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John McHugh M.D.:

One in six men diagnosed each year…

Originally posted on Prostate diaries:

See my list of famous men with prostate cancer on Amazon.com.

Famous Men with Prostate Cancer
The list of men who have had prostate cancer is a long one. This list is not exhaustive, but we are adding to it all the time.

Marion Barry: He was successfully treated in 1995.

Harry Belafonte: He was diagnosed with early-stage prostate cancer in 1996 and successfully treated. He is now a prostate cancer advocate, raising awareness of the disease in men.

Bill Bixby: Diagnosed in 1991. He succumbed to the disease on November 21, 1993.

James Brown: The Godfather of Soul was diagnosed with prostate cancer in 2004 but survived. He died of heart failure in 2006.

Robert DeNiro: The Academy Award winner was diagnosed with early-stage cancer in 2003 at the age of 60. He has kept details of his treatment private. His father died of…

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I pictured you walking backwards and that you were coming back home...I pictured you walking away from me and hoping you were not leaving me alone...

I pictured you walking backwards and that you were coming back home…I pictured you walking away from me and hoping you were not leaving me alone…

Chapter Two-A dog shows up at the lake
John and Karen had two other dogs, Oscar and Tootsie, both of whom they loved dearly, but there was an emptiness around their home without Meg. The couple felt her memory and presence everywhere in and about the house. The couch, the trampoline, the backyard, the bedroom, the children’s rooms, the porch, and years and years of pictures with members of the family framed throughout the house, served as a constant reminder of Meg. The two remaining dogs were dachshunds; Oscar was the grouchy father, and Tootsie, a high maintenance daughter. The female dachshund next door had been Oscar’s wife and Tootsie’s mother. It had been an “arranged” marriage.

“I miss having a big dog around here John,” Karen said.

“I miss having a dog that likes being in water,” John replied. He thought, “Dachshunds are like cats, they do not like water and don’t swim.”

John and Karen had a small piece of property on the lake near their home. They rarely spent the night at the small cabin on the site, but very much enjoyed going there for “day trips” and always got home before the time the street lights came on.

John and Meg could easily consume a Saturday at the lake with cutting grass, fishing, and working in their small garden there. They often visited the big box stores for stuff needed for whatever they would be doing that day. Meg loved riding in John’s truck, ambling around the property, and dipping into the lake for a swim from time to time as John worked.

“John, what on earth do you and Meg do all day out there?” Karen often asked.

John and Meg looked at Karen in unison and agreed that Karen just did not “get it.”
“Well Karen, Meg and me don’t have nothing to do out there, we got all day to do it, and we may not get but half of it done,” John answered. He wasn’t sharing any of their secrets.

With Meg gone there was a void on Saturdays, not only at home for the couple, but also for John at the lake. John attempted to make the dachshunds his “lake dogs,” but they did not like water and just made a mess out of his Saturdays. Oscar hated it at the lake preferring the warm and known confines of their home and being a lovable grouch on his turf. Tootsie loved riding in the truck to the lake and she loved to cuddle in the warmth of John’s jacket during the ride however, Tootsie was always doing something meddlesome. She explored to the extent that John spent the majority of his time looking for her or keeping Tootsie out of trouble.
On one occasion John lost Tootsie for about two hours though it seemed like an eternity. During the time she was missing, he frantically searched the shore of the lake, the cabin, and the surrounding area. He envisioned Karen chastising him for not “taking better care of Tootsie.” All of his worst fears as to her safety ran through his mind only to find her on top of the boat dock. Tootsie had no problem climbing the steps to the top of the deck, but once there, she would not come back down. He found her accidentally because he saw the silhouette of her small head on the horizon of the dock flooring. His fear of finding the more worrisome silhouette of her body floating in water hence relinquished, John commenced to chastise her under his breath. (Tootsie’s head is small for her body. John’s head is small and Karen often made fun of him for it. John’s mother said her first memory of John as a baby was that he could, “cover his whole face with his hand.” On his high school football team in LaGrange, Georgia, he wore the smallest helmet. It was a size 6 and 7/8, and was specially ordered for him. Karen told John, when she perceived he was gaining weight, “John, you need to be careful about gaining too much weight or you’ll start looking like Tootsie. Your head won’t match your body.”)
On another fateful day at the lake, Tootsie chased a mouse or some other rodent under the cabin, which had only a six-inch crawl space, and it took several hours to determine where she was. Once found, she would not come out and there was no obvious way to get to her or to get her out. Complicating the situation and intensifying the anxiety for John, it was not clear if Tootsie was trapped or just would not come out. Exasperated and about to give up, John found a neighbor with a skill saw to cut a hole in the cabin’s kitchen floor to “rescue” her. The sawed out square of flooring replaced the hole in a patch-like fashion serving as a constant reminder of that day’s three-hour ordeal to free Tootsie from the confines of the cabin crawlspace.
“Karen, I am not taking Tootsie out to the lake anymore. She is a good truck dog and likes to ride, but she is way too much trouble for me out there. I can’t get anything done with her. She gets into stuff. “Dachshunds have a Napoleon complex and that’s her problem,” John thought. He, however, did take her again. It would be a mistake to do so, and it would be the last trip to the lake for Tootsie.
The “last” time Tootsie went to the lake with John, she played the “Napoleon role” that only a foot-long dachshund can do with the great dane puppy which lived next door. She barked and taunted the dog until it grabbed her like a pillow, shook her, and then threw her about thirty feet. All of this transpired in a matter of seconds right in front of John to his amazement and chagrin while he was raking leaves and listening to a Georgia football game. Tootsie’s run in with the great dane resulted in a trip to the vet, a V-neck T-shirt soaked with Tootsie’s blood, ten holes in Tootsie’s abdomen (but no damage to her intestine), two hours of surgery in which John assisted the vet, fifty stitches, and another ruined Saturday at the lake. No Tootsie was not to be another Meg and she would not be going to the lake anymore, period. To make matters worse, on the day Tootsie came home from the hospital, John was holding her in his arms, and was about to give her cheek a kiss when she snapped up and bit him on the tip of his nose. He dropped her to the floor out of shock and a bit of anger, only to find her running to Karen. Karen now became the “good-guy” and Tootsie’s savior in this unprovoked attack, which further aggravated John. Karen then laughed uncontrollably at the situation and particularly at John clutching his nose. John’s nose was now bleeding profusely and when he checked it out in the mirror there was an inch long scratch which was deep and devoid of skin. The area subsequently scabbed over and for two weeks was a painful and visual reminder of the little ungrateful troublemaker that was Tootsie.
“Dr. McHugh, what happened to your nose?” John was asked a thousand times over the ensuing weeks.
“My dog bit me,” he answered. Having to respond to that question in light of the history of the event was “salt on the wound” to John. He did, however, forgive Tootsie.

Several months later after blowing leaves at the lake, John alone and without a lake dog, was resting on an old spring swing left at the lake by the original owner of the property Jessie Jewell. He saw a small puppy walking up the gravel driveway. The lake property is at the end of a road that has a cul de sac. His first thought was that someone had dropped off the dog and left it. As the puppy approached her gait and color made John think that the visitor was a golden retriever puppy and probably one of a neighbor’s dogs. She walked nonchalantly to where he was sitting and sat down right next to him. It was as if she was already his dog and that what she was doing now was what she was accustomed to doing naturally and often.

“Well, what’s your name, cutie pie?” John asked somewhat taken aback by the level of the “make yourself right at home” nature of this stranger.

The dog’s tail began wagging as it looked up at John contentedly. John confirmed that the dog was a female, and as best he could tell, she was a thoroughbred. He figured that someone was probably missing her pretty bad about now. She had no collar. It was unknown to John at the time that this was a foreboding sign. He picked her up, held her in his lap with her belly up, legs open and apart, and began to rub her. To John, a dog that will let you rub its belly is an “at peace” dog and a prerequisite characteristic of one you’d want to have. Oscar would not let you do that, but Tootsie would. This dog was as laid back as you please to be on her back and be rubbed, particularly behind her ears.

“I think I’ll keep you my little friend. Do you like the water?”

When John and the new dog arrived home that evening, he said as he entered the house, “Karen, guess what showed up at the lake today?”

Karen immediately said, “She’s pretty. Look at her tongue; it’s got a black spot on it. That means she has chow in her.”

“You don’t know that Karen. A black spot on the tongue? Are you kidding?”

“It means she has Chow in her. I bet she is a Golden-Chow.”
Karen was right about the puppy having Chow in her as evidenced by the way her bushy tail always was curled up over her back. None of the neighbors near the lake cabin reported losing a dog and so the family adopted the golden retriever looking puppy with the bushy tail and black spotted tongue as their own.

Bess, their middle child who was in sixth grade at the time, named the new pet Chloe. The new dog was the same color as Meg and since Meg was named after the spice, nutmeg, Bess wanted to name her after another brownish colored spice. She thought chloe was a spice as well. That chloe was not a spice was something that John and Karen did not note, but would not have corrected it even if they had noticed the error. John, a poor speller, the next day went to PetSmart to make a tag for her collar, but spelled her name “Clohe” much to the sarcastic delight of his family who never let him forget that he spelled her name incorrectly. Named for a spice that wasn’t, and having to wear a tag with the wrong name on it may have very well been a glimpse into Chloe’s unpredictable future.
The couple and their family fell instantly in love with the gentle intruder. As John’s mother would say, “One man’s loss is another one’s gain.”
The “gift” and the coming saga that was Chloe then commenced; the extent and complexity of which was unknown to John or Karen at the time. Chloe on the other hand, knew exactly what was to come and the role she’d play in the lives of John, Karen, their family, and more importantly, other lives.

John McHugh M.D.:

The PSA is very dependable after treatment for prostate cancer but not as much so before the diagnosis.

Originally posted on Prostate diaries:

the concerns of the heart are easily seen in the countenance of the face

  • A lot of what folks do depends on “who they are.”  The anxious patient may want to pursue a biopsy the first time it is elevated. The idea of waiting a couple a weeks and maybe a course of “empiric” antibiotics is something they don’t want to do. Another “calmer” type patient might wait months or as I have seen,”I’ll just repeat it at my yearly Doc.”
  • It is always reasonable to repeat any lab value that is elevated. With the PSA, a two-week interval with or without antibiotics is something I commonly recommend.
  • If there is a history of prostate cancer in the family that would make one more inclined to do a biopsy.
  • The rectal exam trumps the PSA…so i the PSA is high and you are questioning the results and you want to repeat it…to most urologists, if the PSA is normal and the rectal exam…

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John McHugh M.D.:

Oh so many caveats !

Originally posted on Prostate diaries:

losers quit when they are tired...winners quit when they win.

Common searches about sex that end up on my site and some other various tidbits for you…

  • Having sex the night before having a PSA drawn can elevate the value.
  • Having sex before the Prostatic Acid Phosphatase will probably elevate the value.
  • A rectal exam before having the PSA drawn will not elevate the value.
  • A rectal exam before a PAP will elevate the value.
  • You don’t get cancer if you have sex with a man with prostate cancer. (Good try ladies.)
  • Your libido doesn’t change (physiologically wise) after the prostate is removed.
  • Climax after radiation or radical prostatectomy still occurs but the character of which may change…for the better or worse.
  • In both radiation or prostatectomy the male’s climax… will be dry or no fluid.
  • You can have sex before a prostate biopsy.
  • You can have sex after a prostate biopsy…expect blood in the semen. It looks dramatic but is…

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John McHugh M.D.:

The key to curing any type of cancer is to treat it BEFORE it spreads!

Originally posted on Prostate diaries:

a candle loses nothing by lighting another candle

As a surgeon I have to often times dissuade patients from choosing surgery. You think I’m kidding don’t you? Surgeons do it all the time. Radiation therapists also tell some patients that radiation may not be the best option for them. That I know is even harder to believe….just kidding. (It’s a surgeon-radiation therapist thing.)

Many patients and their family think that if you take the prostate out you are cured. When I speak of needing to follow the PSA every three months after a radical prostatectomy, I am often asked why that is necessary. PSA is variable in the diagnosis of prostate cancer, but very reliable in terms of determining if the cancer has returned after treatment.

A PSA should go to negligible, usually something like .02 and stay there. If a PSA rises then that might indicate recurrence.

How does this happen?

  • For surgery it happens because there…

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John McHugh M.D.:

Two questions and an art project!

Originally posted on Prostate diaries:

This is a shadow box I made for a charity auction a couple of years ago. A clock made with Viagra stuff that drug reps had given me over the years. The guy that bought it, brought by for me to autograph it.  I called it …”Hard Times.” The plaque near the hammer says, “In hard times…break glass.” Ps…should have never sold it …it was too clever and valuable to sell.

  • Does a prostatectomy change a man’s libido? No. Libido is in a male is a function of the hormone testosterone and that is produced by the testicles and hence not affected.
  • My free PSA is low. Should I have a biopsy? Well, do put some credence to what your doctor recommended. Remember him or her? The lower the free PSA the higher the likelihood of a positive biopsy. When you get  the report back there will be a percentage…

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John McHugh M.D.:

Think of the bladder as a very large and powerful muscle!

Originally posted on Prostate diaries:

it there are many treatments for a disease, then there is no one good one

When the prostate is removed the surgeon has to put the bladder back together with the urethra. A catheter is placed to “stent” this area of the anastomosis. The reason a catheter is used and left in from 6-14 days is to allow time for this area to heal. In doing so keeping urine from leaking out into the area where the prostate was removed.

So…you have the bladder sewed to the urethra and going through this is a catheter. The catheter, a foley catheter, has a balloon on it that keeps it from falling out. The balloon is just inside the bladder on the proximal side of the anastomosis.

There is a space around the catheter that allows both blood and urine to leak around the catheter, through the anastomosis, and then out the tip of the penis, not through the catheter, but around it.

In the case…

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