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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 8 to 32 of 32. Go back in thread:
Posted by corkskru on March 3, 2014, at 22:59:10
In reply to Re: New Recomendations for over 65, testing, Mammo, Me, posted by baseball55 on March 3, 2014, at 19:22:27
I think there should be a case by case determination of the extent and degree of applying these guidelines (the cases above are fairly easy to determine it more harm than good) but does that not allow someone to play as a Higher Power in who may live or not?
What I see is an erosion of benefits for retired people, less gray areas and flexibility and more power given to others at the disadvantage of the patient. I see this as another movement to take away flexibility of the patient/person that no longer contributes to the "system" but I might just be cynical..
Posted by Willful on March 4, 2014, at 1:23:37
In reply to New Recomendations for over 65, testing, Mammo, Me, posted by Phillipa on March 3, 2014, at 11:50:01
You've unfortunately misinterpreted these recommendations.
They are saying, don't do things that are useless and/or make people worse -- mammograms now are not thought to entend survival, because all the recent large scale studies have shown that those who received yearly mammograms do not survive longer than those who do not-- and they often suffer from false positive that lead to frightening, and painful further testing and sometimes treatment of things that turn out not to be cancer, or , like carcinoma in situ, are thought now not to become cancerous.
Don't give people with anorexia high calorie meals because they are determined not to gain weight and will defeat that type of treatment. There may be other types of treatment that will help, which are not discussed.
Physical restraint are barbaric and unnecessary in most cases.
Don't give meds without assessing cognitive or other side effects so as to prevent people taking meds that are disabling them cognitively.
Anti=psychotics often don't help in people with certain types of dementia and are used solely to sedate people-- not to give them treatment. This helps the staff, but deprives the older person of whatever cognitive ability they have left.
For the same reason, don't use xanax or other sedating meds, simply to control people.
As far as I can tell, every one of these recommendations is done to protect from over=medication, danger of false positives without any evidence of increasing survival, and from useless treatments, and to give vulnerable patients greater self control, safety, and comfort, rather than forcing useless and often draconian treatments on them.
It nowhere says that if you want nutrition, you will deprived of it. It says if nutrition is rejected, or not wanted or not helpful, do not force it on people, Instead, use treatments that provide greater quality of life and are more effective in helping them.
Posted by ed_uk2010 on March 4, 2014, at 13:47:21
In reply to Re: New Recomendations for over 65, testing, Mammo, Me, posted by Phillipa on March 3, 2014, at 20:30:14
>Or be given calorie protein fluids if I have a problem that keeps me from eating?
The guidelines you posted were about tube feeding pts with advanced dementia. I think you missed the point PJ :)
Posted by Dr. Bob on March 5, 2014, at 1:57:40
In reply to Re: New Recomendations for over 65, testing, Mammo, Me, posted by baseball55 on March 3, 2014, at 19:22:27
> > Now no prostrate exams, Mammograms, all the things that were must haves before. And don't feed by tube or supplemental feedings those anorexia.
> >
> Why is it sad and disheartening? Why do you always read these kind of things as saying - just die.Maybe she read don't do test and don't feed as don't care?
Bob
Posted by ed_uk2010 on March 5, 2014, at 13:00:27
In reply to Re: sad and disheartening, posted by Dr. Bob on March 5, 2014, at 1:57:40
>Maybe she read don't do test and don't feed as don't care?
I think so too, but that's not what the guidelines suggest at all.
(((Phillipa)))
Posted by Twinleaf on March 5, 2014, at 13:10:57
In reply to Re: sad and disheartening, posted by Dr. Bob on March 5, 2014, at 1:57:40
Phillipa clearly did read/feel it as uncaring, but I think Willful's explanation was so clear and helpful for each of the topics, pointing out that good judgement should be involved in each decision to ensure that the possibility for improving quality of life is greater than the possibility of harming or shortening it.
It is in accordance with the Hippocratic Oath - "first, do no harm..." which guides all physicians.
Posted by Phillipa on March 5, 2014, at 20:02:44
In reply to Re: sad and disheartening, posted by Twinleaf on March 5, 2014, at 13:10:57
Times have changed. Do no harm can mean do nothing as to do nothing means not doing a thing. So subject to interpretation. The government medical system is flawed and broken right now and monies must be save. Personally I will pay out of pocket. That is my right. Phillipa
Posted by Twinleaf on March 5, 2014, at 20:48:59
In reply to Re: sad and disheartening » Twinleaf, posted by Phillipa on March 5, 2014, at 20:02:44
No, Phillipa - " do no harm" does not mean to do nothing. In the Hippocratic Oath, it is associated with a promise by the physician to promote and prolong life. This has been so for nearly 2500 years,; current social stresses and trends will not change that.
Several readers, including Dr.Bob, have suggested that you had a negative emotional reaction to the guidelines, feeling that they implied rejection or lack of caring, whereas to others they are just medically reasonable, and designed to promote the best possible care for older patients. As a medical professional yourself, I would hope that you could readily understand this.
We do have serious present stresses on our system of medical care, but this is not one of them.
Posted by Ronnjee on March 6, 2014, at 14:03:13
In reply to Re: sad and disheartening » Phillipa, posted by Twinleaf on March 5, 2014, at 20:48:59
Whenever "modern" medicine realigns itself with reality, I think it's a good thing. Everybody dies, and there's a lot of denial about that simple immutable fact. Science has limitations, physicians have limitations, and many frightened people cannot accept that.
Posted by Phillipa on March 6, 2014, at 17:48:59
In reply to Re: sad and disheartening, posted by Dr. Bob on March 5, 2014, at 1:57:40
Dr Bob more like reading it as if one is now being treated, as example for cancer aggressively as some I know are they will continue to be treated. But now that the system is changed that watch out as it's the beginning of no testing for younger also. Take some other countries where even those at age 40 only are allowed mammograms every three years the trend is leading this way. Do to high costs. Phillipa
Posted by Willful on March 6, 2014, at 22:15:53
In reply to Re: sad and disheartening » Dr. Bob, posted by Phillipa on March 6, 2014, at 17:48:59
but the fact that you seem to not want to hear is that mammograms were recommended once a year because it was originally hoped that that would save lives.
However as science advances, new realizations are arrived at. One is that frequent such as yearly mammograms do not save lives. This has become clearer from some recent large scale studies done. The main effect of yearly exams is to produce more false positive results which lead to people being given more invasive tests, and sometimes unnecessary surgery.--
I know you're capable of understanding this concept phillipa, so I wonder why you don't seem to acknowledge it. Did you even read my the post in which I tried to explain the rationales for the new guidelines that you cited?
Sometimes more treatment and testing is worse treatment and testing--as in the case for mammograms, and many others. The problem of false positive results (results tht suggest, incorrectly that a problem exists) was not recognized at first-- but not doctors see how harmful this can be.
Sedating elderly people is not by any means a good thing-- nor is providing food for those who won't eat, or who won't gain weight even if they do eat it, as with those in some stages of wasting.
Can't you understand that these recommendations actually protect patients from bad treatments or testing?
Why does it have to suggest that those for whom treatment is appropriate will not be treated? Just because it saves money, does not make it a bad thing. Sometimes NOT testing saves money-- but it also protects patients.
Posted by Phillipa on March 7, 2014, at 21:02:14
In reply to Re: sad and disheartening » Phillipa, posted by Willful on March 6, 2014, at 22:15:53
About 8 years ago I had a biopsy from a mammogram. A marker chip was inserted. So now when yearly mammogram is done the docs can see if the calcification has gotten larger or stayed the same. So I'm considered high risk. And because of this I also am given an instant reading on my yearly mammogram. The tech marches the film to the radiologist who gives preliminary reading and then about a week later I receive a letter confirming results. So in my case it's been good. My brother in law as a few days ago after prostrate exam found to have prostrate cancer. This motivated my husband to get him physical done. Digital exam okay, next week the blood work, and then he is being set up for his colonoscopy first he ever had. Prostrate cancer runs in the males in his family. His Father also had it and his father as well. His Mother had colon cancer. Without testing an early diagnosis would not be possible. Right now trying to set up the Di Vinci robotic surgery for his Brother rather than old school surgery. Less risky, less complications, less hospital & recovery time, and less risk of cutting the nerve which controls ED. So what's the problem? Phillipa
Posted by Twinleaf on March 7, 2014, at 21:54:01
In reply to Re: sad and disheartening » Willful, posted by Phillipa on March 7, 2014, at 21:02:14
There's no problem, Phillipa. These are all the right choices for you and your family. The guidelines would not suggest anything different for you, but they might suggest different approaches for older patients who have serious pre-existing conditions - that's all the guidelines are saying. Everything is not necessarily related to you.
An even better option for prostate cancer is IMRT or proton beam radiation. No erectile difficulties and higher cure rates. Men in my family have had each kind of radiation, with excellent results for both kinds.
Posted by Phillipa on March 7, 2014, at 22:33:03
In reply to Re: sad and disheartening » Phillipa, posted by Twinleaf on March 7, 2014, at 21:54:01
Twinleaf not for his 58 year old brother. The whole gland must be removed as 6 0f l0 biopsies in gland are positive and prostrate lymph nodes. So now his Brother wrote the doc says traditional prostrate surgery. Makes no sense to me but since he was recently diagnosed with high blood pressure the urologist doesn't want him under anesthesia for long. If the tumor was just part of the gland the radiation would be possible but it's more extensive also due to young age. Phillipa
Posted by Twinleaf on March 7, 2014, at 22:52:35
In reply to Re: sad and disheartening » Twinleaf, posted by Phillipa on March 7, 2014, at 22:33:03
Not an expert at all, but think these new types of radiation would be more curative if the disease has spread beyond the gland. One of the men I mentioned had early spread and IMRT was curative - or at least he's fine 10 years later
Posted by Ronnjee on March 8, 2014, at 15:08:43
In reply to Re: sad and disheartening » Twinleaf, posted by Phillipa on March 7, 2014, at 22:33:03
> Twinleaf not for his 58 year old brother. The whole gland must be removed as 6 0f l0 biopsies in gland are positive and prostrate lymph nodes. So now his Brother wrote the doc says traditional prostrate surgery. Makes no sense to me but since he was recently diagnosed with high blood pressure the urologist doesn't want him under anesthesia for long. If the tumor was just part of the gland the radiation would be possible but it's more extensive also due to young age. Phillipa
"prostrate"?
Posted by Phillipa on March 8, 2014, at 19:23:37
In reply to Re: sad and disheartening, posted by Ronnjee on March 8, 2014, at 15:08:43
Yes & it was ll of 12 sectional biopsies of prostrate positive and the lymph nodes surrounding it. From the further research I have done and talking today to his Brother. He seems pretty convinced that the open approach is what his doc wants. I did see that if the Da Vinci is used and nodes come back positive then the prostrate will not be moved and treatment changes to radiation and possibly chemo? Phillipa
Posted by 10derheart on March 8, 2014, at 19:30:51
In reply to Re: sad and disheartening, posted by Ronnjee on March 8, 2014, at 15:08:43
I know what she means. I'll bet you do, too.
It's a common mistake or misspelling.
No worries, Phillipa.
Posted by corkskru on March 8, 2014, at 20:52:40
In reply to New Recomendations for over 65, testing, Mammo, Me, posted by Phillipa on March 3, 2014, at 11:50:01
"Don't recommend screening for breast or colorectal cancer, nor prostate cancer (with the [prostate-specific antigen] test) without considering life expectancy and the risks of testing, overdiagnosis and overtreatment." Screening for these 3 cancers exposes patients with life expectancies lower than 10 years to potential harms with little benefit potential.How does screening for prostrate cancer expose a patient to potential harm and who is to be the judge of the ones life expectancy?
It seems that once you stop contributing to the system and getting the benefits that they want to put you to pasture. Sure there are some easy calls on benefit vs risks but it seems to me the patient is losing more than gaining...
Posted by ed_uk2010 on March 9, 2014, at 13:25:14
In reply to Re: New Recomendations for over 65, testing, Mammo, Me, posted by corkskru on March 8, 2014, at 20:52:40
>How does screening for prostrate cancer expose a patient to potential harm and who is to be the judge of the ones life expectancy?
Prostate cancer screening is much more complex than it first appears. Initial screening involves the PSA blood test, which frequently comes back with difficult to interpret 'modestly elevated' readings, commonly due to benign prostatic hyperplasia. Some men then go on to have an ultrasound guided biopsy. Malignant cells or other abnormalities are then often detected but it's usually very hard to know the significance of these results, mainly because many elderly men have indolent prostate tumours which are non-aggressive. The outcome is that men and their doctors often have little idea how to act upon the results.
If more reliable tests were available for prostate cancer which produced more useful results, it might be a different story.
Posted by Phillipa on March 9, 2014, at 19:41:23
In reply to Re: New Recomendations for over 65, testing, Mammo, Me » corkskru, posted by ed_uk2010 on March 9, 2014, at 13:25:14
After researching found that PSA doesn't mean a thing unless one has had prostrate cancer then it is used to see if recurrence if it rises. Many men have protrate cancer with PSA of .5 and here normal is .5 to 4. Seems the digital if no lump okay. But if lump and elevated PSA then it warrants a biopsy at least here. Phillipa
Posted by Willful on March 9, 2014, at 20:04:23
In reply to Re: New Recomendations for over 65, testing, Mammo, Me » ed_uk2010, posted by Phillipa on March 9, 2014, at 19:41:23
Is no one here concerned about the effects of false positive results that can come from testing? every test has these== and their impact can be devastating to the people involved.
I personally am very reluctant to get testing with tests that are often inconclusive and are given to producing many false positives. In these cases testing often only achieves the result of scaring you incredibly and subjecting you to further testing that can also be inconclusive-- and that then requires some sort of invasive procedure. If no one thinks this is a widespread problem-- think again-- because it is-- and it is a tremendous cost for the people who have to experience it.
I wouldn't run to get a mammogram now-- because the fact is, if they don't save lives--the more likely I or others are to take this risk for no potential benefit. It is one thing to go take such a risk (of a false positive test) for something that is potentially life-saving-- and another for something that gives you no information at all.
I now am much more concerned about monthly self-exam than I have been ever since I had yearly mammograms. It really is disturbing how the availability of the mammogram in fact probably caused me to neglect something that is very important.
Posted by Phillipa on March 9, 2014, at 20:25:45
In reply to Re: New Recomendations for over 65, testing, Mammo, Me, posted by Willful on March 9, 2014, at 20:04:23
Don't stick you head in the sand and hope nothing goes wrong. For as long as I remember monthly breast exams have been the first order of business. Used to teach others how to do them correctly. But did you know the most common age for breast cancer is age 63? My mamographer also a friend found out at age 63 that she was positive. Have lumpectomy, and further surgery in other breast and isn't taking tamoxifen it's the other med that always alludes me. Phillipa
Posted by ed_uk2010 on March 10, 2014, at 15:00:04
In reply to Re: New Recomendations for over 65, testing, Mammo, Me » ed_uk2010, posted by Phillipa on March 9, 2014, at 19:41:23
> After researching found that PSA doesn't mean a thing unless one has had prostrate cancer then it is used to see if recurrence if it rises. Many men have protrate cancer with PSA of .5 and here normal is .5 to 4. Seems the digital if no lump okay. But if lump and elevated PSA then it warrants a biopsy at least here. Phillipa
Definitely, PSA on its own can be difficult to interpret, but the problems don't stop there. A smooth enlargement on examination most likely represents hypertrophy. A lumpy prostate is more likely malignant. And then the biopsy can be difficult to interpret too. In very elderly men, malignant changes may be present more often than not, but this doesn't necessarily tell you whether the tumour is aggressive or not, which makes it difficult to know whether to treat or just leave it alone + observe.
Posted by Phillipa on March 10, 2014, at 20:34:18
In reply to Re: New Recomendations for over 65, testing, Mammo, Me » Phillipa, posted by ed_uk2010 on March 10, 2014, at 15:00:04
Ed somewhat off track as husband's brother has prostrate cancer. Had lump and all biopsies tissue samples positive. Now the question if form of surgery. He is 57 years old PJ
This is the end of the thread.
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