What the doctor forgot to tell you and you forgot to ask

 The new medical paradigm seems to be that the patient works together with his physician to develop the therapy once the disease is diagnosed.  This approach seems to assume the patient is as informed as his doctor, and which underlines the need for the internet search and the support group visit.  It also reduces the amount of time the doctor must spend with the patient planning the treatment, since the patient is assumed to be well informed.  And if you are not, it is your responsibility anyway.

Some examples spring to mind.  Many of us expect to be incontinent after therapy for prostate cancer.  But in a great many cases, neither the nurse or the doctor explains the exercises required to reestablish continence.  Also after a period of healing, it can be important to use the vacuum device regularly to reestablish the erection where possible and to achieve better blood flow to the penis.  You probably won't be told this.  In the event the shots or Viagra fail to establish erectile function, you may want an implant.  In the event of failure to achieve continence you also may want ureter valve prosthesis.  In the rare event you learn about these options, you may have trouble finding a surgeon.  Again there are our members who can help.

If your prostate cancer is not cured by radiation or surgery or it is too far advanced for these therapies, you may be put on androgen deprivation therapy (AKA hormonal therapy and is chemical castration).  You probably will not be told that physical castration is hundreds to thousands of times cheaper and just as effective as Lupron injections or Casodex pills.  You will be told to expect hot flashes.  You may be told to expect muscle loss, osteoporosis, and breast growth.  You may even be told to do load bearing exercises to reduce bone loss.  You will not in almost all cases, or even all cases, be advised of the psychological consequences of castration or chemical castration.  While castration has the advantage of slowing beard growth, say sayonara to sexual desire.  Also the reversion to 98 pound weakling status, we were familiar with when we were preteens, is threatening to our self image of manhood.  That is we become a boy again, albeit an experienced boy.  These factors can have as great an effect as a the death of loved one although the circumstances are quite different.  Your doctor probably can't help you here, since he has no direct experience with these kinds of problems and also is not trained in these areas.  Again here is where your support group can come into play, but with the caveat that only a licensed psychologist or other mental health professional will be able to help beyond our initial "hand holding" kind of support.

Please plan to investigate the unexpected consequences of your therapy, so you can plan in advance to deal with them.  When you don't here is what I told one lady complaining bitterly about the outcomes of her therapy.   We were at an MD Anderson Network meeting and she had to place a finger over her throat and use a buzzer to speak.  After listening at some length to her regrets expressed to the MDA psychologist after our meeting, I told her she must accept the consequences of her decision and get on with her life.  She was still a beautiful woman with a great personality and now needed to move on.

Remember our meetings are always on the third Tuesdays of every other month at 7:00 pm at the Senior Health Center on Calais Drive off Gallagher road in Sherman Texas, behind the TCOG Tower. 
See you at the October meeting.  Jerry Bylander