There are always trade-offs in life.
It’s been one of Jay Morgan’s favorite sayings, but it resonates now more than ever.
He can’t do all the things he used to enjoy doing, like running a 5K at age 70 in under 30 minutes. He still runs 5Ks, it just takes him 45 minutes now. But he’s alive and well after a stage four, terminal cancer diagnosis last year – a trade-off he’s happy to have made.
What started as routine blood work for a renewal of a life insurance policy quickly turned into a series of events that forever changed his life.
PSA, or prostate-specific antigen, is a test used to determine the health of the prostate gland. Ten years ago, Jay had the test done and his numbers were around 4, Jay recalls. “Not bad for someone who was 61, I thought,” he said.
He’d been offered to have the test repeated at checkups over the years, but declined.
“Not because I was scared,” Jay said. “Pretty much just the opposite. I was pretty active, lifting weights, running 36 5Ks each year. My feeling was that I was sort of invincible and that I wouldn’t have to worry about something like prostate cancer.”
After a standard visit from a nurse from the insurance company to collect health results for his renewal policy, he received a report that said all his various functions were great, but his PSA numbers were off the chart.
“At first I was really irritated,” Jay remembers, after reading the letter that said the company only rejects about four percent of applicants. “I thought, show me someone who is 70 years old and in better shape than I am and I’ll get their autograph.”
Jay took action and scheduled an appointment with his family doctor where he was told his PSA results were “phenomenally high” and he was recommended to a urologist, Dr. Key at Dayton Physicians Network.
Dr. Key conducted more work and the results were the same – extremely high levels of PSA in his blood. In fact, he went from a reading of 4.16 to 437 – no decimal points – in just ten years.
At one point, before Jay knew his numbers, he had asked what PSA reading would be considered dangerous. That number was 20.
It didn’t take long for Jay, a career trained mathematician, to understand that his reading was more than 202 of the number considered serious.
“He looked at me like he was the grim reaper,” Jay recalls about his first appointment with Dr. Key.
Initially, Jay was told he had two years to live with such a serious diagnosis.
“That’s tough,” Jay said with a pause. “I was somewhat in shock about that and anxious – very, very anxious.”
At the same time as his diagnosis, pressure from his enlarged prostate was compressing his urethra making urination difficult before it became nearly impossible – a complication that is seen in some cases of prostate cancer.
It became so uncomfortable, he ended up in the ER where over 1500 cc of urine were removed from his body. The average bladder holds between 300-400 cc. He was told he was lucky his bladder didn’t burst and sent home with instructions to see his urologist ASAP.
So in addition to dealing with facing his mortality, Jay was forced to catheterize himself more than 300 times over the next four months.
With his bladder health restored, Jay began cancer treatment. Drugs to promote bone growth and halt testosterone production and four chemotherapy pills became part of his daily regimen.
And the results are staggering. His PSA has dropped every three months. His most recent reading: 0.31.
Besides an aspirin or two maybe once a year, Jay had never taken pharmaceuticals or prescription drugs for ailments. Now he’s on a cocktail of meds keeping him alive.
“I don’t like taking the drugs and I don’t like the side effects,” he said about hot flashes and a significant decrease in energy levels. “When I do exert myself I become very fatigued, and much more tired than I ever was before.”
“But it’s worth the price,” Jay said about the trade-off.
An outpouring of positive support from friends and family, the extraordinary care team at Dayton Physicians Network and a positive attitude are what Jay credits to his remarkable progress.
“The incredible love and support from my family and friends – it was simply overwhelming,” Jay commented.
“My wife was my guardian angel – I truly did not know she loved me that much,” he said, of Lynn, his wife of 38 years. “I don’t know how I would have gotten through this if it hadn’t been for her. She has been simply amazing.”
Today, Jay’s outlook is far better than it was 18 months ago when he received his diagnosis. But with no cure for stage four prostate cancer, he will live with this disease for the rest of his life.
“My fondest hope, although I’m not sitting on the edge of my seat waiting for it, is that cancer research does literally, truly cure it,” Jay said about prostate cancer. “I’m sure that will happen someday, whether I’m around at that point I don’t know.”
Cure or not, Jay has made an astonishing turnaround.
“I think it’s safe to say I’m the poster patient for Dr. Key,” Jay said. “His cancer treatment plan had incredible results.”
At a recent prostate cancer 5K, Jay had the opportunity to introduce his son, daughter and grandson to Dr. Key. “I introduced him as the person who saved my life,” Jay commented.
If you are thinking about getting a vasectomy, you are not alone. Each year, more than 500,000 men in the U.S. choose vasectomy as permanent birth control. During vasectomy, each vas deferens (the two tubes that move sperm) are sealed off. This blocks sperm from reaching the semen that is ejaculated from the penis. After a vasectomy, the testicles still make sperm but they are absorbed by the body. A vasectomy prevents pregnancy better than any other method of birth control, except abstinence. Only 1 to 2 women out of 1,000 will get pregnant in the first year after their partners have had a vasectomy.
Your doctor can perform a vasectomy in an office or hospital. Vasectomy is a minor surgery that should take about 20 minutes. One urologist who performs vasectomies tells his patients: “take a long hot shower the morning before with a lot of soap. And make sure you have a bag of frozen peas and a couple of rented movies at home.”
Before the vasectomy, your scrotum will be shaved and cleaned. Usually local anesthesia is used. So you will be awake but should not feel any pain. Some patients may also be given medicine to reduce anxiety. With a standard vasectomy, the urologist makes one or two small cuts in the scrotum. One vas deferens tube is cut and tied or sealed with heat. The tube is replaced inside the scrotum. The procedure is then repeated on the other side. Lastly, the skin is closed with stitches that dissolve and do not have to be removed.
Another popular option is a no-scalpel vasectomy. In this procedure, a small clamp with pointed ends is used to puncture the skin. Then each vas deferens is lifted out, cut, sealed and then put back in place. A no-scalpel vasectomy works just as well as a standard vasectomy. Some benefits of a no-scalpel vasectomy are less bleeding, swelling and pain. There is also a smaller hole in the skin.
Vasectomy is a minor surgery that should take about 20 minutes
About 1-2% of men may have ongoing pain or discomfort after a vasectomy. The pain is most often treated with antiinflammatory drugs, like ibuprofen. Exact causes of pain is not known, but in some cases, additional medical or surgical treatment may be needed.
Otherwise, the risk of bad side effects after a vasectomy is very low, but may include:
- Bleeding under the skin, which may cause swelling or bruising. (Call your doctor if your scrotum swells a lot soon after your surgery.)
- Infection at the site of the cut. It is rare for an infection to occur inside the scrotum.
- A small lump forming because sperm leaks from a vas deferens into nearby tissue. This is usually not painful. If it is painful, it can be treated with rest and pain medicine. Sometimes, surgery may be needed to remove the lump.
- Swelling of the vas deferens
- In rare cases, the vas deferens may grow back together, which would allow the man to have children again.
Older studies suggested a risk of prostate cancer and heart disease years later in men who have had vasectomies. But many years of research since then have found no link between vasectomy and these health problems.
More than 500,000 men have vasectomies in the U.S. each year.
Your scrotum will be numb for one to two hours after a vasectomy. Put cold packs on the area. (The bag of frozen peas mentioned before works well.) Lie on your back as much as you can for the rest of the day. Mild discomfort or pain is normal after a vasectomy, and should be treated with pain relievers. Wearing snug underwear or a jockstrap will help ease discomfort and support the area.
You may have some swelling and minor pain in your scrotum for a few days after the surgery. You may be able to go back to work in one or two days. It depends on how you feel. But you should avoid heavy lifting for a week. You can have sex again as soon as you are comfortable, usually within a week. But keep in mind that the vasectomy is not effective from day one. Sperm may still be in the semen for many months after a vasectomy. It takes about 20 ejaculations or three months to clear the sperm from the tubes. However, results vary for different men. Most often, your urologist will test your sperm count three months later. This is done to make sure your semen is clear of sperm. Until the sperm count is zero or there are very few non-moving sperm, sex without another method of birth control may lead to pregnancy.
After recovering from a vasectomy, a man and his partner should notice no difference during sex. An uncomplicated vasectomy does not cause erection problems. Ejaculation and orgasm should feel the same. The amount of semen does not decrease more than five percent. The only change your partner may be able to feel is a lump at the vasectomy site if one has formed.
THINGS TO THINK ABOUT
The choice to have a vasectomy is a very personal one. Talk with your partner, and think about what is best for you and your family. Be sure to bring up any questions you may have with your health care provider.
Below are some things to keep in mind:
- Vasectomy is safer and cheaper than tubal ligation (blocking the fallopian tubes to prevent pregnancy) in women.
- The one-time cost of a vasectomy may be cheaper over time than the cost of other birth control methods, such as condoms or the pill.
- A vasectomy does not protect against sexually transmitted diseases (STDs). Use condoms to protect against STDs.
Lastly, it is important to note vasectomy is a permanent method of birth control. This may be a plus or a minus based on your own situation. You should not have a vasectomy if you may want to father children in the future. While it is possible to have a vasectomy reversed, this is more complex and costly. Also, reversing or “undoing” a vasectomy does not always result in pregnancy. So it is important to think through all your choices carefully before deciding to have a vasectomy.
In English: http://familydoctor.org/familydoctor/en/prevention-wellness/sex-birth-control/birth-control/vasectomy-what-to-expect.html
In Spanish: http://familydoctor.org/familydoctor/es/prevention-wellness/sex-birth-control/birth-control/vasectomy-what-to-expect.html
National Library of Medicine, Medline Plus
In English: http://www.nlm.nih.gov/medlineplus/ency/article/002995.htm
In Spanish: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/002995.htm
Urology Care Foundation
For more facts about testicular cancer and other urologic health problems, please visit the Urology Care Foundation’s website, UrologyHealth.org.
Hospital Again Ranks as Top Hospital in Dayton Area
Congratulations on a great accomplishment to: Premier Health, Miami Valley Hospital, and Dayton Physicians Urology division!
Miami Valley Hospital ranked sixth among all Ohio hospitals in the latest annual rankings released by U.S. News & World Report. The hospital, which is part of Premier Health, again had the best performance among all hospitals in the Dayton metropolitan area.
Miami Valley Hospital with Dayton Physicians Network also ranked 47th in the nation in urology care.
For more information visit: https://health.usnews.com/best-hospitals/rankings/urology/ohio
The entire United States is experiencing a shortage of Urologists. There should be approximately 17,000 Urologists based on our population. Currently there are less than 10,000 active Urologists in the United States and over the next two years that number will decrease to 8,000 due to retirement. In order to address this shortage and continue to give you and our community the best possible urologic access and care in Southwest Ohio, we have developed collaborative health care provider teams in Urology. These collaborating teams will consist of our physicians and our specialty trained nurse practitioners to provide ongoing care for you.
Our collaborating teams of Physicians and Nurse Practitioners are listed below:
- Dr. David Key and Heather Shoup, CNP
- Dr. Mark Monsour and Rachel Perretta, CNP
- Dr. Blake Anderson and Kelsey Patterson, CNP
- Dr. Michael Yu and Bonnie Loesch, CNP
- Dr. Erik Weise and a soon to be announced Nurse Practitioner
We are excited to offer you this innovative model of Urology Collaborative Care and we look forward to seeing you in the office. As we transition to this new model, you may receive a phone call to change your appointment. We apologize for any inconvenience as we work hard to accommodate as many patients’ needs as possible to provide the best care and access.
For appointments at Dayton Physicians Urology, please contact our call center at (937) 293-1622.
We appreciate the opportunity to care for you.
Dayton Physicians Urology Team
Dr. Satheesh Kathula was a representative at a Capitol Hill meeting organized American Association of Physicians from Indian Origin. He met with several US congressmen including Rep. Phil Roe of Tennessee, Rep Joe Wilson of South Carolin, Rp. Ami Bera of California and discussed with them on the following health care issues mainly affecting community oncology care:
- The consequences of pharmacy benefits managers (PBMs) on community oncology care, which are not only more expensive, but have delays in mailing life saving drugs.
- Lowering the Cost of Prescription Drugs: The exorbitant cost of prescription drugs is a critical health care issue, as some life-saving drugs are too expensive for many patients.
- How hospitals get preferential reimbursement over independent practices (340B) which is driving the healthcare cost up.
In mid-April was the Ohio Urologic Society Annual Meeting in Columbus. At this meeting, Dayton Physicians Network’s Blake Anderson, MD took part of a panel about Management of Complex Stone Disease. The moderator for the discussion was Sri Sivalingam and other panelists were Mantu Gupta, MD, Smita De, MD, PhD, Michael Sourial, MD.
Dr. Anderson said “I really enjoyed being on the moderator panel for management of complex stone disease.” In the discussion several cases were presented and the panelists all weighed in on different approaches. One case discussed was, how to treat 10 cm of bladder stones in a man with BPH (enlarged prostate). Also discussed, was a case of a septic woman with recent chemotherapy for breast cancer with bilateral obstructing stones.
All the Panelists noted that there were multiple options for treatment but many factors had to be considered. Below is Dr. Anderson take on the discussion, treatment options, and considerable factors.
“How to treat 10 cm of bladder stones in a man with BPH (enlarged prostate. Options are: shockpulse and laser lithotripsy, then holmium laser enucleation of the prostate.
For the bladder stone cases in general, I am in favor a of combination approach to obstructive prostate tissue under the same anesthetic when feasible as bladder stones typically only form in the setting of obstruction. KUB should be done or can check scout film of CT if that has already been done to see if bladder stones are visible, if not may contain uric acid and preoperative medical therapy with potassium citrate could significantly decrease stone burden.
Kidney stone cases were numerous, incomplete left duplex kidney with large upper pole stone burden, difficult renal access and discussed special techniques to do this and accomplish PCNL.
Another case was of a septic woman with recent chemotherapy for breast cancer with bilateral obstructing stones, discussed ureteral stents or bilateral nephrostomy tubes as options, each with own advantages but both effective in prior studies. This decision involves a lot of patient specific variables, stone size, stone location, anticoagulation status and other anatomic considerations. In patients with low urine pH and low stone Hounsfield units on CT, especially in setting of recent chemotherapy, suspicion for uric acid stones should be high and stone dissolution therapy should be considered (medication, potassium citrate, raises urine pH and can dissolve uric acid stones).”
As an oncologist of 15 years, my work has been transforming. I have been a part of many cancer journeys, the fright and the fight, the hurt and the healing, the stress of finances and the journey of hope. I often succeed in the fight for my patients, but sadly even in this era of modern medicine and advanced research, I have to idly stand by and watch a few succumb.
I have humbly accepted the nomination to be a candidate for The Leukemia & Lymphoma Society’s (LLS) Man & Woman of the Year, 2019 fundraising campaign. The generous funding of LLS to my own patients has enabled them to receive the latest treatments without the stress of losing their homes. A young patient of mine is now undergoing CAR-T-cell immunotherapy, and due to the innovative therapies of LLS research, will survive in spite of recurrent aggressive Non-Hodgkin’s lymphoma. Since 2000, over 40% of all U.S. Food & Drug Administration (FDA) approved cancer drugs were for blood cancer, some even used to treat other forms of cancer and non-malignant diseases. A “win” for blood cancers, therefore, is a win for the cancer community overall. I run this campaign along with my patients Cynthia, Betty, Jeff, Ken, Chalonda, John, Edward, Tatyana, Bobbie, Toni, Jowana, Minnie, Patricia, Essie, Joan & many more; I run in honor of Tim, Anita & Donna.
I dream to erase the connotation of death from the word cancer one day. Every dollar raised in this campaign funds the work of LLS. Cancer research has come a long way. In the 60s, a blood cancer patient’s survival rate was 3%; today, it is 90%. Although 90% is remarkable, someday that 10% must be accounted for. With your support we are well on our way to making that someday today.
Please join the team and help us to cure every cancer patient. Donations can be made starting on February 28, 2019 through May 11, 2019 via credit card at https://pages.mwoy.org/soh/dayton19/jkoduri
or by mailing a check made out to LLS with Team Koduri in the memo and send it to 1029 Whispering Pine Lane, Dayton Oh 45458. Click here to know the impact of your donations. Thank you in advance for helping save lives through your generosity.
Jhansi Koduri, MD
Associate Professor, Wright State University
We are sorry to announce that the ability to send us messages through See Your Chart, has been temporarily turned off. We will update this post when it is turned back on. If you are having login troubles, please click on FORGOT YOUR USERNAME OR PASSWORD.
A local health care company is investing $22 million in facility upgrades and new equipment, including “game-changing” technology that could help save lives.
Dayton Physicians Network, a multi-specialty medical group that provides cancer treatment and urological services, is expanding one of its facilities and renovating two others to make room for new radiation equipment. The expansions also will lead to new hires, with up to 30 employees added in the next year as a result of the project. The group currently employs 400 people at its Dayton-area facilities.
The upcoming expansion also could provide work for area builders and suppliers.
The physician network recently purchased imaging machines and linear accelerators, which can be used as radiation treatments for patients with cancer. The equipment will touch nearly every facility the network operates — seven locations from Greenville to Middletown — but the bulk of investment will occur at the Greater Dayton Cancer Center in Kettering, Atrium Medical Center in Middletown and Upper Valley Medical Center in Troy.
The equipment purchase was a joint venture with Dayton Physicians and Dayton-based Premier Health. The physician network leases space from Premier in a few of its hospitals, including Atrium and Upper Valley, but it is an independent group.
Dr. Gregory Rasp, medical director and radiation oncologist at DPN, said the new equipment will turn “good treatment into great treatment.”
“It’s going to allow for more accurate treatment, and more accurate treatment means better cure rates and lower complication rates,” Rasp said. “Basically, it will help us diagnose cancers better and treat them better.”
The imaging component will include new software called Smart Metal Artifact Reduction, which eliminates what medical professionals call “streaking.” Streaking is common in patients with fillings, artificial hips or other procedures involving the insertion of metal, which makes it difficult to visualize where a tumor starts and stops.
In addition, the equipment will allow physicians to more accurately position patients for treatment. This will cut down on errors that can occur if a patient moves during treatment, and helps doctors pinpoint the exact area needed for radiation therapy.
“With the newer equipment, the computer automatically adjusts for those shifts and rotations, and puts us right on the money with treatment,” Rasp said. “It’s kind of a game-changer because it allows us to treat a smaller area. Small areas mean less complications.”
The hope is enhanced treatment will decrease side effects and increase cure rates by 3 percent to 4 percent. Rasp said even if cure rates improve by just a few percentage points, it will save lives.
“Even if the cure rate stays the same, which we don’t anticipate, we can reduce the number of people having complications from the radiation,” he said. “It’s going to make it a lot easier on them and their families.”
The new equipment is expected to be installed in the first and second quarter of 2019, but before it is up-and-running, DPN must make some upgrades to its facilities.
At the Greater Dayton Cancer Center in Kettering, a new addition will be constructed onto the existing facility, and “significant remodeling” will occur at Upper Valley and Atrium, Rasp said. Wayne Cancer Center in Greenville also will be remodeled, though he said it will be less significant.
Each facility is likely to see an increase of 900 to 1,000 square feet, which include seven-foot-thick concrete walls needed to shield the radiation. Most of these walls are already constructed, though another “vault,” as Rasp described it, may need to be added at the Kettering center.
DPN has contracted with Dayton-based Sharp Conway Architects to design the project. Once the drawings are finalized, construction bids will be released. Rasp said the hope is one construction company will work on each facility.
Construction on each location will be staggered, and the first facility is expected to be completed in four to six months. Rasp said they’ll likely start in Middletown.
The facility upgrades and new equipment add to millions of dollars in investment DPN has been making in the last few years. Rasp said they’ve reinvested $18 million in the practice since 2012, and the latest project will bring them up to $40 million over a six-and-a-half year period.
“In a lot of groups, that money would just funnel to shareholders,” he said. “But we’ve always known that we need to reinvest it to be at the cutting edge of things, and in turn the practice grows. The other thing is we always put patients first over profits. I know that sounds like something every doctor says, but we’ve always had this belief that we need to have the highest quality standards for our patients.”
Urologist Michael Yu of Dayton Physicians Urology Answers Questions about Symptoms and Discusses
a Minimally Invasive Breakthrough Treatment Option
What Are the Symptoms of Enlarged Prostate and When Should Men See a Urologist?
Over 70% of men in their 60s have symptoms of enlarged prostate1. This can cause loss of productivity, interrupted sleep and, in some cases, can cause depression.2
Common symptoms include:
- Frequent need to urinate both day and night
- Weak or slow urinary stream
- A sense that you cannot completely empty your bladder
- Difficulty or delay in starting urination
- Urgent feeling of needing to urinate
- A urinary stream that stops and starts
Enlarged prostate can wreak havoc on a man’s quality of life, so it’s important to see a physician if these problems persist.
What Treatment Options Do You Recommend to Your Patients?
Treatment options for enlarged prostate range from medications to surgery, with minimally invasive options in between.
Medications can be helpful in relieving symptoms for some men, but patients must continue taking them long-term to maintain the effects. Some patients may suffer side effects including dizziness, headaches, or sexual dysfunction. And some may not get adequate relief of their symptoms.
Surgical options, such as transurethral resection of the prostate (TURP) or photovaporization of the prostate (PVP), are very effective. However, these typically require general anesthesia, overnight hospitalization, and post-operative catheterization. Surgery can also increase the risk of erectile dysfunction or loss of ejaculation.
Can You Describe What Minimally Invasive Treatments are Available?
I’m very excited to offer my patients a revolutionary treatment option called the UroLift® System treatment. The UroLift System treatment is a breakthrough, minimally invasive option to treat enlarged prostate. It does not require any cutting, heating, or removal of prostate tissue.
Here’s how it works: a urologist uses the UroLift System device to lift and move the enlarged prostate tissue out of the way so it no longer blocks the urethra (the passageway that urine flows through). Tiny implants are placed to hold the tissue in place, like tiebacks on a window curtain, leaving an unobstructed pathway for urine to flow normally again.
What are the Benefits of the UroLift® System?
I perform the UroLift System treatment in the hospital, which patients like. The treatment typically takes under an hour, preserves sexual function, doesn’t require cutting, heating or removal of tissue. Compared to other BPH surgeries, the UroLift System treatment has a strong safety profile with minimal side effects.3
Most common side effects are mild to moderate and include pain or burning with urination, blood in the urine, pelvic pain, urgent need to urinate and/or the inability to control the urge. Most symptoms resolved within two to four weeks after the procedure.
1. Berry, et al., J Urol 1984
2. Speakman et al., 2014 BJUI International
3. Roehrborn, et al., J Urology 2013