talking to. I am sorry to say that such a thing is reprehensible. I say give the patient the facts, explain them, await his decision. To mislead him "for his own good" is elitist. > For example, when a > doctor says to a patient - "You're going to have a heart attack > if you don't stop smoking and eating like a pig" - is he lying? Not necessarily, if and only if that is a fact. And I am an example of the fact that he is not factual. > Strictly speaking, he should have said, your risk of a heart > attack is increased by N percent. But he might be trying to > motivate this obese smoker by exaggerating the point. Scaring > the patient might be crucial to saving his life. Given the facts, it is in the patient's *sole discretion* how to respond to those facts. Regards, Steve J "...the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others, to do so would be wise, or even right...The only part of the conduct of anyone, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign." -John Stuart Mill > So I don't want to be too quick to judge. > [quoted text clipped - 4 lines] > > Alan >> He lied to you. Labs do make mistakes. > [quoted text clipped - 3 lines] > report. He may believe that the odds are so small that they > shouldn't be considered. I highly doubt that his doctor, any doctor, is batting 1.000 with labs. And while it is a strong perjorative, if it's not the truth (or an honest perception), then it's a lie. I thought the same of my doc when I found out that his 1 in 3 chances almost always translated to 2 in 3 chances and sometimes worse. It might be a "white" lie, or one with good intentions, but labs make mistakes. You and I have seen it with only 800 or so patients coming across our NG path. If us, then surely his doctor. Never the less, I agree with his doctor's prognosis and advice. >> Find a doctor for a second opinion. Your insurance should cover >> that ... > > Excellent advice. Let me second that emotion. 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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08 Non Illegitimi Carborundum Steve wrote: > Sir, have you been drinking? > No. [quoted text clipped - 4 lines] > Okay. > 0.000 > Officer, do I understand that he tested negative for alcohol? > Yes, your honor...... ......but his blood test revealed abcxyz drug in his system. Doesn't DUI include both alcohol and drugs in every state? ___ Blue Wave/QWK v2.12 Steve J. wrote: > Anecdote: A few weeks ago, I underwent a biopsy (bx) of my > third thoracic vertebra (T3) to check for mets. In preparation, > I was sedated with Fentanyl and Versed, > Was I sufficiently alert to drive myself home (~12 miles)? I > think that I was, but I was unwilling to expose the rest of > the world to the possibility that I was not. > Next time, if I'm unlucky enough to be in a similar situation, > things might be different. Steve, I cannot remember is you're disabled/handicapped. If so, ParaTransit should be available to you for a lot less than the cab fare you mentioned. ParaTransit (or whatever your local government wants to call it) is a requirement of ADA. ___ Blue Wave/QWK v2.12 Burney wrote: > Honestly, I.P., have you EVER had a doctor warn you that you > "would be chargeable with DUI if you drove that day........"? > I've had to have someone wait for me and drive me home after > colonoscopies; but, I've never had the warning you describe > from any doctor. Doctors around here warn us to have someone drive a patient to a (medical/dental) treatment and wait to return you home. If there are written instruction (food/liquids/medicines), the warning will also be included there. And I'm sure if a patient asked, "WHY?", the doctor would then state "you would be chargeable with DUI/DWI if you drove and were stopped by the police." ___ Blue Wave/QWK v2.12 I.P. replied to a question: > With absolutely no doubt or exceptions, EVERY single doctor who > has administered ANY systemic drug that may impair driving has > not only merely advised me not to drive until the next day but > emphasized it very strongly and repeatedly. Their paranoia is > universal and almost comic. Their paranoia is understandable if he or a colleague has ever faced criminal and/or civil charges after a patient passed out while driving home from a dental appointment, jumped a curb, and killed two little old ladies sitting on a bus bench. ___ Blue Wave/QWK v2.12 |
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